The explosion of the sixth wave has shaken Spain and nursing homes are not spared the new threat of the virus, attenuated by the effect of vaccines. Weekly infections in centers for the elderly, whose situation is not at all similar to that experienced in the most critical moments of the pandemic, have skyrocketed and, between December 13 and 19, the last week of which the Institute for the Elderly and Social Services (Imserso) has reported data, 613 infections were reported in 195 residences, 56% more than those registered the previous week. In just one month, infections have almost quadrupled: Between November 15 and 21, only 160 infections were reported in 42 centers. The growth of infections observed in the general population is very similar in the same week of December, when they rose by 60%. But if the data for that month are compared between residences and the rest of Spain, the rise was more pronounced: they were multiplied by eight among the population, twice more than in centers.
The experts consulted point out that, although the virus has re-entered the homes of the elderly, the impact is less than other waves thanks to the protection of the third doses – the elderly in nursing homes were the first to receive them in September – and the severe control measures that still weigh on this sector. However, the directors hold their breath in the face of the explosion of cases in the street: their greatest fear now is the impact of the loss of staff due to covid, which can put the assistance service in check. Last week, more than 1,400 nursing home workers were infected, the highest weekly figure since the third wave.
The virus has started to creep back into nursing homes. Since the start of the pandemic, a third of the 300,000 people living in nursing homes have been infected and the communities have reported more than 30,000 deaths with confirmed covid or symptoms compatible with the disease. Wave after wave, residences have once again suffered the stake of the coronavirus, but this time the virulence is less than on other occasions, assure all the voices consulted. At least for now. Most are mild cases or with few symptoms, explains Susana Ruiz, president of the Lares Federation in La Rioja and director of the largest center for the elderly in Logroño: “Vaccines have done that job that they came to do: that the impact on the older was smaller. We are not experiencing so much incidence or so much lethality. If they are infected, they pass it slightly ”.
The death curve, in fact, increases, but little by little: between December 13 and 19, 29 deaths were reported, while in the previous one they were 24 and the first of December, 17. Imserso sources confirm that there are “ a certain calm ”in the centers because you can see that gravity remains low. Although the global fatality since the start of the pandemic in residences was 19%, the percentage of deaths among those infected in the current period (as of March, when the vaccines began to take effect) fell to 9.3% .
Vaccination is key, experts agree. The elderly in nursing homes were the first to receive the vaccine last January and they have also been pioneers in releasing the third dose in September. Studies by the Ministry of Health found in April that the effectiveness of the vaccine in centers for the elderly was between 81% and 88%, asymptomatic infections were avoided and hospitalization was prevented by up to 71% and deaths by 82%. However, the protective effect of vaccines decays over time and for this reason another additional injection was necessary: a Health report in October reported a possible “loss of immunity over time since vaccination” because, although the effectiveness of those vaccinated in May stood at 96%, in the elderly punctured in March the effectiveness fell to 58%, 64%, 65% and 77%, against infection, symptomatic infection, hospitalization and death, respectively.
Albert Garcia (THE COUNTRY)
The additional doses began to be administered in September and, according to Health, as of this Wednesday, 87.3% of those over 70 in Spain have received the puncture. The effect of the third dose, in fact, is already beginning to be noticed and the latest vaccine effectiveness report from the ministry points out that the protection remains above 86% and “The beneficial effect of the booster dose already seems to be observed from the month of October,” the study collects. Vaccination among nursing home staff has also accelerated and, although Health does not give data on punctures to this specific group, Cinta Pascual, president of the employer Ceaps (Círculo Empresarial de Attention to People), assures that 50% already has received the third dose and even in the communities that were lagging behind with the injections to this group they have already accelerated the punctures.
Behind the doors of the residences, caution has been installed, says Pascual: “At the level of fear, when we have suffered what we have suffered, if they tell us that the wolf is coming [por la sexta ola], we see 100 wolves. But now we feel protected ”. In recent months, control measures in the centers have been relaxed and restrictions on visits and exits have been relaxed, but they remain rigid compared to those on the street and this has helped to contain the circulation of the virus. Each community sets its own protocols, but most agree on the measures: they do periodic screening of their professionals, protection measures are intensified when family members go – always a mask, better outings to the open air, hand hygiene, ventilation in the centers. , the covid passport is requested to the visits and the residences are sectorized when there is a positive. “We have never had a complete return to normality. Visits, for example, have always been by appointment, ”says Ruiz.
You cannot lower your guard, warns Iñaki Antón, spokesperson for the Catalan Association of Directors of Centers and Services for Attention to the Gerontological Unit (Ascad). “The third dose reduces mortality and the severity of the disease, but people who have the three vaccines also die because they are very fragile people,” he says. At the residence he runs in the Barcelona municipality of Polinyà, an old woman died a few days ago infected by a relative and another was also infected: “Given the situation in the environment, the feeling is one of concern. Internal barriers and controls must be established because this variant spreads rapidly. Vaccines mitigate the impact, but not 100% ”.
Fear of sick leave
The fear of the directors of the health centers, however, is not only in the residents, but also in the workers. In sick leave due to the explosion of infections among staff. For three weeks there have been more infections from professionals than from the elderly. “Rare is the residence”, says Antón, who does not have an infected professional: “If the cases among workers increase, we run the risk of neglect. It is a real danger ”.
There is not so much job bank in the market to replace the casualties and the replacement operation is complicated, says Vicente Botella, president of the Catalan employer’s association of small residences (Upimir): “In addition to the work overload, if five workers leave And they all have to come new, they do not know the residents, they do not deal with them and that deteriorates the care ”. Jesús Cubero, president of the Aeste sector employers’ association, assures that they have asked the health authorities that, in anticipation of the spread of infections, “to enable the hiring of people who do not have the qualification as workers”, a measure that has already been took in the first wave before the flood of casualties, also with health professionals in hospitals. Sources from the Imserso point out, however, that it is not a generalized demand and they do not see it as “timely.” At least for now. Although they share the fear of the rise of positives among professionals: “The question is to protect care personnel because the main concern is to maintain continuity of care”
In the face of the Christmas holidays, a time of greater risk due to the confluence of the explosion of infections with greater social and family interaction, most of the autonomies have not tightened the restrictions. In Castilla y León, for example, residents are required to have a diagnostic test before entering the center if they are going to spend Christmas with their family. Madrid also shares this recommendation and asks to limit Christmas activities if it implies that other people outside the center have to go there and intensify the screenings (they were fortnightly and now they recommend a weekly test for vaccinated workers and two or three tests every seven days unvaccinated). Several autonomies ask for the vaccination passport to access the centers, such as Aragón, Navarra, La Rioja and Andalusia.
Bottle notes that “most of the family members are strictly complying with the protection measures”, but admits that, in the current epidemic context, they fear prolonged outings: “What scares us is that now they want to take them to sleep home three days. It is not one meal, it is several foods with different bubbles and that is a risk ”. Pascual agrees that, although he has always been “a lover of each sheep being in his corral at Christmas”, he now asks for caution: “We want to make it as easy as possible for our elders to see each other, to have Christmas visits, but with great caution” . In the centers, in addition, they usually do Christmas activities around these dates and celebrate special meals on holidays for the people who stay.
Families reject more limitations and neither are the authorities going along this line. Imserso sources admit that they are “not very supportive” of increasing restrictions: “You have to do things safely, wisely, calmly, but not affect the fundamental rights of residents.” María José Carcelén, spokesperson for the platform for family members of 5 + 1 residences, points out that there are many things to improve, “such as compliance with sectorization and not allowing volunteers or unvaccinated students to enter.” Another confinement is intolerable, he denounces: “Another confinement can be devastating and we will not allow it. If they confine us, that they confine us all, but we are concerned that they will do it only with them, that they will be discriminated against because of their age and place of residence ”, he protests. A complaint with which Miguel Vázquez, president of the Platform Dignity for People in Residences agrees: “We are afraid that they will isolate them again because that would be plunging them into misery.”
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