Several nursing homes in France have been hit hard by the Covid-19 epidemic. - FRED SCHEIBER / SIPA
- The Director General of Health, Jérôme Salomon, has announced the implementation of a Covid-19 mortality count in the Ehpad.
- At least 109 residents died there after contracting the coronavirus, but these deaths are not included in the official report.
- In these establishments, an explosion in mortality is feared.
A unique, official statement, updated every day. The latest report from the Ministry of Health reports 1,100 deaths from the coronavirus. But while, according to scattered figures, many deaths are to be regretted within the Ehpad, is the official count of the mortality of the Covid-19 complete? No: official figures only include deaths recorded in hospital as part of the coronavirus epidemic. Figures that "represent only a small part of mortality" in France, recognized Tuesday evening Professor Jérôme Salomon, Director General of Health, indicating that "the two main places of death are the hospital and nursing homes" .
For their part, directors, doctors and staff of Ehpad fear a massacre in these establishments, where residents are particularly vulnerable to the Covid-19. More than ever, the time has come to respect barrier gestures: for more than two weeks, visits have been prohibited in nursing homes to prevent the virus from entering them. But without success in certain establishments, where the presence of the coronavirus sometimes led to dozens of deaths.
At least 109 deaths from coronavirus in nursing homes
In Saint-Dizier (Haute-Marne), sixteen residents of a structure have died, and forty are under close surveillance. In an Ehpad in Cornimont (Vosges), twenty deaths are "possibly linked to the Covid-19". At the Sillingy nursing home in Haute-Savoie, seven residents died from the Covid-19, and three are in serious condition.
The macabre count does not stop there. In Thise (Doubs), fifteen people died. All had symptoms of coronavirus, but not all were screened, which is no longer systematic. Same problem at the Ehpad Cornimont: "only hospitalized residents have been tested," explains director Sophie Nivel. Thus, only six of the 20 deaths can be formally attributed to Covid-19, but there is little doubt as to the cause of the other 14 deaths.
To date, 148 Ehpad in Ile-de-France have at least two cases of Covid-19 detected, announced this Wednesday the Regional Health Agency (ARS), threshold from which measures of reorganization of the establishment must intervene to prevent spread. In a retirement home of the Rothschild foundation, in Paris, a dozen people died and nearly 80 were positive for Covid-19, according to a provisional assessment of the ARS which could quickly increase. "We do not know today how to measure the extent of the damage in retirement homes," summarized Wednesday the president of the French Hospital Federation, Frédéric Valletoux.
In total, at least 109 deaths attributable to the coronavirus are to be deplored in the Ehpad. "Unfortunately, we can expect an increased mortality of the elderly, as is the case with each health crisis - flu or heat wave -" deplores Romain Gizolme, director of the Association of Directors for the Service of the Elderly ( AD-PA).
Untested cases, therefore not counted
But the actual figure could be much higher. "Within the nursing homes, we only test the first two cases" presenting the symptoms of the coronavirus, explains Candice Morel, general practitioner in Ousse (Pyrénées-Atlantiques), who also regrets that the staff does not always have sufficient equipment, especially overcoats.
Why two tests? The Ministry of Health recommends it in a document of March 16: “only the first patients residing in a collective accommodation structure (…) are subject to a levy. From the second confirmed case, anyone with a symptomatic or close condition is then presumed to be infected ”. A statement still relevant according to the ministry, contacted Wednesday. "The other cases are" treated as Covid-19 cases "on the basis of the clinical picture [observed characteristics and symptoms of the disease], but are not counted because they have not been tested," explains the ARS Ile-de- France.
On Tuesday evening, Jérôme Salomon promised “daily mortality monitoring” in these establishments. "An application" must be operational "in the coming days" and must produce a more reliable estimate of the number of victims in Ehpad, on the statement of the doctors of the establishments, said Wednesday the Directorate General of Health (DGS).
Last gray area: "when an elderly person who has not been hospitalized dies at home, we cannot be sure," warns Dr. Morel. This is why the DGS launches the track of "surveillance of all-cause mortality" on the territory by Public Health France. It would make it possible, by comparing the number of deaths expected over a period to that observed during the epidemic, to "estimate the excess mortality" due to Covid-19.
"The Covid-19 highlights the lack of resources in our sector"
As for the Ehpad, "everyone is in battle order to fight against the coronavirus and protect the residents: this is our primary objective," said Romain Gizolme, from AD-PA, at 20 Minutes . However, the support sector for the elderly has long been under-endowed. The Covid-19 highlights the lack of resources in our sector, due to successive public policies that have not planned to invest in the care of the elderly. ”
The lack of resources translates very concretely into the lack of masks, which are nevertheless essential for respecting barrier measures. "Preserving the integrity of the staff, but also of the residents and the elderly accompanied at home on a daily basis, is the priority," insists Romain Gizolme. But if we don't have enough masks, everything collapses: they are essential to prevent staff who may be healthy carriers from continuing to work without risking transmitting the coronavirus to the elderly ”. And if the Ehpad are almost equipped, the home support sector for dependent elderly people is already hit hard by the shortage. "Auxiliaries of life, nursing assistants: all these city staff today find it very difficult to obtain protective equipment," deplores Romain Gizolme. For home care, it's a disaster. It is really necessary that the deliveries of masks promised by the Minister of Health be ensured, and in the next hours ”.
Because in practice, the lack of masks can kill. "For Ehpad who have not yet implemented barrier measures, there are considerable risks of spread", warned the president of the Association of coordinating physicians in Ehpad, Gaël Durel, referring to "mortality rates »Potentially« catastrophic ».
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- Covid 19