Coronavirus infections multiply by eight in nursing homes in just two weeks | Society

The fifth wave has broken into nursing homes and infections are growing strongly. In just two weeks, the positives have multiplied by eight. If from July 5 to 11 there were 123 elderly infected, from 19 to 25 there were 1,029, according to latest data from the Institute for the Elderly and Social Services (Imserso), which publishes the figures weekly. You have to go back to the beginning of February to find another period with more than a thousand active cases, but there is a big difference compared to then: in those seven days there were 606 deaths; from 19 to 25 there were 37. The immunization campaign has plummeted deaths in these centers, which were one of the major foci of the pandemic, and most of the elderly now remain asymptomatic or with mild forms of the disease. But experts warn that the risk still lurks: the vaccine is not infallible, the elderly do not have an immune system as robust as the young and, in addition, each positive implies isolation, periods that take their toll, especially for those with cognitive impairment . The key is to calibrate the restrictive measures and protocols and adjust them to the epidemiological situation, to achieve a balance between protection and emotional well-being.

Deaths and infections in residences were drastically reduced in Spain when the vaccination campaign ended, also coinciding with the decline in the third wave. Since then, the trickle of cases and deaths has not stopped, although they have been very low figures for a sector that has more than 380,000 jobs. Even a week without deaths was registered, according to the Imserso reports, prepared with data from the autonomous communities. But things have changed, and a lot, in the last month. With a new wave that multiplied by three the incidence accumulated in Spain from July 5 to 23 – a day in which it stood at 677.78 cases per 100,000 inhabitants in 14 days -, it is not surprising that the positives soared in the centers: since the beginning of the pandemic, the Epidemiologists have repeated over and over again that if the situation is bad in a region, it is normal for the virus to creep in. The residences emphasize, yes, that the situation now has nothing to do with that of previous waves. Most of the elderly and staff are vaccinated and that changes everything.

Each community, as throughout the entire pandemic, applies a recipe, and the scenario varies by autonomy. For example, in the Valencian Community have been 17 weeks without deaths. Catalonia has expanded weekly PCRs for unvaccinated residential staff from one to three and the allowed number of visitors has been restricted from three to two, they also have to present a negative antigen test and the exits from the center must be at least three days. In Aragon, at the moment, no new restrictions have been proposed and measures are taken from residence to residence, but unvaccinated workers will have to pay out of pocket for a diagnostic test every three days. In Andalusia, the Junta assumes every week the screening of a third of the staff of its centers, so that every 21 days they have all been examined. In Madrid, where on Monday they will study whether the restrictions should be extended, the tests are monthly. In Galicia, with a weekly screening, even physical contact with family members is allowed during visits, although with a mask and prior disinfection.

“We must take extreme precautionary measures”, defends José Martínez Olmos, professor at the Andalusian School of Public Health. And he explains that there are three vectors of contagion: workers, visits and outings. “The visits should preferably be of people with the double vaccination schedule and in open places,” he continues. Although it asks for a balance, the elderly cannot be totally isolated again. “They have already suffered a long time of isolation and loneliness.” The year and a half of the pandemic is heavy. Ignacio Fernández-Cid, president of the Business Federation of the Dependency, one of the four major employers’ associations in the sector, affirms that they feel “a lot of fatigue and a lot of misunderstanding when facing news that is published.” Since the beginning of the health crisis, 29,675 older people who resided in these centers have died of covid, more than 10,000 of them with symptoms compatible with the disease and who could not even have a test to confirm the diagnosis. “Now, in the centers, we are doing continuous screening, so they are coming out positive. Most of them are asymptomatic, which is very positive, but in a certain way dangerous because the person does not feel anything and there is a greater risk of the contagion spreading ”, says Fernández.

Experts explain that infection in this population can aggravate underlying pathologies. The head of Infectious Diseases at the Vall d’Hebron Hospital in Barcelona, ​​Benito Almirante, recalls that there are patients with a more deficient immunity, transplanted or immunosuppressed people in whom the vaccine does not produce the same response and does not provide the same protection. “It is possible that, being vaccinated, there is less severity of the covid infection, but that other underlying pathologies decompensate and there is more mortality,” adds the specialist. Precisely, a study by the Vall d’Hebron in collaboration with the Catalan employer’s association ACRA has revealed, after studying more than 2,000 cases from 160 residences during March and May 2020, that there are several clinical characteristics that increase the risk of poor evolution due to covid among the residents. Almirante, who is the author of this study, points out that, apart from age, “having dementia is the basic problem that implies a worse prognosis” if the patient contracts covid.

Those with cognitive impairment worry. Toni Andreu, ACRA’s Director of Strategy, argues that, although painful, increasing restrictions is “absolutely necessary” because the alternative would be “terrible”. “When the virus enters the residence, it spreads very quickly and this has the consequence of starting to carry out processes of sectorization and isolation that have a very negative impact on the emotional and physical health of users,” he explains. Especially with dementias. Andrés Rueda, member of the Association of Directors and Managers of Social Services, confirms that one of his main fears right now is isolation. Each case involves a quarantine period. “The guard has been lowered in prevention. We are concerned about the speed with which infections are increasing, in the context of a variant [la delta] more transmissible ”.

The latter coincides with Jaime Pérez, member of the board of directors of the Spanish Association of Vaccination. The preventive medicine specialist indicates that the response of the elderly to the vaccine is “excellent”, but points out that there are studies that suggest that over time it is possible that its effectiveness decreases a little and that a third dose may be necessary in certain groups . And he emphasizes: “The best way to protect these centers against future outbreaks are protection measures and ensure that the entire population is vaccinated as soon as possible to control the incidence in the community.”

Catalonia, the community where the fifth wave has hit the hardest (927 cases per 100,000 inhabitants at 14 days), it is also the region with the greatest impact on their residences. According to data from the Department of Health, more up-to-date than those of the Imserso, deaths, which at the beginning of July were barely one or two a week, are now counted by dozens each week, although they are still far from the figures reported in previous waves . The situation, however, is worrying. There are 122 residences – 12% of all centers in the community – with active cases. Vicente Botella, president of Upimir, a Catalan employer of small and medium-sized residences, speaks of a “brutal setback”. The rise in infections has once again put stress on the centers. “There is a lot of discomfort among the relatives and all of this is also a workload for professionals. They are loading us with work and what is decreasing is the attention to users. We are very understaffed ”, he laments.

Family associations regret the negative effect of increased restrictions. Mariví Nieto, a member of Marea de Residencias, understands that “there has to be”, but criticizes that they are often “excessive”. He asks that if there are infections the entire center is not closed, as some autonomies do. María José Carcelén, spokesperson for the Coordinator of Residences 5 + 1 and member of the state association La Plataforma, defines as an abuse of the rights of the elderly “so many limitations to fundamental rights, such as freedom of movement”. “They are locking them up, they do not consider them full citizens. They are in a prison without crime or conviction ”, he protests, and assures that they have denounced the restrictions to the Prosecutor’s Office. “Our family members take it very badly, they think we have abandoned them. The protection is not to lock them up, but to have enough professionals to do the sectorisations well, maintain the bubble groups and test residents and workers. Now they are taking measures that are not effective and are condemning them to live the last stage of their life in solitude ”.

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