The dimension of residences was one of the factors which influenced the death rate during the first wave of the coronavirus pandemic in Catalonia. This is one of the main conclusions drawn A study about these centers in Catalonia published in the September issue of the magazine Epidemiology. “Mortality varies from a minimum of 3.5% in residences with 30 beds, up to a maximum of 12% in centers with more than 150 beds. It is scandalous”, underlines María Victoria Zunzunegui, lead author of this relationship and professor at the University of Montreal, in conversation with infoLibre. Specific, the risk of dying from covid was triple in residences with between 150 and 200 beds compared to those with between 30 and 70. If we analyze only the centers where the virus has entered, the risk is double in the residences with 150 to 200 beds compared to those with 30 to 70.
This study was published in the September issue of the scientific journal Epidemiology, an international publication which, on a quarterly basis, publishes various popular articles on all sectors of epidemiological research. Its goal, as the publication itself explains on its website, is “to provide a platform for scientists and academics from around the world to promote, share and discuss various topics in the field of epidemiology.”
This is what Zunzunegui did together with Francois Belandalso professor at the University of Montreal; Fernando Garcia Lopezmedical epidemiologist at the National Epidemiology Center of the Carlos III Health Institute, e Manuel Ricojournalist of infoLibre which provided the data of the deceased in the various residences obtained through the Transparency Portal and information on the ownership and management of the centers. The investigation that now comes to light is the second part of what was published last June on what happened in the residences of Madrid and in which it was shown that the public-private model of these centers in the region has been “lethal” in the pandemic.
However, the Madrid case cannot be extrapolated to Catalonia. Although it is true that the residences in this region were, followed by those of the Community of Madrid, the most affected during the first wave of the pandemic. But here the similarities end. On the one hand, Madrid’s public sector “is small, but it still exists,” says the author of both studies. In particular, there is only 25 public centers out of 475. On the other hand, in Catalonia practically “everything is private or concerted”: only 20 are managed by the Generalitat of the 965 in total.
In the Community of Madrid, on the other hand, the size of the residences is much greater. “There are centers with up to 604 beds,” Zunzunegui recalls. On average, the public ones have 250 seats and the private ones 69. However, in Catalonia there are only nine macro-residences with more than 200 beds. However, according to the data extracted from the report, mortality in this autonomy depends on the size: while in the centers with 30-70 beds it was 4%, in those over 150 years old was 12%.
Why do mortality and incidence increase according to the size of the residences? “We are sure that the vector of entry was the workers,” says Zunzunegui, since during the months of March and April the visits and exits of residents were prohibited. Y the bigger the center, the more employees there are: “The number of workers in a center is generally between half and one third of the number of residents”. Therefore, more beds, more workers and “the number of people entering and leaving the residence every day is very high”.
And once the virus gains access, another element comes into play: “working conditions”. “We know that the workers are in very precarious conditions and that they did not have infection prevention programs and, at that time, they did not have the equipment or diagnostic tests”, says the main author of the report, who also points out that “with references we have “, the workload” influences the transmission and quality of care “.
This is not the first time that similar conclusions have been drawn about the importance of the size of these centers. In Spain, three official surveys were carried out on the effects of the pandemic in nursing homes: one of the Junta de Castilla y León published in September 2020, another from the Navarre government also released at the end of that year e one third of Ararteko – the Basque Ombudsman – made public in November 2021. The three sought to identify which factors could have influenced the health crisis to have the greatest impact and the three the same conclusion was reached: the larger the center, the greater the impact. Studies in the United States, Scotland and Wales have come to the same conclusion. However, the scientific evidence has not been an obstacle for managers of Spanish employers’ associations to argue otherwise.
3,887 deaths in Catalan residences
Furthermore, there is another element to be taken into account in the comparison between the two communities. “The data are different in Catalonia because we have covid mortalityinstead, in Madrid we do not have this figure because a part is missing, that of the people who have been transferred to hospitals “, says Zunzunegui, who thus puts on the table the exclusion protocol drawn up by the government of Isabel Díaz Ayuso and for which for several weeks The referral to hospital of elderly people with mobility problems or severe cognitive deficits was prohibited, as revealed infoLibre.
In Catalonia, on the other hand, and with more complete data, in the months of March and April 2020, 3,887 deaths from covid-19 were recorded. According to the centers, 52% recorded a death from covid, meaning the mortality was 6%. This percentage rises to 9% if we consider only the residences that have had a case of coronavirus infection, which were 65%.
The role of the cumulative incidence
In addition to the size, there is another element to take into consideration: the incidence of the region or health area. 80% of Catalan residences are located in areas that have had an incidence of over 500 cases per 100,000 inhabitants. And, as this study explains, the association between mortality and center size was stronger in areas with higher incidence. “The workers usually live in the area around the residence,” says Zunzunegui, making it easier for the virus to enter the center.
On the other hand, when the residence is located in an area with a low cumulative incidence, less than 250 cases per 100,000 inhabitants, “The residence can respond better, because there is not so much virus in circulation”.
Furthermore, there is another element to be taken into consideration regarding the influence of the accumulated incidence. Once the virus is inside the residence, users also infect workers. “And there have been many job losses and few workerstherefore the quality of care was even lower, “says Zunzunegui.
The case of residences with less than 30 beds
This research also highlights the differentiated behavior of residences with less than 30 places. In these centers, mortality reached 10%. A percentage much higher than 4% which was recorded between 30 and 70 years.
“In very small residences one more or less death drastically changes the mortality statistic“, says Zunzunegui, who cites as an example how in a center with 20 people a mortality of 10% means the death of two people. In addition, he also explains that” it could happen “that they have more difficulties as they may have problems accessing medical services. because they usually do not have qualified health personnel to establish treatment or go to the hospital.
The solutions
With all this data on the table, Zunzunegui points out that the recommendations are clear. On the one hand, “like minimal mortality observed in centers with 30-70 beds“, the residence model should focus on a medium size to” adequately address a pandemic such as the coronavirus “.
On the other hand, and seeing the results of the Community of Madrid, “Residences should be public and publicly managed”. “What we cannot recommend are agreed positions or indirect management”, insists Zunzunegui, since “when the public sector organizes or transfers management to private individuals, mortality is higher”.
Official data from 14 communities show that the housing catastrophe was concentrated in large private groups
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