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The pandemic has been a test for all health care and long-term care providers. The psychological costs to staff and residents are only beginning to be understood. One of the first structured and non-observational analyses has been presented in Psychiatric Quarterly.

New situation, new difficulties

Zoe Guerrero, Akmal-Alikhan Aliev, Lucie Kondrátová, Bibiána Jozefiaková, Natálie Nesázalová, Josephine Gabriela Sanáková and Petr Winkler analyzed data collected during the state of emergency that lasted from March 12 to May 17 in the Czech Republic.

They looked at data collected from staff and patients at 27 facilities, including psychiatric hospitals, long-term care facilities and homes that care for the elderly.

The authors of the publication describe the results as 'alarming'. The youngest children were most affected. As many as 70 percent of children under the age of 18 met diagnostic criteria for depression, 57 percent for anxiety, and 50 percent had lowered mood.

Even when data from psychiatric hospitals were excluded, 31 percent of patients had moderate to severe mental health problems.

As the experts point out, all long-term care institutions were exposed to the negative effects of isolation and difficulties in adjusting to a new and difficult situation that involved changing existing habits. Patients' well-being was not facilitated by the fact that staff were not trained in the management of infectious diseases.

The main risk factors negatively affecting staff included the difficult economic situation during the state of emergency. For patients, on the other hand, psychological problems may have been caused by the lack of group activities that had been an integral part of their day before the COVID-19 pandemic. Both groups suffered from sudden and forced isolation and hardships that no one was prepared for.

Depression and anxiety in a time of plague

The results obtained by the researchers are disturbing. Mental well-being deteriorated among both staff and patients. In the case of the latter, 46 percent complained of feeling unwell, 58 percent were depressed and 45 percent had elevated levels of anxiety. Anxiety about their own health and uncertainty about their economic situation were the main drivers of depression, the analyses showed.

Slightly better results, which of course does not mean good, were observed among staff. Bad mood was reported in 17 percent, depression in 22 percent, and anxiety in 14 percent. For staff, health anxiety and a worsening economic situation negatively affected each of the mental health dimensions analyzed.

In a situation where the eyes of the world were on the covid wards, it seems that the other institutions were left alone. However, according to the experts, it is necessary to pay more attention to those other institutions.

New solutions seem to be necessary. A detailed analysis of the data collected has produced strategies that may help in the future. Both during the COVID-19 pandemic and future ones.

Detailed analyses of the results made it possible to identify four main areas that workers and patients complained about most.

  • Improving communication and receiving clear instructions. At the peak of the disease, facilities were not getting clear information in time. There was also no communication authority, so instructions for dealing with the new situation could not be provided. As one staff member notes, "nursing homes were forgotten in a crisis situation, so we only got information from the media." In practice, it was not possible to maintain adequate distance in rooms or to set aside special rooms to isolate COVID-19 patients. On top of this, wearing a mask was often not possible for children or patients with cognitive impairment.
  • Supply process. "Protective equipment was not secured by the institution for a min. 2-3 weeks"- pointed out staff at one of the orphanages. During the epidemic crisis, supply problems were solved by grassroots community initiatives. Supplies of essential materials not only arrived late, but their quality was far from desired. Another necessary measure that needs to be improved in the future is the creation of conditions that allow adequate distance. In hospital practice, this is often impossible in canteens, smoking rooms or corridors. As experts emphasize, the applied limitation of activity and change of daily schedule did not make sense in the case when patients sleep half a meter away from each other.
  • Providing care. "The staff was supported by medical school students - they helped on walks and shifts, talked to patients," - adds one staff member. The primary challenge proved to be maintaining the quality of services provided in the new setting. Staff shortages were one of the biggest obstacles. Fear and uncertainty prevailed, and especially in the case of children's wards, communication with parents was a heavy burden for staff.
  • Patient well-being. The increase in infections and the emergency situation, reported constantly by the media from which information was mainly drawn, increased the level of stress. In the case of children's wards, the main problem appeared to be an increase in escapes. In the group of the youngest patients there was both an increase in the number of cases of aggressive behavior towards staff and a greater number of self-medications.

Unfortunately, the type of analyses used does not allow for drawing cause and effect conclusions. However, the results should give those in power pause for thought, and encourage researchers to make further analyses to assess more accurately the impact of the pandemic on health and care entities. Similarly, to last year, it is easy to forget about coronavirus during the summer. However, not only are there more mutations to worry about, but also the unsatisfactory rate of vaccination.

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And once the pandemic is over, how do we assess the impacts and losses? How do we develop a plan of action? The Periscope project brings together the best scientists and experts from 32 European universities, research institutes and think tanks. Gazeta Wyborcza is the only medium cooperating with them. The Periscope project is funded by the European Commission under the Horizon2020 program.

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Translated by Chris Borowski

This is a translation of the article from June 20, 2021.

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