The reading of the report published in the international magazine Epidemiología is striking: the order issued by the Community of Madrid not to hospitalize the most vulnerable elderly (those who had a high dependency or presented cognitive problems) entrusted with the covid explains the high mortality that was recorded between the months of March and April 2020 (first wave). In fact, according to this study, the mortality of covid patients who were in Madrid residences fluctuated between 40.8 and 46.7%, compared to that of other communities, which was between 7.7% and 25.9%. In these other regions, however, the highest numbers were recorded in hospitals, a logical difference, since it is in health centers where the most serious are admitted.
The figures are devastating: in those months there were 9,468 deaths among the residents, 7,290 of which were in the residence itself and only 2,178 in the corresponding referral hospital. The Community of Madrid has always evaded any responsibility, in the face of the desperation of some families who have taken the matter to court, with little success.
But science goes another way. This report, signed by epidemiologist María Victoria Zunzunegui, retired professor at the University of Montreal, François Béland, also a professor in Montreal, and Fernando García López, medical epidemiologist at the National Center of Epidemiology, makes it clear that ” the directive of the Government of Madrid could have been harmful to many elderly people in residences due to the fact that they were excluded from adequate hospital care based on their disability”. And this, 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 that’s why they review, compare and cross-reference 13 studies carried out in 12 autonomous communities (two in Madrid and the rest in Andalusia, Aragon, the Basque Country, Castilla-La Mancha, Catalonia, Galicia, Navarre and the Valencian Community).
The results leave no doubt: Madrid residents were much more likely to die in the centers than in the hospitals, because the most vulnerable were left in geriatric facilities that did not have staff to assist them or the means to alleviate their situation. The fact that it was the elderly in geriatrics who presented “a worse functional status” than those who were transferred to a hospital “could explain” their higher mortality compared to residents of other communities who remained in the residences, the researchers point out.
The most vulnerable were left in residences that had promised to provide medical treatment but never did. On the contrary, “a lack of staff and the fear of infection could have further aggravated the prognosis of the residents due to poor care, including lack of hydration and nutrition”, this work points out.
The order of March 18, 2020, issued by the general director 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 A few days later, new protocols were issued that were applied “for several weeks until they stopped being used without anyone knowing the reason”, the article states.
According to the authors, screening protocols should aim to save the maximum number of lives, should be developed by committees that include ethical experts, and should be used only if there are no alternatives, but “have not to make categorical exclusions such as place of residence, disability or age”.
