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CONFRONTING CORONAVIRUS

Some Swedish care homes have had no cases of Covid-19 – what did they do right?

At least 234 of Sweden's 290 municipalities have elderly care homes with confirmed or suspected coronavirus cases. But a handful seem to have been able to protect residents from Covid-19, in some cases despite staff being infected. So what did they do differently, and could their strategies be applies elsewhere?

Some Swedish care homes have had no cases of Covid-19 – what did they do right?
An elderly care home in Nödinge allows distanced family visits. Photo: Thomas Johansson/TT

“I think the debate on the flaws in elderly care has been lacking nuance. I don't think there have been sufficient efforts to try to describe the underlying reasons for why the spread of infection has been great in different regions. There are almost 60 municipalities which have had better success,” Ebba Gierow, head of social affairs in the Ale municipality, told the TT newswire.

This is one of the municipalities which by late June had not recorded any cases of coronavirus in its five municipal care homes.

Ale is located in Västra Götaland, a region where the spread arrived later and more slowly than for example Stockholm – partly due to the timing of spring school holidays in both regions.

Gierow said that this meant care homes in Västra Götaland had the chance to improve their hygiene routines and make sure that all employees who showed symptoms stayed at home, two of the factors that have long been identified by authorities as decisive in limiting the spread.

Equipment

Beyond this proactive attitude, another tangible factor which has helped certain care homes in preventing or slowing down the spread of the coronavirus in their facilities has been the access to protective clothing.

Gierow explained that Ale decided that “they couldn't sit around and wait for national channels to provide us with equipment”.

Instead, they immediately drove to construction warehouses and other stores to stock up on equipment, and continually kept stock to ensure their supplies would not run out and source more protective clothing. 


Photo: Fredrik Sandberg/TT

Accessing protective equipment when it was in such high demand not only in Sweden but internationally was one of the major challenges for the care sector.

Greger Bengtsson, head of elderly care at the umbrella association for Sweden's municipalities and regions (SKR), told The Local that “we knew we should protect staff and residents, but we didn't have the necessary materials”, which instead went to Sweden's hospitals in the first instance.

“Not until about a month ago did care homes start to receive adequate supplies,” Bengtsson said.

And in Ale, the investment in protective equipment was not only a way to keep staff and residents safe, but also to boost perceived safety.

“It was a challenge, but protective equipment gives a feeling of security. You can't expect staff to go out and do their job well if they're scared. We put a lot of money into this in Ale. We did an evaluation and decided that was the right thing to do,” she said. 

A recent report published by SKR on the situation in care facilities stated that more equipment is not always the best option. For example, certain high grade face masks have valves which mean that, while the wearer is protected, their exhaled air is released unfiltered into their surroundings. Infected but asymptomatic staff wearing this kind of mask could therefore put elderly residents at increased risk. 

Another problem was that funds varied between municipalities, so in early April SKR began acting as a purchaser on behalf of all Sweden's municipalities, as a way to ensure it could act on the world market and ensure equipment was distributed where needed.


Photo: Fredrik Sandberg / TT

Early visitor bans

According to Bengtsson, another major obstacle in protecting care home residents was legislation.  

It was only on April 1st that the government declared a visitors' ban for all municipal care homes. Some municipalities had prohibited visits days or even weeks earlier. This meant they may have broken the law on accessibility of these facilities, which are intended to be an open part of society, but in doing so they may have saved lives.

One of the quickest to act, Luleå, which banned visits on March 20th, has cited this as a factor behind the municipality reporting only one care home death from Covid-19. And the Skåne region, where 85 percent of homes reported no infection at all, introduced a visitor ban 10-12 days before the national one.

However, this was only one of several measures in Skåne which may have had an effect, with others including more widespread testing of staff and residents in care homes than other regions, multilingual information campaigns about the coronavirus from an early stage, and a deal which means specialised hygiene nurses hired by the region work in care homes.

Signs on a care home entrance warning of a visitor ban. Photo: Anders Wiklund / TT

Fewer hourly staff

Another factor which has repeatedly surfaced in the debate on how the virus spread in Sweden's care homes so quickly is the high proportion of temporary staff, who often work in multiple facilities. On hourly contracts, these workers were not protected by extended sick pay legislation, which may have given them less incentive to follow national guidelines in staying home if showing the slightest cold or flu symptoms.

A relatively low proportion of hourly workers is a factor common to Ale and other municipalities which have not reported any cases of coronavirus, including Stenungssund and Alingsås. However, it's hard to assess the direct impact of this, partly because in the hard hit care homes, it's almost impossible to know how the infection entered the facility and spread.

Speaking to reporters in early May, the Public Health Agency's Head of the Department for Antibiotics and Infection Control Malin Grape said there was no clear common factor that pointed to how the infection got into affected care homes in Stockholm and Sörmland.

Some of the possibilities the Public Health Agency has pointed to after speaking with care homes include new arrivals to the homes or residents returning from hospital stays, family visits, or asymptomatic staff, as well as a high proportion of hourly workers. 

It is not possible to pinpoint the exact actions that determined why some municipalities avoided outbreaks in their care homes – and luck will have played some part.

But in order to give staff the necessary support and training, provide the right equipment in sufficient quantities, and take further measures as needed to protect staff and residents, quick reaction and adaptation to a fast-moving and unprecedented situation was essential. That can only come from an engaged leadership.

In Ale, Gierow says the strategy was hands-on from the start. 

“Managers have worked with a close leadership. They've spent a lot of time on the ground, answering questions, supporting staff and simply being around,” she said. “This provides support and security, which means a lot for staff being able to manage” with the pressure of protecting the most vulnerable group in society from the virus.

With reporting by Anne Grietje Franssen and TT's Petronella Uebel

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ECONOMY

From inflation to Covid: What to expect from Austria’s winter season

Austria’s lucrative winter season has already been hit by pandemic restrictions for the past two years. But this year there is also record inflation, staff shortages and an energy crisis to deal with.

From inflation to Covid: What to expect from Austria's winter season

The winter season in Austria is a big driver of the country’s economy and has been hit hard by Covid-19 restrictions for the past two winters.

But this year the industry faces an even bigger crisis – a combination of rising inflation, concerns over energy supplies, staff shortages and the pandemic (because it’s not over yet).

We took a closer look to find out how these issues could impact the industry and what we could expect from this year’s winter season in Austria.

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Inflation

Winter sports is a big guzzler of energy to operate ski lifts, apres ski venues and snow making machines. 

This means the industry is in a vulnerable position as energy prices rise, with some resort operators already confirming they will have to pass on some costs to customers.

Johann Roth, Managing Director at Präbichl in Styria, said that energy costs at the resort have tripled and admitted he is concerned about the coming winter season.

Roth told the Kronen Zeitung: “Of course we will have to increase the ticket prices, and to an extent that has never been seen in recent years.”

READ MORE: Cost of living: Why are restaurants getting more expensive in Austria?

At Planai ski resort in Schladming, Styria, Director Georg Bliem said they aim to keep the day ticket price under €70, but has also set up an energy task force to find cost-saving measures for this year. 

Suggestions for Planai include narrower slopes, reduced snowmaking capabilities, shorter cable car operating times and even a delayed start to the season.

Electricity costs at Planaibahn (the resort’s ski lift and gondola operator) were already at €3 million before the current energy crisis, according to the Kronen Zeitung.

Then there are hospitality businesses and hotels at ski resorts that are also being hit by rising costs.

As a result, the Kurier reports that room prices in overnight accommodation could increase by a further 15 percent in winter, and many people will no longer be able to afford skiing holidays.

Heating may be an issue in winter as the energy crisis looms (Photo by Achudh Krishna on Unsplash)

Energy

Rising prices are just one element of the energy crisis as there are fears that Austria will not have enough gas for the coming winter season – mostly due to the war in Ukraine.

In March, Austria activated the early warning system – which is the first level of a three-step emergency plan – for the country’s gas supply. If it reaches step three (emergency level), energy control measures will be put in place across the country.

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How this would impact ski resorts is unknown, but at the emergency level, households, essential industries and infrastructure would be prioritised for energy.

So far, there is no indication that step two (alert level) will be activated and the European Aggregated Gas Storage Inventory recently confirmed that Austria’s gas storage capacity was 60 percent full

Austria’s goal is to reach 80 percent capacity by November 1st in order to have a safety reserve.

However, Energy Minister Leonore Gewessler already appealed to businesses and households in July to start saving energy where possible.

Staff shortages

Ever since Austria (and Europe) started opening up after Covid-19 lockdowns, the hospitality and tourism industries have been struggling to find staff.

In fact, shortly before the start of the summer season in Austria, there were 30,000 open job vacancies in the tourism sector. And the Wiener Zeitung recently reported on how restaurants in Vienna are struggling to keep up with customer demand due to staff shortages. 

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The issue is even being discussed in parliament and it has already been made easier for seasonal workers in Austria to access residency through changes to the Red-White-Red card. 

Now, there are expectations of similar staff shortages for the winter season, which could cause further stress for ski resort operators.

Covid-19

Back in July, it was reported that the federal government was working on a Covid-19 contingency plan to get the country through another autumn and winter.

It envisages four scenarios – numbered from the best to the worst case. In the best case scenario, Austrians can live free of any pandemic rules. In the second best scenario, the situation will remain as it is (find out more about Austria’s latest Covid-19 rules here).

In scenario three, if new variants lead to more severe illness, the mask requirement will be expanded and more testing will be carried out.

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There could even be night-time curfews, entry tests and restrictions on private meetings. In addition, major events could be stopped from taking place and nightclubs closed.

Scenario four, the worst case scenario, would mean vaccination no longer offered protection and hospitals became overwhelmed, leading to severe restrictions on people’s social lives.

From what we’ve seen over the past two winters, scenarios three and four would likely impact winter sports operations. But to what degree would depend on the severity of the situation.

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