COVID-19 has hit nursing homes hard
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EDITORIAL
COVID‑19 has hit nursing homes hard Kaisu H. Pitkälä1
© European Geriatric Medicine Society 2020
Key summary points Aim In many countries nursing home populations have accounted for half of all deaths during the first wave of COVID-19. Findings Infection and risk of death are not the only risks related to COVID-19. The lockdown causes risks of cognitive decline, depression, anxiety, frailty and disabilities. Message The risks of prolonged isolation should be weighted against the COVID-19 risks. In most countries the first wave of COVID-19 mainly killed people in nursing homes. Whereas the nursing home population represents less than 1% of the total population in European countries, nursing home residents accounted for 31–80% of all deaths during the first wave in various countries [1–5]. In fact, the reported COVID-19 deaths may be an underestimate since these deaths have accounted only for two-thirds of excess deaths [6]. Once infected, about 26–50% of symptomatic patients in nursing homes have died [4, 7, 8]. While the nursing homes responded to the first wave crisis ad-hoc, we have learnt many things over the past six months about COVID-19 infectivity, how it spreads and— most important of all—what means we have to prevent it. In this issue, Blain and colleagues [9] present EUGMS guidance to prepare European long-term care facilities for COVID-19. This is timely and important summary of what we know about testing for COVID-19, and how to prevent the entrance and spread of the virus to long-term care facilities. Importantly, it also emphasizes the palliative care of these patients and clarifies how to best prevent other harmful COVID-19 outcomes such as loneliness. The virus entered long-term care facilities insidiously. It came in via visitors, staff, and new residents who were asymptomatic and unaware of their infectivity. In fact, when facility-wide testing has been performed, it has been shown
* Kaisu H. Pitkälä [email protected] 1
Unit of Primary Health Care, Department of General Practice and Primary Health Care, Helsinki University Hospital, University of Helsinki, PO Bo x20, 00014 Helsinki, Finland
that half of the infected residents and staff might be asymptomatic [4, 8]. The outbreak revealed how unprepared and vulnerable nursing homes were for the crisis: the staff had too little education in prevention and control of infections. Furthermore, large numbers of deputies and frequent staff turnover exacerbated the spread of infection, and the shortage of personal protective equipment at the beginning of the pandemic was untenable. Thus, COVID-19 has shown the urgent need for staff training and standards of geriatric care in nursing homes—both in terms of resources as well as expertise [10, 11]. It has been suggested that the highest infectivity and mortality rates in nursing homes have been associated with the location and size of nursing homes, shortage of staff, quality of care, high resident density and low socio-economic level of residents [4, 12–14]. These findings chall
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