Protection of vulnerable people in need of care

>> On April 6, 2024, Sabine Rennefanz described in her article in the Tagesspiegel:
“What I cannot forgive – about the death of my mother in the pandemic” her experience and her lasting lack of understanding of the ban on visiting seriously ill and dying people (1).
People in need of care, as well as residents of nursing homes, were among the hardest hit by the SARS-CoV-2 pandemic, not only in Germany. Firstly, the approximately 800,000 residents of Germany's approximately 14,000 nursing homes faced a very high risk of developing severe illness from COVID-19 or dying from it if infected with SARS-CoV-2. Secondly, in numerous facilities, the protective measures and restrictions on visits, including total isolation and seclusion, led to extreme loneliness, a loss of quality of life and will to live, and states of confusion among those in need of care. It seemed that, despite learned knowledge about hygiene, isolation, mask handling, and personal behavior, the thought processes of too many people were switched off.
Figures, data, and facts were inadequate and, despite numerous expert recommendations, were not developed accordingly by the end of the pandemic (2). As a result, too many decisions were initiated and implemented based on superficial evaluations. Until the end of the pandemic, the number of reported infections had no population-based approach, and cohort studies were lacking. Late test availability and complicated access, as well as frequency of use, influenced the reported cases received by the Robert Koch Institute (RKI). Mortality figures could not be presented validly—who had died from or with COVID-19? Due to the continuing deficit in data, decisions such as lockdowns, contact restrictions, or visitation bans caused unspeakable suffering, especially among children and adolescents, but also among those in need of care and the dying. Despite numerous recommendations, controls by supervisory authorities were neglected almost nationwide and, if at all, largely only conducted by telephone.
During the pandemic, positive outcomes were also reported in individual facilities, based primarily on preventive measures and exemplary trained staff (3).
The current attempts by scientists (4), politicians, experts and the media to come to terms with the situation are encouraging and are directed towards the future: In the next pandemic, many things must be different; we must have learned enough from the mistakes of the Corona measures to be able to take humane, precise and confident action.
It is recommended that a nationwide emergency plan be adopted—e.g., a crisis manual. This would include a tiered catalog of measures, which would be regularly trained and continually adapted based on current findings. These include:
• Binding rules and measures in the event of infections and outbreaks have been developed and are known throughout the facility, such as
• A crisis team is prepared and ready to deploy
• all required contact details are up-to-date (internal and external to doctors, clinics, health authorities)
• a spatial separation between infected and non-infected people can be established
• Care procedures for infected patients are structured and regular exercise intervals are organized
• a coherent hygiene concept is in place
• Recommended vaccination campaigns for residents and staff are organized by the company
• Provision of high-quality protective materials is ensured and continuously monitored
• Qualification and training measures for staff (even in “infection-free” times) are regularly organized
• Patient/resident-friendly duty rosters with the highest possible personnel continuity are mandatory and verifiable at any time
• Good and open communication with those affected, their relatives and carers regarding the measures to be taken and their duration becomes the standard.

Society, self-governing organizations, service providers and those affected
Patients and their families are equally called upon to find viable solutions that are acceptable to those affected, based on shared responsibility. The following applies to all preventive measures: Whether in hospitals, inpatient care facilities, or in outpatient care at home: Despite the highest possible protective measures, total isolation of people in need of care should be avoided in the event of newly emerging high infection rates. This includes severely restricted visiting rules, a lack of or insufficient therapeutic and recreational services, and, equally important, inadequate dialogue in the interaction between the individuals and institutions involved. Until then, scientists are called upon to improve the study situation in Germany and the basis of cohort-related data.