Reading the report published in the international journal Epidemiology is overwhelming: the order issued by the Community of Madrid not to hospitalize the most vulnerable elderly (those who were highly dependent or had cognitive problems) infected by covid explains the high mortality that it was registered between the months of March and April 2020 (first wave). In fact, according to this work, the mortality of patients with covid who remained in Madrid residences fluctuated between 40.8 and 46.7% compared to those of other communities, which were between 7.7 and 25. .9% In these other regions, however, the highest figures were recorded in hospitals, which is logical since it is in health centers where the most seriously ill are admitted.
The figures are devastating: in those months there were 9,468 deaths among residents, 7,290 of these deaths occurred in the residence itself and only 2,178 in the corresponding referral hospital. The Community of Madrid has always evaded any responsibility, to the desperation of some families who have taken the matter to court, with little success.
But science goes another way. This work, signed by the epidemiologist María Victoria Zunzunegui, a retired professor from the University of Montreal, François Béland, also a professor in Montreal, and Fernando García López, an epidemiologist at the National Center for Epidemiology, makes it clear that “the directive of the Government of Madrid it could have been detrimental to many older people in nursing homes because they were excluded from adequate hospital care based on their disability.” And that, they indicate, despite the fact that there were alternatives, since beds were available in private hospitals and in the field hospital in Ifema.
The report focuses on studying how the order of the Community of Madrid of March 18, 2020 affected nursing homes. And for this they review, compare and cross-reference 13 studies carried out in 12 autonomous communities (2 in Madrid and the rest in Andalusia, Aragon, the Basque Country, Castilla-La Mancha, Catalonia, Galicia, Navarra and the Valencian Community).
The results leave no room for doubt: the chances of Madrid residents dying in centers was much higher than in hospitals, because the most vulnerable were left in nursing homes that did not have the staff to assist them or the means to alleviate their situation. . The fact that the elderly who had “a worse functional state” remained in nursing homes compared to those who were transferred to a hospital “could explain” their higher mortality compared to residents of other communities who stayed in the residences of other communities, the researchers say.
The most vulnerable were left in residences that they had promised to medicalize but never did. On the contrary, “lack of staff and fear of infection could have further aggravated the prognosis of these residents due to poor care, including lack of hydration and nutrition,” this work indicates.
The order of March 18, 2020, issued by the director general of Social and Health Coordination of Madrid, requested hospitals to follow a protocol that included exclusion criteria that prevented hospital referrals for “certain people” who lived in residences. Days later, new protocols were issued that were applied “for several weeks until they were no longer used” for no one knows the reason, the article maintains.
For the authors, the screening protocols should aim to save the maximum number of lives, be prepared by committees that include ethical experts, and be used only if there are no alternatives, but “categorical exclusions such as place of residence, disability, etc., should not be used.” or age”.
