As of March 7, 2020, hospital referrals of patients living in nursing homes in the Community of Madrid decreased as deaths increased in nursing homes. The decrease in hospital referrals of residents and the stability of resident deaths in hospitals preceded the publication of triage protocols by two weeks: up to four protocols signed by the Ministry of Health, dated March 18, 20, 24 and 25, which prevented the transfer of patients who suffered a certain degree of dependency or cognitive impairment to hospitals. And, mWhile transfers decreased, deaths in nursing homes in the Community of Madrid increased.
This is the main conclusion of the study. Hospital referrals, exclusions from hospital care, and deaths among long-term care residents in the Community of Madrid during the March–April 2020 COVID-19 epidemic period: a multivariate time series analysispublished in mid-August in the journal BMC Geriatricsan international, open-access, peer-reviewed journal of geriatric research led by Université de Montréal professor emeritus François Béland and co-authored by epidemiologists María Victoria Zunzunegui and Fernando García López.
The person responsible for the research, François Béland, explains that, although the objective of the protocols (cContributing to the sustainability of the Health System by avoiding the serious consequences that a collapse would have), is legitimate in times of epidemic with a careful implementation framework, the problem in the Community of Madrid lies in the way of implementing triage.
On the publication of the protocol two weeks after, as the data show, the transfer of patients was halted, the person responsible for the study, François Béland: “This reversal of events cannot be explained”
“The criteria for restricting access to hospital for residents of nursing homes de facto excluded severe cases of Covid-19,” says Béland. “They were based on general geriatric criteria, when the epidemic was one of Covid-19, not of unhealthy ageing; therefore, no effective alternative care was offered outside and inside the nursing homes.” On the publication of the protocol two weeks after, as the data show, the transfer of patients had been halted, he is blunt: “This reversal of events cannot be explained.”
The study uses data from official sources to analyse the interventions of the Government of the Community of Madrid in relation to hospital transfers and deaths that occurred both in nursing homes and after transfer to hospital during the pre-Covid-19 period of January and February 2020; the ascending and descending phases of the first wave of the Covid-19 pandemic during March and April, and in the subsequent period from May to June 2020.
Between January and June 2020, before the Covid-19 pandemic reached Spain (the Government declared a state of emergency on 14 March), 18,895 sick residents from nursing homes were referred to public hospitals in the Community of Madrid.
When the pandemic began, there was a drastic drop in transfers from nursing homes to hospitals, after the Madrid Regional Health Department implemented centralised management of hospital beds on 7 March. The average dropped from 120 people per day in February of that year to just 67 between March 7 and 29, so the subsequent protocols only served to certify the situation that was already occurring.
Nursing homes in the Community of Madrid were the hardest hit in Spain during the first wave of the pandemic, with a 21.5% mortality rate
Their conclusions reinforce what health groups and relatives of those affected have already been denouncing: that the management of the Community of Madrid resulted in excessive mortality, as reported by the European Parliament resolution of 12 July 2023 on the COVID-19 pandemic, Article 21.
LResearch confirms that nursing homes in the Community of Madrid were the hardest hit in Spain during the first wave of the pandemic, with a 21.5% mortality rate (9,470 deaths during the months of March and April 2020), a figure that includes both residents who died from COVID-19 and those who died from other causes. Of these, 7,291 died without hospital care: that is 77%.
Other conclusions
The study also records how, andIn March and April 2020, the curve of daily deaths in nursing homes in the Community of Madrid followed the curve of deaths in the population of the Community of Madrid one week later, with a slightly slower decline.
Furthermore, during the ascending phase of the pandemic (between 7 and 26 March 2020), in the absence of medicalisation and with few transfers to hospitals, deaths in nursing homes increased as the virus entered nursing homes through workers and infections increased within nursing homes in a chaotic organisation of care due to a lack of professional and material resources and in the absence of diagnostic tests and effective control measures.
The daily number of residents dying in hospitals remained constant and low while most were trapped in nursing homes.
As the incidence of cases in the population of the Community of Madrid began to decline, restrictions on the transfer of residents to hospital were gradually relaxed. As a result, there was an increase in the daily number of residents dying in hospitals.
