Coronavirus: Cases in Residences Tripled in Two Months Due to Fear of Health Collapse | Society

Fear has returned to nursing homes. The coronavirus is creeping back into these homes, which have seen a notable increase in positive cases since the summer. There are at least 6,300 active infections, according to data from the end of last week compiled by EL PAÍS by most communities – three have not provided data nor can it be found on their websites. Two months ago, at the end of August, the infections were three times lower.

The residences, which were in the eye of the hurricane in the spring, look suspiciously at the situation in hospitals, which is increasingly saturated. With the pandemic unleashed, what experts call rampant community transmission, the chances of the virus spreading through its doors increase. The situation, they explain, is much more controlled than in the first wave, but they fear that if the health system were to collapse, the elderly would suffer the consequences. Nearly three out of 10 ICU beds are occupied only by coronavirus patients, with communities already approaching 50 percent, like Aragon, or surpassing it, like La Rioja. Last spring, many elderly people died in their homes because they could not be moved to overflowing hospitals.

The situation today has nothing to do with what it was then, the centers argue. Now they have personal protective equipment and it is possible to diagnose cases, even asymptomatic ones. Something unthinkable months ago, when they went blind, trying to stop the entry of a virus that had infiltrated them before the alarm went off in Spain. Something they point out is that, for the time being, there are no problems with referring cases that require it to the hospital. Most of the elderly die outside the residences. In Navarre, for example, of the 54 deaths of residents registered since 1 July, 35 have died in hospitals. Those who die in the centers are generally people in a terminal situation, for whom relocation is not recommended, explains Cinta Pascual, president of the employers’ association Ceaps (about 2,000 residences).

Experts such as Joan Caylà, of the Spanish Society of Epidemiology, warn of the danger of spreading the virus in the centers. “In Catalonia, the age group in which the greatest number of infections occur is between 20 and 29, but we also see that older people are becoming infected. If the virus passed en masse to residences, it would be a disaster, “he says. According to reports from the Carlos III Health Institute, the percentage of infected people over the age of 70 has increased slightly in the past two months: it was 9.7% September 3, and now they are already 11% The percentage of deaths among the over 79 who contract the disease is also increasing, from 5.7% to 9.3%.

“In very old people, lethality increases a lot. If the virus now penetrates massively, we would see that lethality would increase significantly, “Caylà says.” And be careful, because we are already in a global daily death toll of over 100. Everyone considers it something normal, but if we had talked about it last year we would have said that this in Spain, a developed country, cannot happen. But this figure could increase more “, he warns. The epidemiologist recalls that” historically the residences have always been very limited in personnel, and host a population that needs a lot of care “. Low relationships and low wages are one of the main demands of the unions. The epidemiologist also recalls how difficult it is to keep these places isolated from the virus:” Workers spend eight hours, they go home, they come back the next day … There have been entries and exits of personnel, visitors, people who are preparing to bring supplies “.

The only centralized information provided by the government shows a rapid increase in infections. Friday’s report from the Center for Coordination of Health Alerts and Emergencies reflects an 81% increase in newly diagnosed cases related to outbreaks, compared to the previous week: 2,326 compared to 1,281. These data are useful for seeing the evolution of the pandemic in these homes, but they do not capture the extent of the infections: the active cases that appear in community statistics are many more. And this despite the fact that, according to the health protocol, a single case in a residence is considered an outbreak, so it should be reported to the ministry.

José Manuel Ramírez, president of the Association of Directors and Managers of Social Services, criticizes the fact that the country is immersed in a second wave without knowing the data of the first. The government has not yet revealed the figure, despite the fact that Pedro Sánchez promised to do so in May. The Ministry of Health came to consider a figure in an internal document (27,359 deaths from any cause, of which 9,003 with confirmation of covid-19 and 9,830 with compatible symptoms), but in that report it regretted the poor quality of the data from from the autonomous regions.

Early warning

“We do not have an early warning system, nor a common protocol that unifies the coordination mechanisms between health and social services,” explains Ramírez. Last September, the Ministry of Social Rights published a document that includes the mechanisms of social and health coordination of communities. But they are different in each autonomy. Ramírez continues to list the requests he has been making for months: “Not all communities have created safe corridors, centers where infected elderly people are transferred, in order to be able to take them out of their homes and to continue their life there in the most normalized way possible. Not even the funding of addiction has increased by a single euro at this time ”.

“In the first wave, a meteor hit us. We can’t find another one ”, sums up Andrés Rueda, president of Ascad, an association that brings together about 250 Catalan residences. In this community, active infections increased from 158 at the end of August to 1,174 at the end of October. In Spain there are around 373,000 places in around 5,400 centers, according to an estimate by the CSIC. But it is impossible to compare the at least 6,300 infections currently active with those recorded in the first wave. Each autonomy reports as it believes, there are no homogeneous data. But the data allows us to appreciate that after the increase in infections, there is an increase in deaths. On 20 October, half of the 42 deaths in Andalusia were elderly residents. The 134 deaths in these Aragonese centers between August 31 and October 29 represent a third of those recorded in that period in the community.

Rueda says he sensed that the virus is more aggressive in the centers in recent weeks. “A big problem we are experiencing is the shortage of staff, which is contagious or must maintain quarantines,” he says. The government has, in fact, relaxed the requirements for hiring in these centers. “When the virus comes in, in three or four days it’s chaos,” Rueda adds. A mask that gets wet when you shower an elderly person, or that moves when you get out of bed or when getting dressed can be the beginning of the infection. Or an oversight. The causes of the virus entry are many. But there are two vectors of contagion, basically: workers and visitors.

The latter are restricted in many communities, especially in case centers. The situation is not homogeneous. In La Rioja they are suspended, for example, while in Bizkaia, despite the perimeter confinement that affects the municipalities, the visit to a residence is considered comparable to the care of dependents.

Isolation

“We are concerned about isolation and its consequences for the elderly,” explains Juan José García Ferrer, general secretary of the Lares employers’ association, which brings together about a thousand centers run by non-profit organizations. “Not only do they die of covid, they also die of pain,” he explains. Rueda, however, defends that for two or three weeks, a key period for slowing the spread of the virus, they should be limited as much as possible: “The key is communication with families. They have the right to information and, if they receive it, they are the first to collaborate, but if not, the anguish is logical ”.

In what they are unanimous there is the need to carry out periodic tests on employees. In mid-August, Health and Autonomy agreed as a recommendation (ie they did not impose it) bi-weekly tests on employees. Again, the situation varies greatly depending on the community. In the Balearic Islands and Galicia they ensure that they are carried out every 15 days to workers. In Extremadura or Aragon, no.

The basic rules for containing infections cannot be observed in these centers. “We can’t keep all the windows open all the time, it’s a very vulnerable population that can easily catch a cold or pneumonia. The elderly cannot wear a mask because 40% have breathing problems and we cannot avoid physical contact with caregivers. So you have to find solutions, ”says Pascual of Ceaps. That is why he asks for weekly antigen tests, like García Ferrer (by Lares): “The possibility of contagion multiplies according to the surrounding situation. And the workers in the sector earn less than 1,000 euros a month. Many live in small houses ”. Urges to protect employees, under great stress. “If we compare the situation with that of 20 days ago, the cases have multiplied. It has nothing to do with the first wave, coordination with Health has improved. But mortality is high in this population group, ”continues Pascual. “It is very difficult to be constantly with fear in the body,” he says. The worry exists and will exist, it continues.

For now they resist. The problem is that the health system collapses again. And García Ferrer concludes: “Primary care and hospitals have not been strengthened. We fear that, if this happens, nursing homes for the elderly will be damaged again ”.

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