A Reuters investigation looks into the death of carer Sonya Kaygan, one of over 100 frontline health workers killed by the coronavirus in Great Britain
LONDON - On a doorstep in the suburbs of north London, three-year-old Ayse picked up a tissue to wipe away her grandmother’s tears - tears for one more victim of the virus.
A Reuters investigation into Kaygan’s case, the care home where she worked, and the wider community in which she lived provides an intimate view of the frontline of Britain’s war on the coronavirus. It exposes, too, a dangerous lag between promises made by Prime Minister Boris Johnson’s government and the reality on the ground.
The government summed up that policy in the slogan “Protect the NHS.” The approach gave the country’s publicly-funded hospitals priority over its care homes. A UK government spokesman defended the strategy. “This is an unprecedented global pandemic and we have taken the right steps at the right time to combat it, guided by the best scientific advice.”
So far, at least 32,300 people have died in Britain from the coronavirus, the highest toll in Europe, according to official UK data processed by 2 May. Out of those deaths, more than 5,890 were registered as occurring in care homes in England and Wales by April 24, the latest date available. These figures don’t include care home residents who were taken to hospital and died there.
Jeremy Hunt, a former Conservative Party health secretary and now chairman of the House of Commons health select committee, advocated banning visits to care homes by friends and family from early March, advice that wasn’t followed. Speaking to Reuters, he drew a parallel between the UK’s response to the coronavirus and the way it deals with peak winter demand for hospital services.
By the time a “lockdown” was imposed by the prime minister on March 23, the virus was spreading fast and Kaygan was beginning to feel sick. “She started feeling a bit uncomfortable,” her uncle Hasan Rusi said. “She had a temperature and was coughing. It might have been a cold, it might be a virus.” David Halpern, a psychologist who heads a behavioural science team - once nicknamed the “nudge unit” - advising the UK government, had expanded on the idea in a separate media interview on March 11. As the epidemic grew, he said, a point would come “where you’ll want to cocoon, you’ll want to protect those at-risk groups so that they basically don’t catch the disease.”
For local leaders, caring for the most vulnerable became increasingly challenging. Typically, they said, new plans were announced in an afternoon national press conference by a government minister, with instructions to implement them, sometimes the next day, arriving by email to councils later that night. Ministerial promises, handed off to the councils, included drawing up a “shield list” of the most vulnerable, delivering food to them and organising and delivering prescription medicines.
Five days later, Johnson told parliament every care home worker would receive the personal protective equipment they needed “by the end of the week.” This didn’t happen, and more than a month later, the government’s chief medical officer conceded publicly that shortages remained. “I’m one of them,” one care home employee, who asked not to be named, recalls telling her 12-year-old daughter as her neighbours clapped. The daughter teased her: “Oh, Mummy, they don’t talk about you. They talk about the NHS. Mum, do you work for the NHS?”The caregiver was one of three workers who recounted their experiences at an Enfield care home run by a firm called Achieve Together.
The spokesperson for Achieve Together described the health and wellbeing of residents and staff as “our absolute priority.” Staff and residents were tested “when the Government made testing available.” The company did not specify when those tests took place. It declined to comment on details of the home, citing a need to protect patient privacy.Kaygan’s workplace, the Elizabeth Lodge, in a leafy Enfield suburb, was built in the grounds of two former hospitals of infectious diseases.
The Lodge’s management says it hasn’t identified the source of the outbreak there. The home began cutting down on visitors from the start of March, with almost all non-emergency visits barred from March 17. In a plan issued by the NHS on March 17, care homes were exhorted to assist with national priorities. “Timely discharge is important for individuals so they can recuperate in a setting appropriate for rehabilitation and recovery – and the NHS also needs to discharge people in order to maintain capacity for acutely ill patients,” the plan said.
The problem was that most patients had not been tested for COVID-19, and care homes have few facilities to quarantine new arrivals. “It was just so reckless,” she said. “They were not thinking at all about us. It was like they were saying, let’s abandon the old people.” Knight said that at Elizabeth Lodge, no tests were available for staff until after April 15, when Health Minister Hancock announced plans to test all residents and care home workers if they had symptoms. Even after Hancock’s pledge, only six tests were made available to Lodge staff and none to residents, Knight added.
“What the government says is a load of rubbish,” she said. I “I am angry because we are not being supported.” She declined to discuss how many residents have died. Unbeknown to her family, Kaygan had ordered surgical facemasks on Amazon. They arrived in early April after she was hospitalized. Other carers at the Lodge ordered masks, too, said another staff member. And after Kaygan’s death, a different fellow employee posted on Twitter: “I work there and all of this has very hard on us all and every one is right. We as carers don’t have enough PPE.”
It said in a statement that at the time Kaygan worked at the Lodge, face masks were not being used. That, according to the home, was because official guidance then recommended such masks were only necessary when working within a metre of someone with COVID-19 symptoms. Public Health England said the home’s interpretation was in line with advice then in force that masks were only needed when in personal contact with someone, such as washing.
Then news came that Kaygan would be intubated - sedated and put on a ventilator. Her last call was to a family member in Cyprus, about 6 am on April 2. “I’m going in now,” she said.Munuse Nabi, 90, lived in a care home in Ilford, East London. She was extremely fragile, with heart, lung and kidney problems. But she was also mentally strong with a pin-sharp memory, able to talk on the phone and flick through TV channels. “She was all perfect,” said son Erkan Nabi, a driving instructor.
This approach to hospitalisation reflects what many homes took to be national guidance. An NHS England policy document issued on April 10 listed care home residents among those who “should not ordinarily be conveyed to hospital unless authorised by a senior colleague.” Calum Semple, the lead author and professor of outbreak medicine at Liverpool University, said, in an interview with Reuters, this indicated, among other things, that England set a “high bar” for hospital admission. “Essentially, only those who are pretty sick get in.” But, he said, there was no data yet on whether that high bar ultimately made people in Britain with COVID-19 worse off. The NHS didn’t comment.
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