Eamon Hughes (75) is sitting by the window of his ground floor bedroom in St Mary's nursing home in Dublin city's Phoenix Park, with a paintbrush in hand.

He is carefully working away on a vibrant painting of a deer, much like the ones living in the park he often spots from his window.

The HSE-run nursing home, one of the worst hit during the first wave of the pandemic, has been Covid-free since last summer, and now the residents have been fully vaccinated against the virus.

Hospital Report

During the height of the first outbreak, when 24 residents died with Covid-19, Hughes contracted the virus. Struggling to breathe and having been transferred to the Mater Hospital, he feared he was going to die.

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“I think the last Friday in April was the worst day, I thought I was gone that day, it was very, very scary... The gasping for breath, it is very, very testing, that was the worst for me,” he told The Irish Times.

But he pulled through and, like most residents in nursing homes across the country, has spent much of the time since in his bedroom. “Of course my wife, daughters and grandchildren, they visit me regularly at the window,” he says.

Raised on a Co Cavan farm, he trained as a plasterer, and later worked as a homebuilder in Dublin. Working on a site 35 years ago, he was struck by a felled tree branch, which broke several vertebrae, and he has used a wheelchair since.

It was in St Mary’s, where he has lived for the last 5½ years, that he took up painting. Being right-handed but unable to raise that arm above his shoulder, he learned to paint with his left hand.

“I’m interested in art, we had an art class every Tuesday. That stopped, so I’m doing a bit in my room at the moment, I’m only dabbling,” he says.

Painting has been “a great lifeline” for him during the pandemic, given the necessary restrictions on visiting, he says.

There are currently 124 residents in the nursing home, with a separate 53-bed rehabilitation hospital on the campus as well.

St Mary’s had its first confirmed case of Covid-19 in late March 2020, with the virus quickly spreading through the facility to infect nearly half of the residents – and large numbers of staff – in a matter of weeks.

Looking back now, Dr Mimi Fan, consultant geriatrician, says an absence of regular testing of staff and lack of understanding of asymptomatic cases allowed the virus to spread rapidly through St Mary's in those early weeks.

“In the first wave, if you had no temperature, no symptoms, no shortness of breath, you were not getting swabbed,” she says.

Expected signs

Instead of presenting with the expected signs of Covid-19, such as a cough or temperature, elderly residents went off their food, or slept for long periods.

“I remember seeing them and thinking this is not right... Something’s not right, and yet we had to convince other colleagues, I think this is Covid,” Dr Fan says.

Despite being hospitalised herself with the disease, that sense of foreboding uncertainty during the first outbreak was the scariest point of the pandemic, she says.

“It was seeing the fear of my residents getting sick, the staff getting sick, and not knowing what we were dealing with, this invisible thing, that struck me more than going through it myself,” she says.

The introduction of serial testing of staff every two weeks had been “so important” in fighting the virus, enabling them to identify and isolate asymptomatic residents and staff, she says.

Like nearly all healthcare facilities, the early supply of Personal Protective Equipment (PPE) was another challenge. An independent investigation is currently ongoing into a protected disclosure from a former staff member about alleged shortcomings in St Mary’s response during the first wave.

Meanwhile Aisling Coffey, a principal social worker in St Mary’s, says the toll of losing so many residents in the space of a few weeks weighed heavily on the staff, many of whom would have known them for several years. “A nursing home is like a village, in that the frontline carers who care very intimately for older people get to know them very well,” she says.

“The most challenging moment in the last year has been supporting residents and families as they [residents] approached end of life. It has been the worst of times, but also I am glad I was here to do it,” she says.

Family members

Due to restrictions or health concerns, family members were not always able to be present, and those that were had to don full PPE.

“You can only imagine saying goodbye to a loved one while wearing a visor, mask, gloves, and possibly a full hazmat suit,” Coffey says.

Often it fell to the staff to be the ones sitting with the residents as they died. “We would have asked families what kind and comforting words we could whisper into the resident’s ear, we would have asked what possessions of significance we should put in the resident’s arms,” she says.

Last November the nursing home held a remembrance service streamed online for the many residents who had died, with readings, songs and prayers.

As St Mary’s was successful in keeping the virus out after the first wave, it was able to gradually reintroduce social and recreational activities in small groups.

Last Friday afternoon, loud cheers could be heard echoing down the corridors from one of the nursing home’s wards, as a group of residents played a game of bowling.

Alison Fitzgerald, who has worked in St Mary’s for 31 years, is the activities coordinator. Social activities currently allowed include bingo, bowling, story time and quizzes, with Mass said on each ward as well, she says.

Initially after weeks’ cocooning in their rooms during the first wave, some residents were “a bit fearful” about coming out to common areas, she says.

In some cases it was only then residents might learn a friend in the home had died during the outbreak. Fitzgerald says in those moments she would take the resident to a quiet room to explain what had happened, and suggest they say a prayer together.

Like many staff she was redeployed to a care role during the outbreak, and worked on one of the Covid-positive wards. “You were fearful for the residents, you were fearing for yourself, and the other staff. You were exhausted by the end of the day,” she says.

Simone Comiskey, St Mary's director of nursing, said the facility had come through a "tough year".

Cheerful

On many occasions it had been the residents who had kept the staff cheerful, she says. For some it was not their first pandemic – two women in the nursing home had previously lived through the Spanish flu of 1918.

The nursing home was among the first to receive the Covid-19 vaccine in January. The residents “all dressed up for it, it was like they were going to a wedding, they knew this was a big occasion,” Comiskey says.

Essene Cassidy, head of HSE community older person services in Dublin north city and county, said in the early weeks of the pandemic the "guidance was changing on an hourly basis".

“We were in crisis management mode across the whole health service. This was new, this was a pandemic, this was something that was very far away and suddenly was here,” she says.

“The focus quite rightly was on hospital preparation, but viruses don’t see any walls, it came at a different angle at us all,” she says. In total half of the overall deaths linked to Covid-19 during the first wave were in nursing homes.

Through serial testing of staff, and other learnings from the first wave, St Mary’s had been able to keep residents free of Covid-19 since last summer, Cassidy says.

The rehabilitation hospital on the campus did see a small outbreak of three cases at the start of this year, among patients quarantining for 14 days following a transfer from acute hospital, she says.

Watching the residents line up to receive the vaccine earlier this year “was like watching history”, she adds.

Dr Fan hopes when the country finally comes through the pandemic, all the residents and staff in St Mary’s will be able to come together and celebrate, and also remember those who died.

“One day I hope that we can do a big barbecue here, where we will safely be able to stand together and eat together, and hug each other, and say ‘yeah we went through it, we lost quite a lot of people’, but we want to remember,” she says.