Every time Aoife Kiernan starts a shift, the battle begins. She puts on a set of gloves first, then another set on top of those. Next, over her mouth and nose, she carefully attaches a FFP2 mask, a special grade respirator that filters airborne particles.
full-length protective gown is next to go on over her clothes, followed by an apron, a hair net and, finally, a face visor.
Ready and armed, the 26-year-old takes a deep breath, opens the door, and steps on to the frontline.
"When you're going into a room where someone has Covid, it's a very daunting moment," Aoife told Independent.ie.
"You are meeting this ferocious virus head on. It's in the room with you and, yes, it's scary."
The invisible killer found its way into the nursing home where Aoife works a number of weeks ago. Since then, Covid-19 has been stalking the corridors of the family run facility, turning sunshine-lit living spaces into a viral stalking ground for some of the most frail and elderly.
Four residents have died. Of the 17 who remain, six are Covid positive and eight others have symptoms and are awaiting test results.
"This is so serious," said Aoife. "We have controlled the virus in the home at this stage, but this is coming for nursing homes across the country and when it hits, it truly hits. It's like being hit by a bus."
The devastating toll Covid-19 has taken on nursing homes has been impossible to miss. At least 348 people living in long-term care have died in the outbreak. The actual count is very likely far higher, many believe, in part because the early testing protocols meant that many who died went untested.
The escalating crisis led Aoife Kiernan to go public. Almost two weeks ago, she took on the role of interim director of nursing in her current place of work after the permanent holder of the position fell ill with Covid-19. Since then she's been battling the virus, scouring the country for PPE, and begging the HSE for help.
"I think it's time I spoke up," she said. "We are being sent to war with no armour. This virus is inside nursing homes across the country and the PPE the HSE is offering won't protect us during battle. We won't survive the war if we aren't given the best available tools to protect and I'm not willing to put my staff at risk with what the HSE is offering in terms of protection." According to Aoife, the HSE has been forthcoming with supplies of PPE. Her issue is with the standard, in line with national guidelines, of what is being offered.
“They have told me that surgical masks are to be used in this environment,” she said.
“The HSE argue that because we are not doing ventilation in nursing homes FFP2 masks aren’t required. I have patients who are mobile and Covid-19 positive as well as dementia patients for example and some of those don’t have the awareness that they are symptomatic for Covid 19.
"They are eating and drinking, they’re walking in the halls, they are passing staff. They are unaware of the need to cover their mouths when they cough. They are unaware of the need to cover when they sneeze. They touch multiple surfaces, and this is their home.
"The only way I can protect my staff is by ensuring they have the best quality PPE there is to protect them. I cannot control where the Covid-19 is in the home. It’s absolutely impossible to control given the circumstances when you have mobile patients who are unaware that they are Covid positive.”
Last week, following a visit from the Community Liaison Services via the Department of Medicine for Older Persons at St Vincent's University Hospital (SVUH), Aoife was told to treat her nursing home like a "Covid ward".
But she says the setting is not designed or equipped for such a change of use. "There are patients in here who are not symptomatic," she said.
"This is their home. If they say to me that they want to go to the dayroom and sit with their family, and bear in mind that the residents here are all family, I can't stop them.
"I can advise them, I can advise their families on the outside, but I can't physically stop them. That is their decision. They are aware of the risks but this is their home."
As the CEO of the HSE, Paul Reid, announced on Thursday that 18,000 residents and staff had been tested for Covid-19 since last Saturday, Aoife was still waiting on tests for her eight symptomatic residents. She had been waiting more than five days for a team to arrive to take swabs. They finally arrived yesterday.
"Even though they have said they are screening all the homes, it took until today to get to me and I have actual patients who are very ill.
"Delays for staff are fine, delays for asymptomatic patients I can understand, but I had eight symptomatic patients. I was on to them constantly, so why did they have to wait this long?"
Aoife, like many other nurses and healthcare workers in nursing home settings around the country, faces an impossible dilemma when it comes to Covid-19. She is in an environment that, by its very nature, is a caring one that is focused on physical interaction. Social distancing, in a confined setting where many patients need close attention, is almost impossible.
"I have a number of patients who are bed-bound," she said.
"Every mouthful of water they get has to be given to them by one of our team. How can we social distance within the home here? We can't.
"These people rely on us for everything from oral care to bathing, to hygiene, clothing, feeding, turning. It's a very intimate level of care and it cannot be done at a distance.
"Just think about that, every single mouthful of water they drink is given at the hands of a carer. That's why that carer needs maximum protection. They are in that intimate proximity to the virus."
In a statement, the HSE said it was providing assistance to the staff and residents of the home where Aoife works.
In relation to testing delays, it said "the HSE is conscious of delays to date in terms of systematically testing residents and staff" at the facility "due to a complex set of circumstances pertaining to testing nationally".
On the issue of masks, the HSE said: "On April 22, the HSE updated its guidance on the use of surgical masks in healthcare settings in the context of the Covid-19 pandemic. This follows a decision by NPHET [National Public Health Emergency Team] based on advice from the Expert Advice Group. The HSE is now implementing this decision."
The HSE said new guidance on mask requires staff to wear surgical masks when providing care if they are within two metres of a patient.
It added: "This applies to all patients including...where there is no concern that the patient may have Covid-19. In addition, surgical masks should be worn by all healthcare workers for all encounters with other healthcare workers in the workplace if they will be together for more than 15 minutes and if a distance of two metres cannot be maintained."
For Aoife, and many others like her, the HSE guidelines on healthcare workers and masks bring little comfort. She wants the guidelines reviewed, as a matter of urgency. In the meantime, she will continue spending her time minding sick patients, protecting staff and searching for PPE.
"I refuse to drop the standard that I know will protect and keep my staff safe," she said.
"It would be unsafe to do so, and I wouldn't stand over that decision, so I will continue giving my staff FFP2 masks. Every day, 24 hours a day, the door needs to open to allow staff to come in to care for 17 vulnerable people.
"All I am asking the HSE to do is to ensure I have a supply of proper and adequate PPE. As a healthcare worker on the front line, I am extremely concerned for others who are in similar settings.
"A lot of them left their partner, their families, their loved ones to come in and do this.
"This is about giving healthcare workers protection and that's the minimum we can do, the absolute least. They are coming in and they are risking their lives - why can't we give them maximum protection?"