I keep seeing this 'opinion' of "why did we vaccinate the elderly first because now the young are unprotected and everyone in this outbreak are younger". It's wild that I have to explain this, especially as it's coming from corners of the medical community, but here goes. 1/
Putting aside for the moment, that dying from coronavirus (not dying with, but from), is horrible. And the fact that the death rate in the elderly is 20-30%, not 3%. Because in some circles, this distressing fact is not enough to justify vaccination, even though it should be.
Older people make up a fairly big proportion of our population. If they are in a nursing home or in hospital, then chances are they have multiple complex medical problems and have high nursing care needs. This means that when unwell, they often need 1-2 nurses to care for them.
By care for them, I mean, shower them, dress them, help them roll over in bed, open food packets, and even feed them. Not all are like this, but many, many can become temporarily like this when unwell. Even well older people living in the community.
They just do not have the same immune system, even the common cold can leave them unwell, dependent, and frequently with pneumonia. And if in a nursing home, their risk of catching things goes up, because it's a lot of people under the same roof.
Covid doesn't even respect single rooms. Also, the people caring for the elderly in the community, are frequently grossly underpaid for what they do. So they do contract work for agencies, and work at multiple sites, at both nursing homes AND hospitals, to make ends meet.
This creates a perfect storm. Covid gets into a privately run nursing home, carers, kitchen staff, cleaners all do work at hospitals too to pay the bills, and at other nursing homes.
Pretty soon, you've got multiple outbreak sites, at nursing homes and hospitals. And going back to earlier, when older people get sick, they get really sick, and suddenly everyone needs at least 2 nurses/carers to help feed, toilet, and bathe them.
Nursing home staff are suddenly all tier-1 contacts and have to go into iso, so new staff have to be brought in. From where? Other nursing homes or hospitals. Excepthospitals are now also exposure sites and they're now down 200 staff because they're in even closer quarters.
And because Covid kills 20-30% of the elderly, they now have palliative care requirements. End of life care is specialist level care, requiring RNs or drug-endorsed ENs, as well as people who know how to operate syringe drivers (these deliver continuous analgesia and sedation)..
..and doctors who know how to prescribe for them. The caring staff need to know how to recognise end-of life symptoms that cause distress and deliver care and medication to mitigate this. They also need to do this in full PPE, AND find the time to help families say goodbye...
Over ipads, AND take the time to console them. There are also the cohort of older patients who wont die, except it's often hard to tell who will pull through and who wont, so staff need to pay close attention to them and make sure they are being fed, bathed, and toileted...
...all the time being so sick, they frequently need two people to do that for them. When you're talking about hundreds or thousands of older patients, that's at least twice as many staff. You need to make sure they are meeting their caloric requirements...
...turning them hourly or two hourly so they don't get pressure sores. Checking their oxygen levels and blood pressure etc. You can't prone them (lie them on their stomachs to get more oxygen), because they're too frail and if you've got oxygen to deliver, you can't give much
...because high flow oxygen can only be given in intensive care in this pandemic, and intensive care is full already of the younger ones, and those likely to survive without profound disability.
I've had the more cynical question of 'well if they're so frail to begin with, why not just make everyone palliative?'
And this question, makes me angry, not for it's callousness, but for it's laziness.
And this question, makes me angry, not for it's callousness, but for it's laziness.
Remember that palliative level medicine and nursing is a specialist area. If there's not enough aged care RNs, ENs, GP specialists and non-GP specialists, there's even LESS available for mass palliation of extremely sick older people, who in spite of dying...
still need to be turned regularly to prevent pressure sores, need to have their continence pads changed, need to be toileted, need to be fed. And on top of that, then need someone qualified enough to deliver highly restricted medications, using devices...
...that there aren't enough of in a bad flu season, let alone a pandemic. Even if you moved them physically 'elsewhere' (like a field hospital), it still doesn't account for the intense numbers of staffing or equipment needed for nursing older people.
Lifting machines. Standing machines. Syringe drivers. Wheelchairs. All require people trained in how to use them. Humans are heavy. One carer can't turn them over in bed to change a pad. And I haven't even started on delirium and the occupational injury that goes with that
I could write this thread all night. But I'll stop there, and if anyone ever asks you why the elderly got vaccinated first, tell them, "because it rescued the hospital system and the younger patients within, from a far worse fate".
This was our lived experience in Victoria last year. Thank you for listening. 💖🙏
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