How to protect people who live in retirement homes? The question is crucial. Authorities announced Thursday (April 2nd) that since the start of the epidemic, 884 people have died from Coronavirus in shelters for dependent elderly people (Ehpad). An already terrible figure, which could climb in the coming weeks. “But we must stop talking about a massacre that would be inevitable everywhere in France. We have the means to protect residents of nursing homes. The worst is not certain “, annoys a school director.
→ MAINTENANCE. Coronavirus: for Pascal Champvert, the Ehpad are not threatened with a “tsunami”
A “Korean” strategy
The first means of protection is of course strict compliance with the barrier measures on the part of the staff. “We had to shout loudly 15 days ago to have masks in all establishments but it is better today”, says Dr. Odile Reynaud-Levy, vice-president of the National Association of Coordinating Physicians in Ehpad.
However, another major weapon to protect residents remains the targeted and intensive use of screening tests. With a “Korean” strategy to quickly detect any infected caregiver to keep them away from residents. It is this strategy that began to be implemented by the Occitanie Regional Health Agency (ARS). “As soon as a caregiver shows signs of Covid, he is screened. Either his attending physician makes him a prescription and he will do a test in a city laboratory. Either he’ll get tested at the hospital “, explains Professor Hubert Blain, head of the geriatrics department of the Montpellier University Hospital.
Anyone in contact with a caregiver is also screened as soon as they develop signs. And if it is positive, the caregiver is tested in turn. This way, you can spot an infection in a caregiver who is asymptomatic. “Finally, if you find an infection in a caregiver, you immediately test all of your work colleagues. The goal is to quickly cut any chain of contamination. Because in an Ehpad, it can burn very quickly ”, recognizes Professor Blain.
The use of tests is also crucial among residents. Again, the goal is to quickly detect the very first positive case to prevent proliferation of the virus. But it is not easy because the elderly, at the beginning, often have atypical symptoms. “Covid infection can result in diarrhea, falls or a deterioration in general health”, says Professor Blain. “Another sign is the occurrence of sudden and intense fatigue. We see people who do not have a cough or fever but who can no longer get up “, adds Doctor Reynaud-Lévy.
“Covid” residents isolated from others
For residents, screening stops from the third positive case. “If we have three infected residents in an Ehpad, that means that the virus is circulating. And without testing them, we consider that all the people who will develop symptoms are contaminated by Covid ”, says Doctor Claude Rabatel, coordinating doctor in two nursing homes in the Paris region. These “Covid” residents are then isolated from the others. “In one of the Ehpad, we set up an entire floor for around 30 people and changed rooms, taking just a few things and their TV”, says Doctor Rabatel.
The use of tests will also be essential for deconfinement which, in all likelihood, will be more spread out over time for the elderly. And the challenge for the weeks, if not months, to come will be to protect this fragile public, while enabling them to reconnect with family contacts. Because no one imagines that individual confinement in a room, or even a total ban on visits by loved ones, is humanly and ethically acceptable over a long period.
In this context, the use of serological tests, which make it possible to detect antibodies in a person who has been contaminated, will be essential. With these tests, we will be able to identify the personnel but also the family members of a resident who, being immunized, will be able to cross the door of an Ehpad without fear of bringing the virus there.
This could obviously create some inequality between residents. Between those who will again be able to receive visits from an “immunized” loved one and the others, of whom no family member has been infected. “For the latter, it may be necessary, at some point, to consider re-authorizing visits, with very strict barrier measures, says Doctor Reynaud-Lévy. Because protection against the Covid is crucial. But we must also take into account the deleterious effects of very prolonged confinement. “