In late March as the coronavirus pandemic spread to the U.S., news of a wave of deaths in Spanish nursing homes caught the attention of David Grabowski, a professor of health policy at Harvard Medical School.
Tweeting a March 25 story about a probe into elderly coronavirus victims found dead in their beds by the Spanish army, he said it was at that point he realized the U.S. could be headed for trouble with its own care home facilities. “We should have learned this lesson from Europe and we didn’t,” Grabowski told MarketWatch in an interview.
Stories of nursing home deaths in virus-battered Italy had also begun trickling out in March, and would soon be followed by similar tragedies in Spain, France, the U.K. and the U.S. The Kaiser Family Foundation estimates that 16,556 American deaths since April 29 have been in long-term care facilities, including residents and staff. A New York Times analysis concluded those deaths were a fifth of the U.S. total.
Europe paints a grim path forward. The World Health Organization estimates that over half of all Covid-19 deaths in the European Union have occurred in those care homes which can also spread to the community. Europe’s total death toll stood at 143,898 as of Tuesday, according to the European Centre for Disease Prevention and Control.
Authorities in Milan are probing one of the largest care homes — Pio Albergo Trivulzio — where 190 residents out of 1,000 are believed to have died of the illness. Spanish authorities are also investigating deaths, such as at Madrid’s Monte Hermoso care home, where 48 people reportedly died.
Last Wednesday, the U.K. coronavirus death toll jumped to 26,097 after the government started counting deaths in care homes and the wider community for the first time. It had previously faced criticism over the fact that the daily number of deaths from COVID-19 provided by Britain’s Department of Health had only included hospital fatalities. The country now has Europe’s highest death toll, at 29,427 as of Tuesday.
“This pandemic has shone a spotlight on the overlooked and undervalued corners of our society. Across the European region, long-term care has often been notoriously neglected,” said Dr. Hans Henri P. Kluge, WHO Regional Director for Europe, in a statement on April 23, as he urged more protective gear, training and medical supplies to prepare for another wave or pandemic.
“We were not ready. I must absolutely recognize that,” Professor Raffaele Antonelli Incalzi, president of the Italian Society of Gerontology and Geriatrics, told MarketWatch in a recent interview.
Among the first errors made in Italy were a lag in imposing strict measures, such as limits on visitations, and lack of testing as not all symptoms were the same, he said.
“We were convinced that fever and cough were the presenting symptoms and actually they are in the vast proportion, but some complained of headache, fatigue, diarrhea and so on. It’s absolutely necessary to have a high degree of suspicion,” Incalzi said.
They also learned that using nursing homes as convalescent facilities for people discharged from hospitals and recuperating from the virus was a costly mistake. Kluge has also urged the isolation of cases via separate wards or spaces for residents with the virus.
“This was a terrible error in Northern Italy and Lombardy … many of these people were not completely healed, they were still infected with COVID and that accounted for the spreading of the disease in a very frail population,” he said, adding that it’s “mandatory to avoid such a strategy.”
Yet, that is exactly what is happening in some U.S. states. In late March, New York authorities started requiring nursing homes to accept patients infected with the virus, against a recommendation by some experts, while similar orders came from California and New Jersey.
Kaiser data shows New York has so far seen the highest number of fatalities from those institutions at 3,653 and Governor Andrew Cuomo has said keeping those places free of the disease is “virtually impossible.”
Incalzi said they have also learned that the virus may have spread more rapidly in centers without specialists in elderly care, or with just one general practitioner in charge. “When a nursing home is directly followed by a geriatrician, there’s a lesser risk of spreading infections,” he said. “Many elderly people were in good health before dying from COVID,” he said.
Jesús Cubero, the president of the Spanish association of senior care homes, Aeste, complained that a lack of protective equipment was a problem in the early days. He added that of Spain’s 5,400 or so elder care facilities — 75% private and 25% public run — the larger ones often fared better.
“The biggest problems were in small companies and those run by religious structures, which were less professional as they had lots of volunteers, which is normally OK,” he told MarketWatch. “But with big companies you can manage with workers going from one place to another. If you have a lot of workers you can manage better.”
One complaint of Spanish geriatric doctors was that few patients 80 or older were admitted to ICU compared with younger patients and they have asked the government to try to equip care homes better to confront the next wave of the virus.
In Italy, one big step toward trying to prepare for the next outbreak has been taken at the behest of Incalzi and his colleagues via the GeroCovid Observational Study, an electronic registry of 60 nursing homes in Italy and their affected patients.
“From this, you will know which practices really matter and need to be enforced to decrease the risk,” of coronavirus among the elderly, Dr. Susanna Del Signore, CEO and founder of BlueCompanion that designed the registry, told MarketWatch. “All this data will help us see how older people can influence the outcome.”
She said the study, which began April 25, should be ready by November, with lessons learned perhaps just in time for the second wave of the pandemic that some have already warned is coming.