In Europe’s Nursing Homes, a Soaring Covid-19 Death Toll and the Pain of Isolation

PARIS—The coronavirus has resurged in Europe’s nursing homes, killing thousands of older people and forcing facilities to make a difficult choice: impose another period of crushing isolation or risk greater exposure to the virus.

Nursing home outbreaks have dashed hopes that their residents could be shielded from the virus when it is spreading quickly in society at large. As cases soared across Europe this fall, nursing home personnel and visitors brought the virus in with them despite strict sanitary rules, infecting tens of thousands of residents, who are most vulnerable to the pathogen because of their age and frailty.

Countries such as France, Belgium and the Netherlands that closely track nursing home deaths have recorded more than 9,000 since the beginning of October. Other nations such as Italy and Spain that don’t yet have data on nursing home deaths have reported outbreaks in hundreds of facilities in recent weeks.

In France, one of the hardest hit countries during Europe’s second wave, 71,000 residents of nursing homes and other care facilities have tested positive for the virus since the beginning of October. More than 5000 residents have died in the facilities during the second wave, and another 1,500 died after being transferred to hospitals. Around 22,000 residents have died since the start of the pandemic, rivaling the per capita nursing-home death toll in the U.S., where more than 100,000 nursing home residents have died, according to a Wall Street Journal tally.

France locked down nursing homes during the first pandemic wave in the spring, when more than 14,000 residents died. This time, the government has allowed visits to continue to avoid the physical and mental decline that can set in after an extended period of isolation. Depression and cognitive problems among residents surged during the first lockdown, while their physical condition deteriorated from being largely confined to their rooms, health authorities said.

However, many nursing homes decided individually to bar visitors and confine residents during the second wave, after being hit with outbreaks.

After France lifted its first lockdown in May, Claude Debeda, 80, received regular visits from two of his daughters, who live near his nursing home in Dieulefit, a town in southeastern France in the foothills of the Alps. Then dozens of residents tested positive for the virus in the fall, prompting the facility to lock down three weeks ago.

“It’s like a prison,” Mr. Debeda said. “We have no conversation with other residents. We’re completely isolated in our rooms.”

Mr. Debeda’s daughters are lobbying him to move out of the facility, but he doesn’t want to deal with the disruption.

“I want the rules to be relaxed and that at least we can go into the halls and walk,” he said. “Imagine, it’s been three weeks, and I practically haven’t walked.”

Some French nursing homes that have taken a less strict approach have seen the virus decimate their residents. At Les Vergers, a nursing home in Noyarey, a town in the Alps, the coronavirus has killed 24 residents since the beginning of October, a third of the facility’s total, said director Dominique Gerbi.

She decided to keep visits in place despite the infections. Masks are required at all times in the facility for staff and visitors. But many residents are suffering from cognitive problems and are incapable of wearing a mask properly during visits, she said. Residents and their visitors aren’t supposed to touch each other, but that restriction, too, is difficult to enforce.

“Many residents don’t understand these rules, so they spontaneously go to touch their families, who have difficulty refusing this contact,” Ms. Gerbi said.

She doesn’t regret continuing to allow visits during the second wave.

“The first confinement was brutal and detrimental for the residents,” she said. “It worsened cognitive problems and made them physically more dependent.”

The virus has entered nursing homes despite staff being much better equipped with masks and other protective equipment than in March, when gear was in short supply and some authorities advised against wearing masks. Widespread testing for the virus—which was unavailable during the first wave—has also failed to stop contagion.

“We’re not lacking sanitary gel, we’re not lacking masks, blouses or gloves,” said Philippe Marissal, a doctor who practices in two nursing homes in southeast France that have been hit with outbreaks. “Despite all this, the virus has entered again…we’re missing something.”

A new round of outbreaks in nursing homes in Spain has put the system there under severe stress. After mass deaths in nursing homes during the spring, Spanish facilities are buckling under staffing shortages and additional sanitary rules to prevent outbreaks.

“People are not aware of the speed we need to work at,” said Juani Peñafiel, head of Madrid nursing-home workers at the CCOO labor union. “We just don’t have time to take care of the residents properly.”

In Italy, which suffered a wave of nursing home deaths linked to coronavirus in the spring, deaths are surging again in the facilities. Excess mortality has been the highest in Europe in recent weeks, according to Euromomo, which monitors mortality rates across the region.

The Italian government doesn’t yet have data on how many of those deaths are among nursing home residents, but some regions are reporting infections in hundreds of the facilities. In the northeastern Veneto region, more than 200 nursing homes had outbreaks, compared with just 60 facilities during the first wave of the pandemic, said Roberto Volpe, president of an association of nursing homes in Veneto that groups around 340 care centers.

During the first lockdown, infections were limited among personnel because Italy’s lockdown was so strict, Mr. Volpe said. Now, more nursing home personnel are infecting the residents.

“Every employee goes back home, lives with people who go out too, may have kids who go to school and so can be infected outside of the nursing home,” he said. “Then they carry the virus inside the nursing home.”

Bans on visits since October have prompted an outcry from residents and their families. Even before then, in some cases, visits were allowed during the summer only in nursing homes that had gardens, as relatives weren’t allowed to enter the buildings.

“They are depressed, cry and feel abandoned,” said Barbara Mezzio, from Verona. She said that until recently she was allowed to see her father from outside the nursing home where he is staying, through the thick glass of the entrance door. But after a cleaning person and another employee tested positive, she isn’t allowed to see her father even this way.

“The guests are desperate. Many just don’t understand why their children cannot visit them,” said Laura Aspromonte, who chairs an association grouping the relatives of 75 nursing homes in Lombardy. “This isolation kills more than Covid.”

Write to Matthew Dalton at [email protected] and Giovanni Legorano at [email protected]

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