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Preprint in English | medRxiv | ID: ppmedrxiv-21266650


Shortly after the COVID-19 pandemic reached Aotearoa New Zealand, a stringent lockdown lasting seven weeks was introduced to manage community spread of the virus. This paper reports the findings of a qualitative study examining how lockdown policies impacted upon the lives of those caring for community-based patients. The study involved nationwide surveys and ethnographic interviews with 15 registered nurses (RN) employed in community settings, two community midwives, and five personal care assistants (PCAs). During the strict lockdown levels 4 and 3, RNs and PCAs in the community showed considerable courage in answering their "call to duty" by taking on heightened care responsibilities and going "the extra mile" to help others. They faced significant risks to personal and professional relationships when they were required to take on additional and complex responsibilities for community-based patients. Despite, and sometimes due to the hypervigilant monitoring of their personal protective equipment (PPE), the need to safeguard family and community members generated considerable stress and anxiety. Many also faced personal isolation and loneliness as a result of lockdown restrictions. Although care and kindness became social expectations throughout Aotearoa New Zealand during the lockdown, RNs and PCAs who were already doing care work in patient homes had to do more. This article makes five core service delivery and policy recommendations for supporting community-based nurses and PCAs in respiratory disease pandemics: acknowledging the crucial role played by community-based carers and the associated stress and anxiety endured, through championing respect and compassion; demystifying the "heroism" or "self-sacrifice" projected onto care workers to facilitate boundary setting; the timely provision of adequate protective equipment; improving remuneration with adequate provision for time off; and regular counselling, peer support groups, and education on work-life balance delivered by support workers in recognition of stressors arising from these complex and isolated working conditions. What is known about the topicO_LINurses and personal care assistants play a pivotal role in community responses to pandemics. C_LIO_LIThe COVID-19 pandemic has intensified many community healthcare workers clinical duties. C_LIO_LIPandemics pose risks to healthcare workers physical and mental wellbeing. C_LI What this paper addsO_LICommunity healthcare workers pressured themselves to be a "good carer" or "hero" during the lockdown. C_LIO_LICaring for patients in the community also became about caring about patients, further intensifying workload. C_LIO_LIThe COVID-19 pandemic has negatively impacted community healthcare workers relationships, as well as their wellbeing. Impacts continued even once the virus was eliminated. C_LIO_LINeed for recognition of this workforce distinct from other care workers. C_LI

Preprint in English | medRxiv | ID: ppmedrxiv-21263837


ObjectivesTo investigate how successfully SARS-CoV-2 elimination strategies fulfil their promise of allowing a return to a normal social life, and to identify obstacles and challenges that may inhibit the realisation of this goal. DesignQualitative cross-sectional survey. SettingNew Zealand community cohort. Participants1040 respondents entered the study (18-90 years, M = 48.18.11, SD = 15.52, 76% women). 966 completed the questions relevant to this article. Participants were recruited via online advertisement campaigns designed to maximise variation in the sample as far as practicably possible. Main outcome measuresThematic analysis of participants narratives. ResultsA majority of participants reported that the elimination of SARS-CoV-2 had allowed their life to go back to being more or less the same as before the pandemic. A small number indicated the pandemic had inspired them to become more social following elimination. Nevertheless, a sizeable minority of respondents reported being less social, even many months after SARS-CoV-2 had been eliminated. This was often because of fears that the virus might be circulating undetected, or because the March-May 2020 lockdown had led to changes in relationships and personal habits that were not easily reversed. Becoming less social was associated with having an underlying health condition that heightened ones vulnerability to COVID-19 (p = 0.00005) and older age (p = 0.007). ConclusionsElimination strategies can successfully allow the public to return to a pre-pandemic normal - or reinvent and improve their social lives should they wish. However, such outcomes are not inevitable. Re-establishing social connections after elimination can sometimes be a challenging process, with which people may need support. Plans for providing such support should be an integral part of elimination strategies.