Back at the beginning of March, the lodge was bracing itself for the pandemic. Staff who had travelled to high risk countries were not allowed to return directly to work and those with flu-like symptoms were asked to stay home. So it came as a surprise that a staffer who had not travelled overseas tested positive to the disease.
Two of the lodge’s residents were in hospital with respiratory symptoms at the time and one of them, a 95-year-old woman, died on the same day that the carer tested positive. The other, an 82-year-old man, died a few days later. They were both confirmed to have coronavirus. Ryde Hospital, which does a regular back-and-forth of patients with Dorothy Henderson Lodge, had been treating COVID-19 patients around the same time.
Infectious diseases physician Lyn Gilbert, chief investigator at the Australian Partnership for Preparedness Research on Infectious Disease Emergencies, said although the virus was first recognised in the staff member, she was not believed to be the person who introduced it to the lodge.
“Nobody knows where the first case came from but it was certainly part of the big outbreak in that geographic area and around Ryde Hospital and there’s inevitably a lot of contact between a hospital like that and an aged care facility,” Professor Gilbert said.
BaptistCare notified families that coronavirus had been detected the day after the outbreak was detected and shut down the lodge to visitors. Dorothy Henderson Lodge is advantaged by its design when it comes to disease containment. Broken into six wings, staff members are assigned to one area. This meant that residents in the affected wing could be confined to their rooms and staff members prevented from mingling with those in other parts of the lodge.
But staff began to panic, and soon BaptistCare faced a critical shortfall in carers. Many had been told to self-isolate. Others simply stopped coming to work.
Health Services Union organiser Anul Mahimkar said the staff were afraid. “I think there was fear overall that ‘I don’t want to get it’,” she said. This was particularly the case for those who were aged over 60 or caring for people who were susceptible. BaptistCare had allowed these staff to take leave.
BaptistCare was forced to draw from other facilities in the network and hire staff from agencies. The lodge was well practised in infection control from experience with flu outbreaks. But this was unlike anything it had done before.
“Staffing is a major challenge when your entire complement of care and clinical staff are required to self-isolate as a precautionary measure,” BaptistCare chief executive Ross Low said.
“It is certainly not ideal, or best practice, to introduce a complete care team who our residents aren’t familiar with – but there are greater risks associated with COVID-19 that had to take precedence. This approach was about saving lives.”
Professor Gilbert said the most effective things the lodge did were closing the facility to visitors, engaging a senior infection control specialist at the start and requiring the regular staff to self-quarantine.
“It wasn’t easy to do, any of it,” Professor Gilbert said. “It’s a terrible situation and it’s very hard to control these things once they occur, but they did as much as you could reasonably expect an organisation to do to bring it under control.”
It was thought the virus spread between wings because residents had shared a dining room before they were symptomatic, she said. “Once all the containment measures were implemented, there was very little transmission after that. There was quite a big cluster in the first few days.”
On March 15, a 90-year-old woman died. Six residents and three staff had by then tested positive. Each time the lodge notified families that another person had died, it reassured them that those who were directly affected had already been called. Mrs Mould started listening out for the telephone.
“When your mum gets to 93 years old and she says she’s ready to go when the time comes, you feel resigned that it’s going to happen some time I guess,” she said. “I just hoped it wasn’t going to be COVID-19 because of that risk of infection, I wouldn’t have wanted her to be on her own.”
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As the lockdown continued, concerns about residents being isolated grew. BaptistCare appointed a “connection co-ordinator”, who had worked at the lodge and was familiar with residents, to organise Skype calls, emails and, later, physical visits with their family.
The process for the visits was convoluted. The resident sat under a marquee. The visitor stood under a covered driveway on the other side of a fence. If the resident was hard of hearing, it could be difficult to maintain a conversation. It could also be confusing. “Why don’t you go through the door and come inside?” Mrs Mould’s mother asked her daughter. But seeing each other was almost enough.
What are the main symptoms of COVID-19?
- Shortness of breath
A patient might also complain of chills, headaches, a sore throat, diarrhea, nausea or a runny nose. It usually takes about 5-6 days for symptoms to appear after someone is infected but 14 days is considered the total incubation period for the virus to emerge.
If you suspect you or a family member has the coronavirus you should call (not visit) your GP or ring the national Coronavirus Health Information Hotline on 1800 020 080. If you have serious symptoms, such as difficulty breathing, call 000.
On March 20, NSW Health tested all residents at the lodge to produce perhaps the biggest lesson of that outbreak. Four of the residents who tested positive had no symptoms and some never developed symptoms at all.
“We assume that older people are more likely to have more severe disease and that’s certainly true,” Professor Gilbert said. “But there were some who had very mild disease and some who were completely asymptomatic. The lesson is that once it gets into that close institutional setting you’ve got to test.”
Some of those who tested positive did go on to develop symptoms. A 90-year-old woman died eight days later, followed by a 95-year-old woman on April 1 and, finally, a 90-year-old man on April 6.
The outbreak had largely followed the trajectory of the pandemic in the wider Australian community. NSW Health declined to comment until a proper review has been completed.
The biggest change that BaptistCare made was to employ 110 people as “care reserves” who can be deployed to any of its aged care homes in the event of another outbreak.
“As an aged care provider we are prepared for outbreaks of infectious diseases,” Mr Low said. “It was truly challenging to be impacted with a virus that was new to the world and which we knew could have a significant impact on our most vulnerable residents.
“We are most proud of our staff, who showed they would do anything for our residents.”
Two weeks after the virus was first notified at Dorothy Henderson Lodge, at the height of the crisis, Mrs Mould’s mother, Jan Hodge, celebrated her 93rd birthday. Mrs Mould asked if she could bring a cake and flowers for her mother.
“Of course you can,” she was told. “Bring them to the front door and then go around and stand under her balcony. We will bring her out.”
Mrs Mould tries sometimes to get inside the head of her mother, living in a small room with a balcony she forgets is there, with her daily routine the only certainty in life. Does time pass very slowly in that little world, or does having a jumbly memory make it go very fast?
When Mrs Hodge came blinking into the daylight she was confused to arrive in a place beyond her known realm, with her daughter waiting on the other side. At first it seemed that her dementia had deteriorated. But then she realised it was her birthday and her face crackled into smiles. Mother and daughter conversed a little over the railing. “Come and see me some time,” Mrs Hodge said.
Harriet Alexander is a reporter for the Herald.