The Community of Madrid began to limit the referral of elderly people with COVID from residences to hospitals a week before the state of alarm and the publication of the protocol of the Ministry of Health. And the medicalization promised to the centers never arrived. These are two of the conclusions reached by a study published by the scientific journal BMC Geriatrics, revealed this week by InfoLibre, on the so-called “protocols of shame”, developed to restrict the referral of resident patients to hospitals and which led to the death of 7,291 people in the same nursing homes.
“The number of COVID cases in nursing homes increased a week after the increase in deaths in the population aged 65 and over. “So there were several days during which public health personnel could have intervened, done something to limit the impact of the coronavirus entering the centers,” said by telephone the study’s principal investigator and professor emeritus at the School of Public Health. University of Michigan, François Béland.
He became interested in the case of Madrid four years ago, when the first of four versions of the instructions preventing the referral of infected elderly people was released. “I was attracted by the situation of residences in the pandemic. In Canada, it was in Quebec that the outlook was the worst, but the mortality rate in Madrid was exceptional. “It is unacceptable from a medical and ethical point of view.” The sources consulted were the Transparency Office and the INE to examine the death certificates and conclude, among other things, that the daily average of deaths in care centers reached a number 15 times higher than the pre-COVID average in March 2020. , while the daily average of deaths of hospitalized residents was only 1.58 times higher.
The study, co-authored by Spanish doctors María Zunzunegui, Fernando García and Francisco Pozo-Rodríguez, indicates that 19% of the elderly living in convalescent centers in the Community of Madrid have died. Added to this data is the fact that Spain had the highest level of mortality due to COVID-19 among people over 65 years of age among the 12 countries of the Organization for Economic Cooperation and Development (OECD), and that Madrid was the community with the highest mortality. in the first wave.
An avoidable disaster
Unlike President Isabel Díaz Ayuso, who assured the Madrid Assembly in February of this year that “when an elderly person was seriously ill, with COVID, they could not be saved anywhere,” Béland believes that the number of deaths could have been avoided. “A state of confusion and disorganization reigned in the residences more than elsewhere. There was no protective equipment or beds and staff was scarce.” As an example of management, he mentions that in the Canadian province of British Columbia, staff were paid financially to go to a single residence center and not to several, as is usually the case for social workers and geriatricians. He also mentions that the beds should have been separated by sectors of elderly people with and without COVID. “It’s common sense.”
The protocol was promulgated on March 18, 2020. Three other versions were approved on March 20, 24 and 25. However, the investigation highlights that only what happened from the sixth day onwards was noted. If the daily average of referrals, the study details, was 120 in February, between March 7 and 29, this figure fell to 67. The highest peak of deaths in the nursing sector. The homes arrived on April 2, when around 330 deaths were recorded. One of the most controversial points of the document was to exclude patients with fragility level seven or higher, that is, who were dependent for their personal care and needed a wheelchair, for example. People with significant cognitive impairment were also excluded from hospital transfers, but the study said those who were hospitalized had “significantly less” disability or cognitive impairment than those who were not hospitalized.
“In Quebec, the restriction criteria were linked to the progression of COVID in older people, not to whether they had chronic diseases or cognitive impairments. They were calculated based on the severity of the coronavirus; the higher it was, the greater the risk of hospitalization. From a medical point of view, the use of the Madrid Protocol criteria is not explained. “What happened has nothing to do with the virus, but with political decisions,” Béland explains in perfect Spanish. The implementation of guidelines that conditioned the transfer of residents from retirement homes to hospitals has also occurred in other European countries, such as Italy, the United Kingdom or Belgium, but Amnesty International criticized Spain for the fact that it was an explicit policy, published in writing.
“It is a legitimate system in a disaster situation with the aim of prioritizing hospital capacity. In Italy, in Lombardy for example, it was a shame. But there are ways to do it. Regarding the cover-up of Ayuso’s policies and his refusal to apologize to relatives – in fact, he demanded payment for the month in which all the elderly died – Béland prefers not to give an opinion, but says that the least they deserve are explanations.
