In shielding its hospitals from COVID-19, Britain left many of the weakest exposed

The coffin of Ozcan Aygin, 85, is placed in a hearse at the Shacklewell Lane Mosque, east London, in late April.

Stephen Grey & Andrew Macaskill

Knight, the residential services chief executive at Lodge operator CareUK, said it was essential that hospital patients be tested before they were transferred. “We need to ensure not just that the test has been done, but that the results are available prior to making the decision about admission” to the home, he said in a statement to Reuters.
Test, test, test
On March 12, Britain’s chief medical officer, Chris Whitty, announced the ending of most testing of the general population to focus on patients admitted to hospital. But Vallance, the chief scientific adviser, clarified to parliament a week later there would still be testing in isolated clusters of cases in the wider population.
By April 6, the Enfield council had recorded at least 26 deaths in care homes, and 126 suspected cases. Yet only 10 tests per day were being offered for the thousands of care staff across the whole of north London, said Enfield Council leader Caliskan.
Knight said that at Elizabeth Lodge, no tests were available for staff until after April 15, when Health Minister Hancock announced plans to test all residents and care home workers if they had symptoms. Even after Hancock’s pledge, only six tests were made available to Lodge staff and none to residents, Knight added.
Guidance from the Government, which has struggled to rapidly increase the overall availability of tests, remained that staff should simply stay at home and isolate if symptomatic. In his statement to Reuters, Knight said he and others in the industry had appealed to “senior members of the government to explain the challenges we were facing and how best they could support us.” He didn’t say who he spoke to.
Finally, on April 28, Hancock said all care home residents and staff could be tested even if they were not displaying symptoms. Again, the words didn’t match the experience on the ground.
Lisa Coombs, manager of the Minchenden Lodge in Enfield, home to up to 25 residents, said she had only secured a pack of 10 tests. Eight of these had returned a positive result. She’d been unable to secure tests for a further 10 residents even though some were displaying symptoms.
“What the government says is a load of rubbish,” she said. “I am angry because we are not being supported.” She declined to discuss how many residents have died.
At Elizabeth Lodge, no residents were tested until April 29, said Knight. Even after that date the government’s Care Quality Commission, which has been supplying tests to homes, only provided enough for residents showing symptoms of coronavirus. Things improved “in a very limited way” in the last two weeks of April, said Knight, and now “appear to be gaining momentum.” Getting access to testing on a meaningful scale now could reduce the impact of the virus in the coming months, he added.
A government spokesman said that a policy of testing everyone prior to admission into care homes was now being instituted, with a recommendation that hospital patients discharged into care homes are isolated for 14 days, even with negative test results.
Sonya Kaygan, her mother Ayse recalled, never said much about her work or conditions at the Lodge. But one day, at the start of the outbreak, Sonya saw the long-sleeved gloves that her mother, a caregiver at another home, was using. “We don’t have those at our place,” Kaygan said. The Lodge told Reuters staff had all the equipment that was required.
Unbeknown to her family, Kaygan had ordered surgical facemasks on Amazon. They arrived in early April after she was hospitalized. Other carers at the Lodge ordered masks, too, said another staff member. And after Kaygan’s death, a different fellow employee posted on Twitter: “I work there and all of this has (been) very hard on us all and every one is right. We as carers don’t have enough PPE.”
Another employee at Elizabeth Lodge told Reuters that although staff raised concerns, many had to operate for weeks without face masks or visors. “I was petrified. Every time I went in there, I worried for myself, my family, the people living there, my colleagues,” she said.
“If I never make it back, look after my baby.”
Sonya Kaygan’s words to her mother as she left for hospital
She said at the start of March, she remembers two meetings where managers discussed with staff how they would respond if there was a coronavirus outbreak. She said employees questioned why they did not have more protective equipment. The management responded saying they were doing their best to bring more in.
Reuters could not independently verify this account. The Lodge’s management told Reuters that neither Kaygan nor any other employee raised concerns to managers about protective equipment.
It said in a statement that at the time Kaygan worked at the Lodge, face masks were not being used. That, according to the home, was because official guidance then recommended such masks were only necessary when working within a metre (three feet) of someone with COVID-19 symptoms. Public Health England said the home’s interpretation was in line with advice then in force that masks were only needed when in personal contact with someone, such as washing.
Across Enfield, supply of PPE was a major problem. According to council leader Caliskan, by the end of March, supplies in some homes were inadequate, and others were running out. The government repeatedly promised to send supplies, but when a much-anticipated delivery by the army arrived at the council depot on March 28, it took just 6 minutes to unload, she said. It contained only 2,000 aprons and 6,000 masks, which aren’t designed for repeated or prolonged use, for Enfield’s 5,500 care workers.
Getting To Hospital
On March 31, just after 2 pm, Sonya Kaygan was picked up by an ambulance from the two-up, two-down home she shared with her mother and daughter. Kaygan was finding it increasingly difficult to breathe. As she walked to the ambulance, she turned to her mother and said: “If I never make it back, look after my baby.”
The ambulance crew said Kaygan would be taken to the nearby North Middlesex Hospital, but when the family called there later, there was no one of that name. Uncle Hasan tracked her down to Whipps Cross Hospital in Leytonstone, northeast London. Kaygan made video calls to her family, and asked Ayse to come and visit. But, as is the case in many countries, the hospital wouldn’t allow it.
In an email to Reuters, the NHS trust managing Whipps Cross said all visiting was “currently suspended other than in exceptional circumstances” to stop the spread of COVID-19.
Then news came that Kaygan would be intubated – sedated and put on a ventilator. Her last call was to a family member in Cyprus, about 6 am on April 2. “I’m going in now,” she said.
Kaygan’s hospital admission was swift. Many others have reported difficulties getting in.
Munuse Nabi, 90, lived in a care home in Ilford, East London. She was extremely fragile, with heart, lung and kidney problems. But she was also mentally strong with a pin-sharp memory, able to talk on the phone and flick through TV channels. “She was all perfect,” said son Erkan Nabi, a driving instructor.
In early April, Munuse developed a temperature and a dry and persistent cough, and lost her voice. As she got worse, a doctor examined Munuse by video link. When she began to struggle to breathe, Nabi urged the home to send her to hospital.
A nurse, he said, told him: “We’ve been told not to send people to hospital. Just leave them here. They’re comfortable.” He was upset. “They were trying to encourage me to leave her there basically to die.” He insisted they call an ambulance, and she was taken to hospital.
A spokesperson for the care home involved said staff were “doing everything we can to make sure our residents and colleagues stay safe and well throughout these challenging times.”
This approach to hospitalisation reflects what many homes took to be national guidance. An NHS England policy document issued on April 10 listed care home residents among those who “should not ordinarily be conveyed to hospital unless authorised by a senior colleague.”
The document was withdrawn within five days, after public criticism. The NHS did not respond to a request to discuss the document.
London’s ambulance service also issued new guidance.
Ambulance crews assess patients using a standard scoring system of vital signs. According to the Royal College of Physicians, a professional body for doctors, a patient who scores five or more on a 20-point scale should be provided with clinical care and monitored each hour. A patient scoring five would normally be taken to hospital.
But in early March, London’s ambulance service raised the bar for COVID-19 patients to seven.
“I have never seen a score of seven being used before,” said one NHS paramedic interviewed by Reuters. The medic spoke on condition of anonymity.
On April 10, the required score was lowered to five. In a statement, the London Ambulance Service told Reuters its previous guidance was one of several assessments used and clinical judgment was the deciding factor. Asked if the guidance reflected the national approach, the NHS did not respond.
Possible evidence of restrictions on admissions came in a study of 17,000 patients admitted for COVID-19 to 166 NHS hospitals between February 6 and April 1. The study showed that one-third of these patients died, a high fatality rate.
Calum Semple, the lead author and professor of outbreak medicine at Liverpool University, said, in an interview with Reuters, this indicated, among other things, that England set a “high bar” for hospital admission. “Essentially, only those who are pretty sick get in.” But, he said, there was no data yet on whether that high bar ultimately made people in Britain with COVID-19 worse off. The NHS didn’t comment.
False Victory
On the hospital wards of London, by Easter Sunday, April 12, there was a sense of light at the end of the tunnel. Over the long holiday weekend, according to several doctors contacted by Reuters, some hospitals saw just a handful of new admissions.
But on the frontline of the efforts to protect the capital’s most vulnerable people, the worst was far from over. According to an official closely involved in London’s response to the coronavirus, the capital’s mayor, Sadiq Khan, was getting reports that food banks were close to running out. Crisis meetings were held all weekend to replenish stocks.
In Enfield, by Easter Sunday a total of 39 care home deaths linked to COVID-19 had been recorded, and 142 residents had suspected infections. By the end of last month, nearly 100 more residents of Enfield care homes would die. The total in the borough, as recorded by the council, would rise to 136 deaths linked to the virus in care homes by April 30, including care home residents who died in hospital.
On the national stage, the government projected a picture of success. Prime Minister Boris Johnson, at his first daily Downing Street briefing since recovering from coronavirus, said on April 30 that Britain was past the peak and had avoided overwhelming the health service.
“It is thanks to that massive collective effort to shield the NHS that we avoided an uncontrollable and catastrophic epidemic,” said Johnson.
Even so, deaths in care homes were surging.
On the third night of 90-year-old Munuse Nabi’s hospital stay, a doctor called her son Erkan to say her COVID-19 test had come back positive. As her condition was worsening and she was too fragile for invasive treatment, they would not be able to save her life.
Erkan, urged to visit, went to the hospital and was dressed up by staff in what he calls the “full battledress” protective gear, including visor and gown.
As doctors gave Munuse small doses of morphine to make her comfortable, Erkan stayed by her bedside all through April 19 and into the early hours of April 20, holding her hand as she slipped away.
It was in the early hours of April 17 that Kaygan’s family got the call they dreaded. She, too, had passed away.
Her mother posted a message on Facebook: “My soul, my angel, I lost the most beautiful angel in this world. We lost the most beautiful angel in this world.”
She still hasn’t worked up the strength to tell Kaygan’s daughter, three-year-old Ayse, that her mother is dead.

Additional reporting by Ryan McNeill.
Reuters is examining the UK’s response to COVID-19 crisis. If you have information you can direct message our reporters @StephenGrey or @andymacaskill on Twitter.

A shattered community
In Britain’s Turkish-Cypriot community, early April was a period of anxious waiting. With a strong presence in Enfield, people of Turkish origin number around 500,000 in the UK, and, like many minorities, feel they have suffered disproportionately from the COVID-19 pandemic.
There is no data yet on the full extent of deaths in the community or to show if the death rate is higher than for other UK citizens. According to Ipek Ozerim, a community activist and journalist, the number of fatalities of Turkish origin is at least 137. That compares to 87 deaths among those of Turkish origin in Germany, which has a community of over 4 million.
No one is quite sure why the virus spread within the community. Hussain Hashim, a Turkish-Cypriot imam, said one reason is they are a close-knit community that is very family oriented, meaning the disease may have spread rapidly ahead of the lockdown. In the last few weeks, he has been the only person present at burials because all the close relatives of the deceased were sick with COVID-19.
On the frontline is the community funeral director, Erkin Guney, a bald-headed chairman of Shacklewell Lane Mosque in east London and known to most as ‘Egg’.
The first death in the community was of 61-year-old Ahmet Ra?it on March 15 in south London. By April 2, the outbreak was becoming severe. With the help of a local council, Guney installed two container freezers in the mosque’s front yard to deal with the influx of bodies. The freezers were covered by a large white gazebo, to avoid the gaze of neighbours. He also turned to Facebook to issue an appeal for body bags, after being told by several hospitals they had run out. A spokeswoman for the NHS in London said they have had a sufficient number of body bags.
Guney said that to prevent transmission of the virus, the COVID-19 deceased needed to be double-bagged, and picked up by his team in full-protective equipment. After phoning round, he eventually located a supplier for the bags.
“I work so hard to provide dignity,” he said in an interview at the mosque. But the disease, he said, robbed people of so much, including the traditional ways of washing, blessing and wrapping bodies and then displaying them for mourners to say their goodbyes.
The best he could do, he said, at the risk of releasing dangerous vapours, was to briefly unzip the body bag and take a photo of the face of the victim. “At least they can be satisfied it is their loved one in the coffin,” said Guney.
At a funeral later, on a community plot in Chadwell Heath, east London, Guney and his team lowered the body of Ozcan Aygin, 85, another member of the community, into the ground. A handful of mourners gathered round. A cemetery staffer hovered nearby to spray disinfectant and, in a break with normal tradition, the mourners were not allowed to fill in the earth. -Courtesy: Reuters