As coronavirus creeps into French care homes, a 'tsunami' of deaths goes uncounted
Long a neglected branch of French healthcare, care homes for the elderly are accustomed to working in the shadows, their losses unremarked. As the coronavirus pandemic spreads like wildfire, they are bracing for a “bloodbath” – the full scale of which may never be known.
For someone her age, Sarah Marcenat has an uncommon familiarity with the end of life. At 25, the assistant nurse at a care home in eastern France is used to accompanying the elderly in their twilight years. But she has never witnessed death on this scale – so sudden, so sinister, so lonely.
Located in the Alsace region, the heart of France’s coronavirus outbreak, Marcenat’s nursing home has been operating in a vacuum for close to a month now. Isolated in their rooms, its residents are dying one by one, their families kept at bay.
“I’m terrified at the idea they’ll pass away alone in their rooms, far from everyone,” she says in an interview with FRANCE 24. “They only have us now, with whom to share their last breath.”
At Marcenat’s care home, near the city of Mulhouse, nine residents have died in the last week alone. There are no test kits available to determine the cause of death, but seven of the victims presented the symptoms typical of Covid-19, the deadly disease caused by the new coronavirus.
Other homes, including one in the nearby Vosges department, have reported casualty numbers in the double digits. With elderly people especially vulnerable to the virus, France’s more than 7,000 state-funded “EHPAD” care homes have been described as ticking time bombs.
“The tsunami has entered the building, it’s a disaster,” says Pierre Gouabault, a care home director, describing the catastrophe under way at one nursing home in the central Loire valley, where 10 people have died in recent days and 19 others present symptoms.
With the home’s director and other staff members among the infected, Gouabault, who runs a nearby nursing home, has stepped in as caretaker. In a matter of days, he managed to cobble together a new team, hiring students from medical school and reserve nurses from across France. It's in crises like these, he says, “that the true solidarity of a nation comes forward".
Gouabault has worked in an EHPAD long enough to remember the last time the public “woke up” to a tragedy unfolding at France’s nursing homes. During the sweltering summer of 2003, as French holidaymakers lounged on the beaches, a deadly heatwave quietly preyed on the elderly left behind. Officials spoke at first of dozens of casualties, then a few hundred. It would be months before a shocked nation discovered the staggering death toll of more than 15,000.
Years later, the paucity of figures has compounded fears that another carnage – this one even greater – is currently under way, far from the public eye.
Since the start of the pandemic, nursing homes have been excluded from the daily tallies reported by the government, which only count the coronavirus deaths in France’s hospitals – where elderly patients are now seldom admitted, due to a desperate lack of beds.
A first, provisional estimate of “at least 884” deaths at nursing homes was finally announced on Thursday, though officials cautioned that many homes were yet to report. And in the absence of widespread testing of residents, it is not clear how the government plans to collect and verify the figures.
In a letter to the health minister last month, the main association of EHPAD workers had warned that the epidemic “could end up killing more than 100,000 people”.
Body bags over masks
The lack of testing is just one in a long list of grievances voiced by staff at France’s EHPAD homes, long accustomed to being at the bottom of the pecking order when it comes to healthcare funding and equipment.
“Hospitals are the priority, nobody cares about nursing homes,” says Marcenat. “We’re not doing real care work here, the conditions won’t allow it. We’re doing survival work.”
While the country’s hospitals are struggling with a desperate shortage of masks and other protective gear, several nursing homes have received none at all, despite catering to an especially vulnerable public with high rates of infection. With the government unable to provide even basic protection to frontline workers, rules are being rewritten by the hour. Masks were still “mandatory” only a few days ago, but they are now “advised”. Instead, EHPAD directors are encouraged to stock up on body bags before they too run out.
As one director told French daily Le Monde, “It’s body bags instead of masks, the message is pretty clear.”
At a care home in the Maine-et-Loire department, near Angers, 43-year-old Muriel says staff have just one mask per day, generally a surgical mask offering limited protection.
“The type of mask changes almost every day, depending on the donor,” she says. “We received some from the local mayor, from dentists and even from building inspectors who go looking for asbestos.”
Muriel was to strengthen the weekend team at the start of the crisis, and immediately assigned to the special isolation zone set up for residents with possible Covid-19 symptoms. Her protective gear included gloves, glasses, a shower cap and a gown, which she shared with the person replacing her on the following shift. Two weeks into the job, she resigned for fear of catching the virus and passing it on to her parents, with whom she is under lockdown.
“I feel ashamed quitting so soon,” she says. “But I have to look after my parents. My father is 75 and has Parkinson's. I was too scared I would bring the virus back with me.”
‘If we don’t care for them, then who will?’
What staff at France’s care homes lack in equipment and manpower they more than make up for in spirit and abnegation.
At an EHPAD in the Alpes-Maritimes department, in France’s southeasternmost corner, 54-year-old Catherine has been getting ready to weather the storm since late February. Her care home has been spared so far, but staff are taking no chances. The food hall has been converted into a “field hospital”, equipped with beds and ventilators. Catherine has volunteered to work there as soon as the first case is declared.
“It’s my calling, helping others,” says the head nurse, who refused to let the youngest in her team volunteer. If the virus gets inside, she will self-isolate with residents who have been infected, staying with them night and day. For the time being, she self-isolates when she returns home, careful not to contaminate her family or the elderly in her care.
Back at Marcenat’s care home, 15 of the 25 staff members that cover day and night shifts have fallen ill since the start of the crisis. But “not once have we been short of staff,” she says. “We’ve called in reinforcements, worked extra hours and pulled together. And the management has slipped a gown on whenever necessary.”
She says the four weeks of solitary confinement have taken a heavy toll on the morale of residents at the Alsatian care home, where isolation was enforced in early March – a week before the rest of France.
“They’re lonely and depressed. In somes cases a sliding syndrome [a rapid deterioration of one’s health] has kicked in,” she says. “Many don’t understand why they are being kept in forced isolation, why they eat alone in their rooms, and why nobody comes to see them.”
Marcenat and her colleagues organise skype sessions with the families whenever possible. They also answer regular phone calls from anguished relatives eager for news.
“The families give us a lot of encouragement. They bring cakes and refreshments, and send us messages of support. It’s heartwarming,” says the young care worker, whose profession rarely enjoys much recognition and appreciation.
Like many health workers, Marcenat is not appreciative of the government’s handling of the crisis, coming after years of budget cuts and months of strikes and protests over the dire state of hospitals and care homes across the country. She’s angry at the authorities for reacting “much too late”.
“We get no attention, our jobs are not valued, and we’re paid a pittance,” says Marcenat, who earns little more than the minimum wage for performing a vital, taxing and increasingly dangerous task. “Now we have to put our lives in peril. But if we don’t, then who will?”
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