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The first moments of a baby born to a mother with Covid are etched in the mind of Eerika Puolitaival, a nurse in the pulmonary disease ward of Päijät-Häme Central Hospital in the city of Lahti.

"A baby delivered by Caesarean section was immediately separated from its mother and brought to the newborn ward, the mother went to the Covid ward and the father was sick at home," she said of moments that have stuck in her mind during the pandemic.

Puolitaival's unit became her hospital's Covid ward during the pandemic, sometimes even caring for entire families. The age distribution of patients, she told Yle, can vary from newborn baby to elderly grandparent — and the range of different patients can lead to a multitude of different challenges.

Elderly people with memory problems do not always know where they are, and some of them write distressed letters to their caregivers, asking for help.

Drug addicts, on the other hand, have had to be kept in isolation on the ward, often against their will, under the terms of Finland's Communicable Diseases Act.

Puolitaival described how the unit is divided into 'dirty' and 'clean' sides. Patients can get to the 'clean' side when they are no longer considered to be contagious, or about 20 days after becoming infected.

There are a total of 20 beds on the dirty side: ten isolation rooms and three air proofed rooms. There are currently 19 patients being treated on that side.

No visitors are admitted to the dirty side, with the exception of people who have recovered from the virus.

Puolitaival described how she and her colleagues always go from the clean side to the dirty side by following the same pattern of preparation: firstly hand disinfectant, then the FFP3 mask, protective head covering, plastic overalls, and hand disinfectant again. They also put rubber gloves on their hands, maybe even a few pairs, and no rings.

After the patient has been treated, the protective clothing is removed in the isolated space between the two sides and discarded. Masks are only ever changed on the clean side. Still, despite all these careful preparations, there will still be exposures to the virus.

During the course of one shift, Puolitaival may have to change equipment up to ten times, and takes about 10,000 steps.

A large proportion of Covid-19 patients in Päijät-Häme are unvaccinated. Their risk of being hospitalised is 19 times higher than that of people who are double-vaccinated. The typical Covid patient in the hospital is a working-age, overweight man.

A Covid infection often comes as a surprise to most patients, as was the case for 57-year-old Jouni Marttinen. He thought the prolonged fever was common in the autumn flu.

Marttinen told Yle he had been in good health, exercised a lot for his age, and had made jokes about the coronavirus vaccine. Then he fell ill and was rushed to hospital via ambulance in November.

Marttinen's inflammation levels were high and oxygen saturation low, and he was transferred to the intensive care unit. Referring to the nurses' protective clothing, Marttinen calls the unit "astronaut treatment".

He was given supplemental oxygen, which he still receives, and he described the most frightening aspect of a Covid infection as being the feeling of suffocation.

"I tried to calm my mind by humming the childhood songs that my mother sang in the evenings at bedtime. That's how I eventually got some sleep. I also had an indescribable gratitude for being in such good care," he said.

When Eerika Puolitaival arrives to begin her shift, she does not always know when she will finish work and get home to her children, although working overtime is voluntary. However, there are often one or even two nurses missing from the coronavirus ward per shift, with an average shortage of three nurses every day.

Puolitaival said she tries to avoid overtime, but she often works double shifts: an evening shift on top of a morning shift or a night shift after an evening shift.

Nurses receive emergency pay for working overtime, but supervisors at the hospital think it's a double-edged sword. Many nurses may find themselves working too much because the basic salary in the healthcare sector is low.

Patients do not always realise when their oxygen levels are dropping, and may even feel fine so detach their oxygen tubes, according to Puolitaival. In this type of situation, the nurse must be one step ahead, she explained, as unvaccinated patients can crash very quickly.

Emotions also tend to run high. Patients get irritated when nurses are working around them on what can seem like a constant basis.

This was the case for Marttinen.

"I couldn't sleep. It was foggy and confusing. I was angry with the nurses. It's annoying, even though they held my hand and tried to help," Marttinen recalled.

A healthy person breathes about 12 times a minute, a person with a severe Covid infection breathes 30 to 40 times. This is because an inflammatory condition develops in the lungs. When breathing becomes wheezing it is a clear sign for nurses that the patient's condition is worsening.

In severe Covid-19 infections, the transfer of oxygen to the body becomes more difficult and therefore extra oxygen is needed, even via a ventilator.

Marttinen compared the feeling of a lack of oxygen to when, as a young man, he dived under the ice at his parents' summer cottage.

"I couldn't see the light, and my sense of direction disappeared. I searched in the dark looking for the hole in the ice. A lack of oxygen is similar but lasts longer. There is a feeling that this will never be overcome," he described.

The number of Covid patients in hospitals across Finland is currently higher than at any other stage during the pandemic. Most of the patients are in Helsinki University Hospital's area of responsibility, which also includes Päijät-Häme Central Hospital in Lahti.

The cost of treating Covid patients is expensive for taxpayers. The cost of one drug, given to Covid patients as an infusion, costs one thousand euros per dose alone. Another costly medicine, heparin — which prevents blood clots — is also provided.

Marttinen, for example, has received almost the entire range of medicines available to treat a Covid patient.

According to figures provided by the Helsinki and Uusimaa hospital district (HUS), hospital treatment for one Covid patient costs an average of 16,000 euros.

Marttinen spent five days in intensive care. From there he was transferred to an isolated section of the hospital's Covid ward and eventually, a few days later, he was transferred to the 'clean' side.

He made the 30-metre journey from the dirty side to the clean side in a wheelchair, connected all the time to an oxygen supply. For a man who had considered himself to be in good health, the collapse of his fitness and the loss of muscle mass have been a shock. A drop in his oxygen levels as he described the transfer demonstrated that even talking is an effort.

"Even a toilet trip in a wheelchair is as tough as the Cooper's test used to be when I was young. It's hard to put in words. There is this feeling of having given absolutely everything when in reality you have not really done anything," he said.

While on the ward, Marttinen called some people he had met before his infection was diagnosed. He has been troubled by the fact that he may have unknowingly spread the virus.

Marttinen added that he believes people's reasons for not getting vaccinated are not necessarily straightforward. There may be depression, loneliness or a feeling of social isolation behind people's reasons for not wanting to get jabbed.

"No one intentionally infects another. I've never been a model student, but it's a shame and annoying that I didn't get vaccinated. I especially recommend young people to take what doctors say seriously," he said.

On Päijät-Häme Central Hospital's Covid ward, the day has been very busy. A male patient has been brought to Marttinen's former isolation room. The elderly man in the neighbouring booth has been fighting for his life all day, while another is preparing to go home via a taxi covered by Finland's social insurance institution Kela.

"The fact that I'm here now is bigger than winning the lottery. I am deeply grateful to all the healthcare staff who have helped me," Marttinen said.

Despite the heavy toll of working at the heart of the pandemic, the nurses at Päijät-Häme Central Hospital still smile behind their masks. According to Puolitaival, the sincere gratitude expressed by patients helps to drive them on. Humour helps too.

However, there are times when the best efforts of the workers on the ward are not enough, and the patient should be transferred — but there is nowhere for them to go.

"I'm alone in the room with the patient. Without a computer, without a phone. I'm pressing the alarm for help. That's when the protective clothing starts to feel awkward and the sweat starts to flow."

Sometimes a patient dies on the ward without anyone holding their hand. This can occur in particular if their loved ones are quarantined at home.

"The worst thing is when you know that even if you do your best, it is not enough," Puolitaival said.