Principles in the COVID-WORLD

Pace yourself – this may be a marathon not a sprint!

all we do all must do together”  WB Yeats


Health care professionals

The collegiality, goodwill, camaraderie and expertise that exists among health care professionals and providers in Ireland, across the community and hospital sector, has been mobilized into a powerful force.  We are collaborating like never before as we strive to combat COVID-19 and its effects.

Frontline workers and health care professionals are now all playing their part, heroically going quietly, conscientiously and compassionately about their work.  While we are all professionals, we too are processing this crisis along with our families.  At the same time, we are heading off to work meeting the challenge of treating those that are ill with acute effects of COVID-19 in our acute hospitals, residential and nursing home services.  So, first and most importantly, a sincere thank you for your dedication and the selfless sacrifices you are making.  This is likely to be a marathon, not a sprint.  So pace yourself and give yourself permission to take breaks, time off and rest, when you can.   

Consideration, Compassion and Kindness are qualities that are always important, but now more so than ever.    So as you take time to consider the past few weeks, think of your colleagues and how they are doing.  Ask your colleagues how they are doing, and listen to how they respond.  Remember that a few well-placed words of encouragement or appreciation cost little, but can make a real difference in someone’s day.

Health care professionals and communities

Each of us has a very specific role to play in slowing the rise of the Coronavirus.  We have been given the playbook by Public Health and the HSE   We are trying to “flatten the curve” to protect those that are most vulnerable if they become ill with the Coronavirus.  We are also trying to buy time and capacity for the health care sector to manage and treat those that become ill with COVID-19.

We have been doing some of this since before March 13th.  The next few weeks will be vital in the fight against this virus.  Since March 27th we have been asked to double up on our efforts to socially isolate, and pay even more attention to the measures laid out in the HSE website.  We know about the importance of hand washing, cough etiquette, social distancing and are now learning about cocooning.  I asked in the blog last week "Can I Do More?'"  As a famous American president said "Is feidir linn!" Yes we can!

A community army is being mobilised to assist and support all of us, in particular those who are less able.  Working together, local community initiatives, voluntary organisations, in tandem with the HSE, the Department of Health, the Department of Rural Affairs will try to connect with those that need support and assistance.  Organisations like ALONE, Age Action and the Alzheimer’s society will play an important role.  Look at how An Garda Siochana, An Post, and Public Transport are playing their part.  Look at the initiative set up by the GAA, Centra and Supervalu.  These initiatives can only make a difference if our local communities rally together, and that is something we do very well in Ireland at times of hardship and need.  But now is our greatest need and our greatest challenge.

This pandemic will pass and we must get the balance right

Ageing populations will influence social and health systems in multiple ways, including the need to increase health and social care spend.  During this pandemic we must be mindful that, like every age group in society, older people are a very heterogeneous group.  There are many older people who are very well.  We must caution against placing all older people in one large “homogenous” group.  Labelling all older individuals as highly vulnerable, frail and passive agents is obviously incorrect and inappropriate. This ignores the positive contribution they make and the important influences they have had and continue to have on all our lives.  We must, however, be careful not to stigmatize, marginalise or disadvantage any group. 

We are all well aware of the many benefits of intergenerational and cross generational connectivity and interactions.  We have all benefitted through the years from these relationships.  The Irish Longitundinal Study in Ageing (TILDA) has highlighted many of these in recent publications.  

Modern Ireland has evolved into a forward thinking society, leading the world in certain areas.  While there is a lot of the very good information available on the health websites, and from other key agencies, they are not easy, or user friendly for everyone to access.  So we must ensure that information that is online, be it digital or icloud, is accessible to not just the young.  This information must be readily available in many other ways, including radio, TV and newspaper.   The practicalities of day to day living should be easier for all of us to negotiate. 

As our familiarity with what “Cocooning” means increases, we also need to have a better understanding of the risks and adverse effects that come with social isolation.  This includes heightened levels of loneliness, due to the disruption of social and support networks because of the need for restricted interpersonal contact and ‘cocooning’.  This is where local community and local authority efforts are so important. We must find new ways to connect with those socially isolating, through letter, phone, technology and other innovative ways to bridge these gaps. They will be required long after this pandemic has passes, and it will pass.

Resource allocation – based on need not age

Treatment for COVID-19, and other forms of resource allocation associated with this crisis, must be based on need.  It is concerning that we are hearing reports from other countries that when it comes to decisions around available treatments – be it home care supports, medicines or ventilation – that age alone was being used as a criteria. 

Morbidity, cumulative chronic illnesses and pre-acute illness physical condition (or Frailty) should sufficiently indicate or predict likelihood of a good outcome and surviving an illness.  An arbitrary age cut off takes none of these into account.  Prioritizing younger, healthier patients with a higher chance of recovery, as has been suggested in other countries, is “ageist” in the extreme.  Indeed the concept of “life years saved”, could be considered to be similarly “ageist” and if extended could include many people, young an old, perceived as marginalized groups in our society.  This is not something we should countenance in our country. 

Decisions around policy and strategies combating COVID-19 must not be based on a problematisation of ageing and older people in the context of this crisis. We must not let this crises undo all the work many before us have done to establish, in Ireland, the very strong bond that we have witnessed across the generations.  There are many benefits to these intergenerational and cross generational connectivities and interactions that we have all benefitted from, and we must not diminish them.

The work being done by our health care workers on the front line to treat those requiring hospital care, residential and nursing care is work we are all extremely proud of and support.  We must continue the same battle for everyone living this out in their own homes and communities as well.  We can play our part by following the guidelines laid down by the HSE

Uphold dignity, respect and compassion

Modern Ireland has evolved into a forward thinking society, leading the world in certain areas.  We need to continue to grow the culture in our country that upholds dignity, respect and compassion for each other over the course of our lives.  There is no doubt that our thinking and actions are being challenged in this new “COVID–WORLD”.  But we are up to this challenge, and should not compromise our principles.  WB Yeats said “We thread the needle’s eye, and all we do all must do together”.    While we each have a personal responsibility, there is also a shared societal and governmental policy responsibility. 

I will leave the last words to our own President, Michael D Higgins.  In his inaugural speech at the start of his second term in office he spoke of "a life lived together, one where there is a commitment to equality, to strong sustainable communities, to the sharing of history and to shaping of the future together; recognising our vulnerabilities, drawing on and enhancing our individual and collective capacities."

Never has this been truer, more challenged and more needed. 

Dr. Diarmuid O'Shea

President, Irish Gerontological Society

3 April 2020