"We warned that the residences were going to be a perfect breeding ground for the virus"

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SARS-CoV-2 has been primed with the elderly. With the generation that survived the war, suffered the postwar period, managed to get ahead in a dictatorship and, in many cases, continued to support his family in the worst years of the last crisis.

The figures speak for themselves: "87% of the reported deceased are over 70 years old," explains José Augusto García Navarro, president of the Spanish Society of Geriatrics and Gerontology (SEGG), who is following with concern these days the evolution of the epidemic.

The elderly are especially vulnerable to Covid-19 infection - and also to developing serious complications - due to the loss of immune response that is associated with age and, to a large extent, also due to the frequent existence of previous health problems, like cardiovascular, explains the specialist.

In Spain, the virus has found a population in which, in less than 30 years, the number of people over 65 has doubled and, according to INE data, it already has 19% of its total population, which means about 9 million, in the elderly (25% of them are octogenarians).

But, in addition, he has found a perfect breeding ground to wreak havoc: nursing homes. "They are being a great focus of contagion," says García Navarro, who stresses that the society he chairs has already warned of the importance of preventing and stopping infections in these centers long before the health crisis broke out in Spain.

"From the first moment we were in contact with our Italian colleagues, who told us that there were many outbreaks in residences and that the infection was spreading not only among those admitted, but also among workers, which contributed to amplifying the outbreak," he points out. the doctor. "Residences were not an important focus in China, because it is more common for the elderly to remain in their homes, but it is being in Spain and other European countries," he adds.

In residences there is "a perfect storm for the virus" because the people who live in them are very dependent, they need a lot of physical contact, explains García Navarro. In addition, "they are centers not designed to be hospitals, but for there to be coexistence. It is difficult to achieve isolation in many of them," he exemplifies.

If you add to that the lack of personnel and health resources, there is an ideal space for the virus to spread, he adds.

"We notified the authorities that the residences were going to be an important breeding ground, but they did not pay much attention to us until a few days ago," regrets García Navarro, who claims that, given the general shortage of protection and sanitary resources, " ICUs and residences must be placed on the same level of importance " because they are" the two extremes where the virus most attacks ".

In Madrid alone, 3,400 elderly people have died since the start of the coronavirus crisis, while in March last year this number barely reached a thousand, reports Europa Press.

"It is difficult to know the real number of deaths due to the coronavirus, since there is a great underdiagnosis," says García Navarro. And the lack of screening tests is one of the causes of this problem, he adds.

The specialist stresses that those responsible for the residences are being blamed for the situation, when the problem does not lie there. "We cannot continue separating social services and health services in these people with so much dependency burden," he explains.

Along the same lines, Josep María Via, advisor to the Age and Life Foundation, speaks. According to his point of view, to face "this critical situation" it is necessary to urgently reinforce the presence of health professionals in nursing homes .

"We propose that Primary Care physicians be the ones who provide support and care for people living in the centers for the elderly," says Via, a doctor by training and with extensive experience in health management.

In addition, he adds, "it is essential that these professionals have basic therapeutic kits with oxygen and palliative care," as well as personal protective equipment to guarantee adequate care.

"This is key to containing the pandemic in residences and protecting older people living in them," he stresses.

Measurements

These days, "we have believed that residences are hospitals, if not even health centers," continues Via. For this reason, in his opinion, when the emergency situation passes, a debate will have to be opened on the integration of social and health services in the care of the elderly.

"Personally, I believe that residences should be transferred to the National Health System, with the close collaboration of social services," he says.

Having a healthier approach, he suggests, would improve the care of these people and prevent situations like this from happening again.

"Right now, even if the diagnostic tests come to the residences. Who is going to decide what is done with each positive patient if there is no doctor who determines it?"

García Navarro, for his part, points out the need for "all hospital services in Spain to have Geriatric specialists ".

It is these professionals, he points out, who can best assess what benefit or harm certain interventions, such as mechanical ventilation, bring to the aging patient.

"The age criterion is not used, but other considerations, such as life expectancy, the quality of life left to the patient or what are his chances of recovery, among others," he points out.

In this sense, both specialists agree that even before the arrival of the coronavirus, the indication for mechanical ventilation in patients with a high degree of fragility and disease was scarce.

"Recovery after mechanical ventilation is complex. I think doctors are acting on clinical criteria. The opposite in many cases can lead to therapeutic frenzy," concludes Via.

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