Nursing homes, sad protagonists of the pandemic in Europe

Despite the fact that virtually all countries took measures to try to prevent it, nursing homes have become sad protagonists of the pandemic in Europe, accumulating very high rates of infections and deaths from COVID-19.

Most institutions for the elderly, the population group with the highest number of deaths caused by the coronavirus, were overwhelmed from the beginning of the pandemic, with a shortage of prepared staff and without the appropriate equipment to deal with what was to come.

The collapse of national health systems also did not help these institutions to refer their patients to overcrowded hospitals, while the number of infected workers and the elderly grew, an explosive cocktail with thousands of deaths that has now placed them in the spotlight.

In the nearly 5,000 homes for the elderly in Spain, a country with slightly more than 6 million people over 70 years old, several thousand deaths have been recorded: in the region of Madrid alone, authorities estimated on Wednesday that 4,750 people died in these centers due to coronavirus, while in Catalonia the official figure is over a thousand.

However, it is clear that there will be many more, since in addition to the deaths in the two most populated regions of the country, there are also numerous cases of deaths with clear symptoms, but without diagnosis, whose cause is listed on the death certificates as "possible COVID-19".

Some of these elderly people died unattended and some residents even lived with the bodies for days, a situation that shocked Spanish society and forced the Government to deploy military personnel to take charge of the centres, while several territorial prosecutors' offices opened investigations.

The caretakers, for their part, protested at their lack of resources and training, and the families complained of a lack of information.

In the 6,715 homes in Italy, most of them private, there are no official figures on deaths either: in February and March "they have doubled and even tripled" in the northern regions, Franco Massi, president of the Union of Social Assistance Institutions and Initiatives (Uneba), told Efe, although the exact number of deaths is not known because until last week no tests were carried out in the homes for the elderly.

"At first there was a lot of attention to the hospitals. Only in recent days the measures have begun to be directed to the residences, but the damage is already done," explained Massi, for whom they have arrived "with delay", since the only one taken a month ago was the prohibition to the relatives to visit these centers.

In the province of Bergamo, the most affected by the epidemic, the number of elderly who have died can reach 600, according to the nursing home associations cited by Italian media.

In France, which has some 7,200 nursing homes, 43% of which are public, 4,166 deaths from COVID-19 have been recorded to date in these facilities since the beginning of the epidemic, compared to a total of 12,200.

Since 11 March, the government has prohibited visits to the elderly to prevent infection and last Monday the Minister of Health, Olivier Veran, announced a massive programme of testing in these homes to be able to confine those who test positive.

The staff of these centres, some 400,000 workers, have reported a lack of protective equipment and, in some cases, a dozen throughout the country, have decided to confine themselves to residents in order to limit external contacts.

In the UK, only 24 elderly deaths in two homes in Scotland have been officially recorded so far, although the figure is likely to be much higher given that the number of homes caring for the elderly is 11,293, according to official data for 2017.

British nursing homes, which are mostly private, may or may not have health care staff (they are more expensive), which also raises doubts about the care received by residents with less purchasing power.

The British Conservative Executive has issued guidelines to nursing homes on COVID-19 and promised adequate protective equipment for carers, although carers have complained that they lack the necessary equipment, such as masks and gloves.

As of last Sunday, the number of residents who had died of the coronavirus in Germany exceeded 150, with a particularly dramatic situation in the states of North Rhine-Westphalia, Bavaria, Lower Saxony and Baden-Württemberg.

Some 820,000 people live in Germany's 14,500 nursing homes, most of which are run by church bodies and private companies, but only 682 are public.

The homes had mostly restricted visiting arrangements in order to prevent contagion, and several facilities had recorded cases of mass contagion not only among their residents, but also among their caretakers, due particularly to a lack of protective equipment.

Of the 2,500 homes for the elderly in the Netherlands, where some 125,000 people live, it is estimated that approximately 900 (40%) have reported coronavirus infections, with the number of cases close to 1,800, as not everyone is tested.

At least 389 elderly people have confirmed died, but without testing all the deceased - even those with symptoms - the Association of Specialists in Medicine for the Elderly (Verenso) believes the death toll is much higher.

There is no general measure of "isolation," although visits to facilities nationwide were banned to protect the elderly, with the curious fact that some facilities allow confinement of the admitted person's partner in the facility for the duration of the epidemic.

In Belgium, with around 143,000 beds for a population of 500,000 elderly people over 80, no unified figure is published, but each region provides its data and there are hardly any: in Flanders between April 1st and 4th, 241 people and in Wallonia, 106 until March 31st.

These are partial and very limited figures, which will no doubt increase with the calculations at the end of the pandemic.

Throughout this week, 20,000 rapid tests have been distributed among residents and workers in the centres, and from some sectors, such as the Santhea association, the lack of personnel, protective material and effective measures during the quarantine has been reported.

In Portugal, the impact of the coronavirus in the approximately 2,500 residences that exist (the majority of which are non-profit organizations, such as Santa Casa de la Misericordia) has not been massive, although there are outstanding cases, such as the center of Aveiro in which 15 people died and another 78 tested positive.

Special recommendations have been developed for nursing homes during the pandemic and family visits have been limited since March 13, when the state of alert was declared.

Greece appears to be the exception to the rule: in the approximately 300 homes for the elderly there are no cases of coronavirus detected so far and there are even free beds in the centres to be able to treat cases of COVID-19 if there is no space in the hospitals.

In view of the fact that the health system is not prepared to deal with a wave of infections in the homes - there are around 30,000 residents - the government imposed a total quarantine on these nursing homes on 24 March, and that measure has worked.

In Greece, around half of the homes are private. The rest are run by municipalities or the Orthodox Church.

In Austria there are about 900 homes for the elderly or people requiring special care, most of which (66%) are private.

There are no data on deaths and hospitalisations, and although the Ministry of Health has not even reported how many cases of coronavirus have been in nursing homes, the media have reported at least 30 in about twenty homes.

The Government has not imposed a total ban on visits, only "strongly recommended" that they be avoided or reduced as much as possible, although some regional governments have done so.

And, as in many other countries, caregivers have reported a lack of protective equipment.

The protective measures taken in the 500 public and private homes for the elderly in the Czech Republic, with a capacity of about 40,000 people, have succeeded in protecting this group at least for the time being.

There had been cases of contagion in nursing homes, but no deaths had been reported, and in nine centres workers had voluntarily isolated themselves for two weeks with their elderly dependents to reduce the risk.

In Turkey, with a population of more than 83 million people, there are only 395 geriatric homes: the families of the elderly are the ones who have to pay for the care of their children.
So far, no cases of coronavirus have been reported in these centers.

Visits are restricted, special hygiene rules for staff have been disseminated, and it has been recommended that those who might become infected be isolated.

At present, there are no data on the incidence of coronavirus in this sector in Russia, although many residences reported that they have complied with the authorities' recommendations to carry out disinfection work in the centres and to suspend mass activities.

Unlike in the rest of Europe, the majority of retirement homes in Russia are public and their occupants are mostly lonely and economically vulnerable elderly people without fixed residences.