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Nursing homes linked to up to half of coronavirus deaths in Europe, WHO says Nursing homes linked to up to half of coronavirus deaths in Europe, WHO says
(about 2 hours later)
BRUSSELS — Up to half of coronavirus-related deaths in Europe are taking place in long-term care facilities such as nursing homes, the World Health Organization said Thursday, an assessment that suggests public health authorities may have allowed the pandemic to rage among some of their most vulnerable populations as they focused on hospitals and other aspects of their response.BRUSSELS — Up to half of coronavirus-related deaths in Europe are taking place in long-term care facilities such as nursing homes, the World Health Organization said Thursday, an assessment that suggests public health authorities may have allowed the pandemic to rage among some of their most vulnerable populations as they focused on hospitals and other aspects of their response.
A “deeply concerning picture” is emerging about residents of homes for the elderly, Hans Kluge, the WHO’s top official for Europe, told reporters on Thursday. According to countries’ estimates, he said, “up to half of those who have died from Covid-19 were resident in long-term care facilities. This is an unimaginable human tragedy.” A “deeply concerning picture” is emerging about residents of homes for the elderly, Hans Kluge, the WHO’s top official for Europe, told reporters at a news conference on Thursday. According to countries’ estimates, he said, “up to half of those who have died from covid-19 were resident in long-term care facilities. This is an unimaginable human tragedy.”
Kluge’s warning was focused on Europe, but the United States has also struggled with the pandemic inside homes for the elderly. A Washington Post analysis this week found that nearly one in 10 nursing homes in America have reported cases of the coronavirus, with a death count that has reached the thousands. Kluge’s warning focused on Europe, but the United States has also struggled with the pandemic inside homes for the elderly. A Washington Post analysis this week found that nearly one in 10 nursing homes in America have reported cases of the coronavirus, with a death count that has reached the thousands.
Many countries in Europe have banned family visits to nursing homes, an attempt to shelter the facilities from the spread of the disease, since it is far more fatal among older people. But those ban, though well-intentioned, may have deprived the elderly of advocates and added to the burdens of the often undertrained staff. Many countries in Europe have banned family visits to nursing homes, an attempt to shelter the facilities from the spread of the disease, since it is far more fatal among older people and those with pre-existing conditions. But those bans, though well-intentioned, may have deprived the elderly of advocates as conditions swiftly deteriorated.
Kluge said that he was trying to draw attention to the “overlooked and undervalued corners of our society” in warning of the stark death toll in nursing homes and care centers. “This pandemic has shown a spotlight on the overlooked and undervalued corners of our society,” Kluge said.
Measuring deaths and comparing the numbers across countries can be difficult, since each country uses different accounting methods and not all are counting deaths outside of hospitals. He and other WHO officials who spoke Thursday said they did not have enough data to say conclusively that people in nursing homes were being transferred to hospitals less often than they should be, or that they were being discharged from hospitals prematurely — fears raised by advocates in Britain and elsewhere. But the WHO officials hinted strongly that those factors might be contributing to the high death rates.
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“It is important that the decisions, the very tough decisions that have to be made, are not based on a single criteria like age,” said Manfred Huber, a WHO long-term care specialist.
Measuring and comparing coronavirus death rates can be difficult, since some nations are testing more suspected coronvirus cases than others are and each country is using different accounting methods as they record cases and deaths.
Many coutries in Europe have essentially ignored coronavirus testing in nursing homes to focus their testing capacity on hospital patients and hospital staff. In Italy, for instance, a recent national health service report indicated that people dying in nursing homes were overwhelmingly unlikely to have been tested for the virus.
And many countries have not been carefully tracking deaths outside of hospitals.
“The challenge is we don’t have very good information for people in care homes,” said Adelina Comas-Herrera, a researcher at the London School of Economics.“The challenge is we don’t have very good information for people in care homes,” said Adelina Comas-Herrera, a researcher at the London School of Economics.
Comas-Herrera and colleagues reported last week that covid-19 deaths in nursing facilities in Belgium, Canada, France, Ireland and Norway might account for half of all deaths from the virus in those countries.Comas-Herrera and colleagues reported last week that covid-19 deaths in nursing facilities in Belgium, Canada, France, Ireland and Norway might account for half of all deaths from the virus in those countries.
British Health Secretary Matt Hancock on Wednesday told Parliament that nursing home residents might represent 20 percent of all deaths in that country. Some researchers in Britain have put the number as high as 40 percent for deaths in care homes — a staggering number, considering such facilities house less than 1 percent of the country’s population. She noted that noted that most elderly care homes were never designed to serve as acute care hospitals. Many do not even have a nurse on duty.
Britain’s National Care Forum estimates that more than 4,000 elderly and disabled people have died across all residential and nursing homes. There have been almost 19,000 recorded deaths across Britain to date. British Health Secretary Matt Hancock on Wednesday told Parliament that nursing home residents might represent 20 percent of all deaths in that country. That corresponds to an estimate by the nonprofit National Care Forum, which says elderly and disabled people in residential and nursing homes account for 4,000 of Britain’s nearly 19,000 coronavirus-related deaths. But some researchers in Britain have put the number as high as 40 percent for deaths in care homes — a staggering number, considering such facilities house less than 1 percent of the country’s population.
Few countries are testing residents and staff in nursing homes. British officials have essentially ignored testing in care homes to focus all initial testing on patients in hospitals and hospital staff. In Belgium, where officials have included suspected cases in their overall death count since early this month, more than half of the 6,450 official deaths were in long-term care facilities, not hospitals. And of those nursing home deaths, 95 percent are “suspected” cases, meaning that patients displayed some of the symptoms of covid-19 but were never tested for the disease. 
Comas-Herrera said it was important that infections of residents and staff not be ignored, and that more resources need to be quickly applied to the elderly facilities, many of which do not even have a nurse on duty. Most care homes were never designed to serve as acute care hospitals, she said.
Adding to the challenge, clinicians note that many elderly suffering from covid-19 display symptoms different from those most commonly associated with the disease. They may have no cough, and very low fever, but many express delirium.
Coronavirus is likely to result in a high mortality rate in nursing homes, said England's chief medical officer, Chris Whitty, on Wednesday.
“In care homes, what we have is a large number of people of the most vulnerable age for this virus,” Whitty said. When a more accurate count is available, “I’m sure we will see a high mortality rate in care homes, sadly, because this is a very vulnerable group and people are coming in and out of care homes and that cannot, to some extent, be prevented.”
Kluge and others say now is the time to pour resources into nursing homes — to provide more testing of staff and residents, to supply caregivers with proper protective gowns and visors, to give them quick training to protect themselves and residents. Nurses and doctors should be visiting the facilities, advocates say.
The situation in nursing homes has led to a fierce debate in Europe and elsewhere about how to count overall numbers of coronavirus deaths. Belgium, where officials have included suspected cases in their overall death count since early this month, now ranks worse than hard-hit Spain and Italy when accounting for population, with 55 deaths per 100,000 people, according to statistics from Johns Hopkins University.
Public health officials there have hotly defend their broad-based approach to counting, which they say is the best way to understand and fight the pandemic.
“We have not had enough testing capacity in the past to confirm all of them in the laboratory,” said Steven van Gucht, the head of viral diseases at Belgium’s public health institute, at a news conference this week. “But that does not mean that those cases are less real.”“We have not had enough testing capacity in the past to confirm all of them in the laboratory,” said Steven van Gucht, the head of viral diseases at Belgium’s public health institute, at a news conference this week. “But that does not mean that those cases are less real.”
Kluge and others say now is the time to pour resources into nursing homes — to provide more testing of staff and residents, to supply caregivers with proper protective gowns and visors, to give them quick training to protect themselves and residents.
Despite the vulnerability of most residents of the facilities, Kluge said, good medical care ought to be able to prevent many deaths.
“Even among very old people who are frail and live with multiple chronic conditions, many have a good chance of recovery if they are well-cared for,” he said.
Italian authorities have said some of the worst outbreaks at nursing homes might have been preventable, and they have launched investigations into malpractice at a series of facilities, including one of the largest in the country: the 1,000-bed Pio Albergo Trivulzio in Milan. Italy’s ANSA news service reported that 200 elderly residents had died at that facility.
In Germany, about one third of the country’s 5,000 deaths have been among residents of care centers, according to data from the Robert Koch Institute, the official government public health research agency. Many of those deaths have taken place in recent weeks, as the outbreak has spread to nursing homes and care facilities after initially being concentrated among younger people.In Germany, about one third of the country’s 5,000 deaths have been among residents of care centers, according to data from the Robert Koch Institute, the official government public health research agency. Many of those deaths have taken place in recent weeks, as the outbreak has spread to nursing homes and care facilities after initially being concentrated among younger people.
“We are seeing more and more outbreaks in old age and nursing homes,” institute president Lothar Weiler told reporters last week.
The mortality rate among care home residents who are infected by covid-19 is about 17 percent, according to German government data. People over 70 years old comprise just 19 percent of Germany’s total confirmed cases but 87 percent of deaths.
Germany has imposed restrictions on visits to care homes to prevent outbreaks, but Chancellor Angela Merkel on Thursday said she was particularly “burdened” by what those in nursing and assisted-living facilities “have to endure.”Germany has imposed restrictions on visits to care homes to prevent outbreaks, but Chancellor Angela Merkel on Thursday said she was particularly “burdened” by what those in nursing and assisted-living facilities “have to endure.”
“It’s cruel that, aside from the staff doing their best, no one can be there for those nearing the end of their lives, their strength ebbing,” she said. “We will not forget these people and the isolation they now have to live,” she said.“It’s cruel that, aside from the staff doing their best, no one can be there for those nearing the end of their lives, their strength ebbing,” she said. “We will not forget these people and the isolation they now have to live,” she said.
Booth reported from London. Loveday Morris and William Glucroft in Berlin and Quentin Ariès in Brussels contributed to this report. Booth reported from London. Christine Spolar in London, Loveday Morris and William Glucroft in Berlin, Chico Harlan in Rome and Quentin Ariès in Brussels contributed to this report.
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