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Coronavirus: How to protect the most vulnerable in society

The high number of deaths in retirement and nursing homes have aroused concern in Belgium and other countries. About half of all fatalities have taken place there.

According to the latest figures published by Sciensano, the federal health authority, the number of deaths in Belgium reached 4,157 yesterday (14 April). Thereof, 46 % passed away at retirement places. In fact, in recent days the number had increased to 65 %, possibly because of delays in the reporting.

These figures places Belgium among the hardest hit countries in Europe or even the world, both in terms of case fatality rate (number of deaths divided by the number of confirmed infected cases) and the fatality rate per 100,000 inhabitants.

Figures from Johns Hopkins Corona Resource Center show that the case mortality rate in Belgium is about 13 %, which is the same as in Italy and slightly higher than in France, the Netherlands and Spain. While the actual case mortality rate is still uncertain because of the limited number of tests, the other figure is more suitable for comparisons during the crisis.

The highest figure, 38 deaths per 100,000 inhabitants, was reported from Spain, followed by Belgium (34), Italy (34), France (22), United Kingdom (17), The Netherlands (16), Sweden (9) and Germany (4), to mention the hardest hit countries in Europe.

While the number of new infections is fluctuating and the number of hospitalisations has stabilised, the number of deaths in Belgium is worrying. “The number of deaths is still very high, and is expected to rise in the days to come,” virologist Steven Van Gucht said on Tuesday.

Because of lack of test kits, the Belgian guidelines limited the tests to people whose health condition required hospitalisation according to a physician and COVID-19 was suspected and to health care staff who met a case definition (acute infection in the respiratory tracts) and had been in contact with people at risk.

Admittedly, until now, far from enough tests were made in retirement homes, prisons and other institutions. In those places, only the first cases up to maximum of five people that met the case definition were tested, leaving the rest who might have been infected in danger.

Belatedly and after growing concern in society, the authorities have decided to roll out a program of testing all residents and staff in the retirement homes.

Responses from authorities

Most of the elderly passed away in retirement homes and were not hospitalised or offered intensive care at the hospitals although there were, and still are, enough ICU beds. The Brussels Times asked the regional health authorises for a comment. At the time of publishing the article, responses had been received from the Flemish and Brussels regions.

“The fact that of lot of the elderly pass away in their retirement home is no due to a lack of ICU or other hospital resources or any guideline that prioritizes the treatment of other patients,” replied Joris Moonens, spokesperson of the Flemish Agency for Care and Health.

“In Flanders and Belgium as a whole, there is still a lot of ICU capacity available, a bit more than half of the total capacity is occupied. The elderly who can benefit from a hospital treatment in a hospital are transferred.”

“Most of the elderly in our nursing homes however have reached a very old age and suffer from multiple afflictions. In lot of cases when they are severely infected buy COVID-19, the chances of recovery are slim and hospital treatment is no longer beneficial for them,” he says. “It’s not about withholding capacity or reaching a capacity limit.”

A similar response was received from the health authority in the Brussels region. “It’s a misconception that elderly people have been denied hospitalization,” a spokesperson said. “More tests of residents and staff will start already this week.” He added that the number of COVID-19 related cases in retirement homes might be inaccurate and that the true figures will be known after the tests.

Excess mortality rate

In fact, the European Centre for Disease Prevention and Control (ECDC) reported last week that the European all-cause mortality monitoring system showed all-cause excess mortality above the expected rate in Belgium, France, Italy, Malta, Spain, Switzerland and the United Kingdom, mainly in the age group of 65 years and above.

ECDC explains that all-cause mortality refers to all the deaths that occur in a population due to any cause. That could include all the deaths due to heart attacks, stroke, cancer, influenza, etc. in that population.

In Sweden, 22 researchers and experts published an op-ed yesterday (Dagens Nyheter, 14 April) where they criticized the national health authority and the politicians for not having adopted a strategy to prevent the spread of the virus at the retiring homes. According to the experts, infection by asymptomatic cases contributed to the mortality among elderly people.

In Greece, professor Sotiros Tsidoras is head of the Greek government’s medical response and gives a daily update of the situation in the country. “An acquaintance wrote to me that we’re making too much of a fuss of a bunch of citizens who are elderly and incapacitated by cronic illness,” he said (The New York Times, 8 April).

“The miracle of medical science in 2020 is the extension of a high-quality life for these people who are our mothers and our fathers, and grandmothers and grandfathers. We cannot exist or have an identity without them.”

The Brussels Times asked the European Commission at yesterday’s on-line press briefing about the high fatality rates in retirement homes in EU member states and if the Commission is following the situation. The chief spokesperson replied, not surprisingly, that the Commission is following it globally but it is the responsibility of the member states to act and protect all citizens.

M. Apelblat
The Brussels Times

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