AMADORA – Tears well up in Diana Correia’s eyes as she recalls the October day that 24 of the 55 residents of her nursing home in Portugal tested positive for COVID-19.
The stunning discovery set off a scramble to enact the home’s contingency plan and stiffen safety procedures. With some staff sent into isolation, others worked double shifts of up to 16 hours in full protective equipment, leaving them lathered in sweat and bone-weary. Some of the home’s residents, suddenly confined to their rooms or their floor, were bewildered and chafed at restrictions, even trying to take the elevator and escape confinement.
“They were hard times,” Correia says, trying hard to keep her composure. “Very hard times.”
As a resurgence of the pandemic in the fall looked set to overwhelm Portuguese nursing homes like Correia’s, and the country’s public health service struggled to cope, the government mobilized all the resources it could. That included deploying military units.
The soldiers’ mission: fan out across the country to visit hundreds of nursing homes and help shore up their defenses against the pandemic.
Long-term care facilities have proven vulnerable worldwide during the pandemic. The age of their residents, their physical closeness inside what is essentially a large house, and the residents’ underlying health problems put them in peril. On top of that, nursing home staff in Portugal commonly work in several different care homes and travel between them on public transport.
Noting that international data on nursing home COVID-19 deaths is “imperfect and limited,” a study of 21 countries by the London-based International Long-term Care Policy Network, which includes scientific researchers, found in October that those homes’ average share of coronavirus deaths was around 46%.
The European Centre for Disease Control, an EU agency that monitors 31 countries, said the same month that up to 66% of all fatal COVID-19 cases have been among nursing home residents.
By that measure, Portugal hasn’t fared badly. Care home deaths through Dec. 14 accounted for 30% of the country's COVID-19 fatalities, the General Directorate for Health told The Associated Press.
On Friday, Portugal's total deaths reached almost 6,000.
At the end of September, fearing a calamity, the Portuguese government sent a distress call to its military. As well as helping with contact tracing, disinfecting buildings and providing beds for hundreds of virus patients at military hospitals, the armed forces were now being asked to buttress nursing home protections.
Dr. Maria Salazar, a physician and a colonel in the Portuguese Air Force, swiftly drew up a nationwide program to train care home staff at their workplace. The program also ensures the staff get the specific medical advice they need in almost daily online Q&A sessions with doctors, nurses and pharmacists.
Within a week, the program was launched, coordinated from the CECOM military operations command center near Lisbon.
About 140 teams of one to three people, taken from the Portuguese Army, Navy and Air Force, have traveled across the country since early October. They have already been to more than half of the targeted 2,770 care homes.
Salazar, a 49-year-old gastroenterologist, says the military presence is reassuring for nursing home staff and residents who were spooked by the virus threat and desperately short of medical know-how.
“Suddenly, all these staff ... felt like they didn’t know what they were doing and they were scared to death,” Salazar says.
At the root of some muddled decision-making was, simply, fear. “We’ve identified that very clearly,” she says.
In a first phase, troops go in person to the nursing homes and give talks with slideshows that go through the rudimentary rules of cooking, laundry, cleaning and social distancing. It’s COVID-19 101.
Correia, the technical director of an AFID charitable association nursing home in Amadora, just north of Lisbon, acknowledges it’s nothing her staff haven’t heard many times before. The difference is who the instructions are coming from.
“It’s a voice from the outside, a military voice with all the weight that carries,” she says.
In a recent afternoon session at the AFID home, 10 of Correia’s staff listened intently to Sgt. Ari Silva, from the No. 2 Lancers Regiment, whose barracks are nearby. Wearing military fatigues, a beret and an olive-green face mask, Silva asked his audience how many times they had washed their hands that day. A man sitting at the front said four.
Silva was unimpressed: “Friend, I've done at least double that,” he said.
The benefits of the military presence are as much psychological as practical, says 38-year-old Correia.
“We feel like someone outside of here feels concern for us,” she said. “It’s not just us who are concerned.”