Behind Closed Doors in Time of Corona

Friday, March 27, 2020

Behind closed doors in time of coronaAuthor: Shazeera Zawawi

As the global community continues to be challenged by the COVID-19 pandemic, the risk is high that the weakest and most vulnerable become invisible.

The recent deaths of residents living in nursing homes in the United States and Italy demonstrated how persons confined in closed facilities are in an even more vulnerable position due to the pandemic. Meanwhile, a COVID-19 tragedy at a psychiatric ward in South Korea exposed the grim past of the deceased living at the facility: decades of loneliness, little chance of recovery, deteriorating health, unhygienic living conditions and malnourishment. As the news aptly described it, "calamities have a way of further exposing a society’s fault".

While social distancing is essential to prevent widespread transmission of COVID-19, it affects the lives of those in long-term care institutions in a worrying way. Catalina Devandas, the UN Special Rapporteur on the rights of persons with disabilities, stated recently that preventive measures such as social distancing and self-isolation may be impossible for those who rely on the support of others to function daily. This is, indeed, true. Alzheimer patients, for example, require physical contact with their caretakers for assistance with daily routines. Furthermore, regular visits and communication with family are important for persons living in long-term care facilities, particularly in helping them deal with feelings of isolation and loneliness.

Anxiety and loneliness are a threat to physical, emotional and psychological stability.  A 2015 study found that loneliness increased the rate of early death by twenty-six per cent while social isolation increased mortality rates by twenty-nine per cent. Imagine the situation of those who are confined to aged care facilities and psychiatric institutions in the current pandemic? During this challenging time, communication is key. As the UN High Commissioner for Human Rights recommended in her recent public statement, restriction of contact, while necessary, needs to be done  “in a transparent way and communicated clearly to those affected. Suddenly halting contact with the outside world risks aggravating what may be tense, difficult and potentially dangerous situations.”

Under the Optional Protocol to the Convention against Torture, Cruel, Inhuman and Degrading Treatment (OPCAT), nursing homes, psychiatric wards and other forms of long-term care institutions are considered to be places of deprivation of liberty. In this regard, states parties to the OPCAT have to ensure that these places are subjected to regular and independent oversight by their National Preventive Mechanisms (NPMs). However, in the current situation, long-term care facilities are also obliged to minimise access and contact with the outside world. From a detention monitoring perspective, applying the “do no harm principle” poses a difficult dilemma. NPMs have the mandate and responsibility to monitor conditions and treatment in detention, and this is even more critical during this period, as the above case of South Korea confirms. At the same time, oversight bodies need to avoid putting detainees, staff of the facilities and their own visiting teams at risk of contracting COVID-19 by continuing their monitoring work.

The dilemma may require us to meet in the middle with creative solutions that prioritise community health and safety but not at the expense of compassion and human dignity. If usual detention monitoring activities cannot resume, NPMs can still explore ways of conducting “remote” monitoring. This may include keeping in regular contact with staff and residents using videoconferencing, mobile messaging applications or email. Front line staff at the facilities may suffer from stress and fatigue and engaging them regularly may also help them address their work challenges constructively.

The pandemic is a chance for us to reflect on how we treat and protect the most vulnerable persons in our society. It is an opportunity for NPMs and oversight bodies to explore new and creative ways of continuing their important work during the crisis.

As Desmond Tutu succinctly put it, “Hope is being able to see that there is light despite all of the darkness”.

Cartoon: Shazeera Zawawi / APT

Staff members