Doctors Without Borders (MSF) warns that the risk that the elderly living in residences will be infected has not remitted. In a report published this Tuesday, he collects his experience during the first months of the pandemic in 486 centers, mainly from six autonomous communities, although with specific interventions up to 10. It concludes that nursing homes, which are social centers, not health centers, were not prepared to the epidemic. He criticizes that the "institutional lack of coordination and lack of leadership" of the Administrations forgot the elderly: "The effective assistance from the health system failed". She maintains that "keeping the sick in closed spaces and without adequate medical care multiplied infections, accelerated mortality and produced unworthy and inhuman situations" and criticizes the "iron" isolation to which the residents were subjected. MSF also indicates that "the high mortality rate" in the residences reveals that "a good part of the difficulties were linked to structural deficiencies, as well as job insecurity and cuts in the sector."
The official data has not yet been published, but the Ministry of Health estimated in an internal report about 19,000 older people who died from covid during the first months of the pandemic in health centers. The NGO intervened in these centers during the worst of the crisis. He gave them support in the design of sectorization protocols (to separate the infected and their contacts from the rest) or the use of individual protection equipment, he verified that "hospital referrals were not prioritized" and that the centers "were forced to provide care for those who, despite their good will, were not prepared. Ximena Di Lollo, responsible for the response in MSF residences, points out that the lack of training to use the personal protective equipment, as well as the delay and the shortage with which they arrived, was “one of the great failures” of that time. The NGO speaks of "serious problems" in the management and coordination model between the management companies and the authorities, which led to the "abandonment" of the elderly and the "lack of protection" of the staff who cared for them and points out that the "casualties labor were not replaced at the appropriate rate and rate ”. The document also collects testimonies that reflect the anguish experienced in the centers hardest hit by the pandemic. These are some snippets:
"I did not inject him with sedation and he ended up recovering"
Natalia runs a small, private residence. According to the report, she begins to cry as she recounts her experience: “One day the palliative care team that was sent from health arrived and they gave the first sedation injection to one of the residents who was very serious and we had not been able to refer to the hospital. Before leaving, they left another two injections loaded for me to give them according to the deadlines that they indicated. I looked at the injections and knew that I couldn't do that, no matter how simple they said it was. It wasn't because of the injection itself, but because of what it meant. Nobody has prepared me for a situation like that, much less for me to do it. I never gave her the injections and the fact is that Ana ended up recovering and we still have her here with us. He is very old and very weak, but he is still there. We have had other cases that were sedated by the palliative care team to avoid suffering; perhaps there were many, now we will not know. But this being left to us the responsibility of doing it is something that I could never have overcome.
"They banged on doors and begged to get out"
Andrés, a fire chief who led disinfection work with MSF, recounted the relief in the centers when he explained that the cleaning work on walls, floors or beds was carried out by them: “But the fear of moving people persisted, with all their belongings, from one place to another, to create clean [without positives] and dirty [with people with coronavirus] areas. Many times they preferred that the elderly, while there were no reliable results of the tests, were locked in their rooms, instead of regrouping them into zones, for fear of losing control and that the whole building would be thus contaminated. The result was appalling: a succession of closed doors, sometimes locked, and people banging and begging to get out. A horror ”.
An isolated resident in the room "stopped eating and died"
Carmen, director of a small family residence, explains about the confinement in the rooms: “We immediately saw that there were residents who were not going to be able to bear it. Eugenia, for example, stopped eating and moving; she spent hours looking out the window. There were other residents who complained and tried to get out of the rooms, and the truth is that it has been very painful to have to keep them locked up. In Eugenia's case, I was afraid that she would let herself die and I began to take her out every day for a while, to see if she would regain her will. And she started to eat, she started to get better, until one day the primary care people came just when we had her out, and they told me that she was unconscious and was putting everyone in danger. I had no choice but to return her to the room; they made me feel really bad. She stopped eating again and within a few days she died. I am not saying that he would not die anyway, but I am clear that he did not want to go through this. When the elementary team came back and I told them that she had died from locking her up again, they said, 'Don't tell us that.' They were quite touched. The same thing has happened to all of us. We were so scared by the virus that we have not thought of anything other than isolating as much as possible, without thinking about what this meant for them ”.
"The ambulance did not come and they died"
Luisa, a social worker from a residence that MSF visited on four occasions: "You called the referral hospital and they said: 'I'm sorry, today we can only admit one person from a nursing home, you choose.' Even so, the ambulance did not come to pick her up and they died in a few hours or days ”.
"I've been splicing for two days, I can't take it anymore"
Magdalena is a nurse and is responsible for a small rural residence: “I have been working for two days, because there is no one else who can take care of the residents who will not let me send to the hospital, and I can't take it anymore. Yesterday one died and tonight another will die if I don't stay, but I have to rest to be able to continue managing all this: half of the workforce is out, family members call non-stop and there are a lot of protocols to implement. Here it is very difficult to hire health personnel, nobody wants to come to work in such a remote place. I got another nurse friend to help me out, but the hospital has claimed all those who were in the job boards and I am left alone again. The mayor is looking, but I already told you that he will only find people and volunteers for cleaning matters, nothing for health care. I have called the entire province. In the hospital they have set up a covid team for the residences, but there are three people and they have not passed through here. I don't think they are going to do much either; I imagine that, as in this residence, many cases will be found and they will not prescribe referrals, but at least they could guide me with the treatments and procedures. I'll stay tonight, of course, and whatever else is needed. After all, I am a nurse, this is vocational, and even more so when you work with older people. But here alone I can't do much. Even if I stay, they will continue to die ”.
Solutions to outbreaks
Doctors Without Borders urges in its report to have contingency plans easily adaptable to residences (the centers are already required to have one). In its conclusions, it urges to improve the data collection system, to give "greater budgetary and training attention" and for the centers to have strategic reserves of personal protective equipment. It places special emphasis on the need to achieve a “balance between isolation, quarantine and coexistence” of the elderly in the centers, who in the first wave suffered “strict isolation measures, sometimes indiscriminate”, which had serious consequences for the elderly. And it calls for there to be a "certain flexibility in the occupation of them", to be able to zoning them when necessary. Given that one of the main deficiencies that the organization found in the nursing homes was the deficient capacity in the prevention and control of infections, it considers it advisable to create in each center the figure of a person in charge in this matter.
Information about the coronavirus
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