Long-term facilities half of toll in Europe

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. According to countries’ estimates, he said, “up to half of those who have died of COVID-19 were residents in long-term care facilities. This is an unimaginable human tragedy.”

Kluge’s warning focused on Europe, but the United States also has struggled with the pandemic inside homes for the elderly. A Washington Post analysis found that nearly 1-in- 10 nursing homes in America have reported cases of the coronavirus, with a death count that has reached the thousands.

Kluge said that he was trying to draw attention to the “overlooked and undervalued corners of our society.”

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.

“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.

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.

Britain’s National Care Forum estimates that more than 4,000 elderly and disabled people have died across all residential and nursing homes. Almost 19,000 deaths have been recorded across Britain to date.

Few countries are testing residents and staff in nursing homes. British officials essentially have ignored testing in care homes to focus all initial testing on patients in hospitals and hospital staff.

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.

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 training to protect themselves and residents and to have nurses and doctors visiting the facilities.

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.

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 make up 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 said Thursday she was particularly “burdened” by what those in nursing and assistedliving 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.”