Why is the situation improving in nursing homes?

Vaccination in nursing homes, illustration. More than 80% of residents received a first dose of vaccine. – Bony / SIPA

  • The situation in nursing homes, particularly affected by the coronavirus, seems to have improved in recent weeks.
  • The number of daily deaths but also the incidence of the coronavirus are in free fall.
  • If vaccines probably play a major role, other explanations are possible.

The daily number of deaths related to coronavirus in
Ehpad fell by more than 50% in three weeks, from 110 deaths to 52 per day on average over the past week. At the same time, the incidence rate fell by more than 30% in two weeks among people aged 80 or over in France. Faced with these auspicious figures, the government is considering reducing the protocol for visiting nursing homes.

Minister of Health Olivier Véran declared on Friday: “I hope, like the 700,000 residents in nursing homes, that we can further lift the health constraints”, asking just a little more time (immunity linked to vaccination is considered to be definitively acquired several days later the second injection). According to
France Inter, some nursing homes, mostly vaccinated, could even relax certain constraints in March without waiting for government approval. (Rare) good news in this epidemic, but how to explain it?

Double effect of the vaccine

The most obvious reason seems to be the campaign to vaccination mass that takes place in nursing homes, the first population to have received doses in France. This Thursday, more than 80% of nursing home residents received at least one vaccine injection according to the Ministry of Health. And the curves of declining mortality and increasing immunization seem to be correlated. “It is certain that having the majority of residents with vaccine doses plays a role in the number of deaths. In addition, nursing staff are also vaccinated, ”explains epidemiology doctor Michaël Rochoy in detail.

More and more studies suggest that the Pfizer vaccine, the one administered in nursing homes, not only protects against serious forms but also reduces transmission. A vaccinated person would be less likely to infect other people. “We think that it is the nursing staff who bring the virus to nursing homes from outside. Once this staff is vaccinated and less contagious, the virus circulates less in the residences, ”argues the doctor. Double beneficial effect of the vaccine.

A population of survivors?

Vaccination is probably not the only reason. As often with the coronavirus, the causes are multiple. Several other phenomena are at play, in particular the fact that nursing homes are less full. “With the health crisis, families are much more hesitant to put their elderly in nursing homes, the house seems safer to them in a period of coronavirus”, raises Michaël Rochoy. Fewer residents, therefore less contamination and fewer deaths.

Another explanation would lie in what is called the depletion of the most susceptible. Mahmoud Zureik, professor of epidemiology and public health at the University of Versailles-Saint-Quentin-en-Yvelines, explains: “The oldest, most vulnerable and most fragile people are already dead, and there is nothing left. than a more resistant public therefore less fragile in the face of the virus. This phenomenon is often observed in epidemiology : an epidemic gives the impression of being less and less fatal over time, when in reality, the most fragile people died in the first wave.

Immunity and Christmas effect

Following somewhat the same idea, the professor also questions another type of resistance of the population in nursing homes: “A lot of people have already been infected, there may be partial collective immunity, which slows the circulation of the virus in residences. . “Finally, Michaël Rochoy warns of a decrease linked to a possible Christmas effect:” Residents in nursing homes were able to have outgoing permissions or exceptional visits for the holiday season, which would have resulted in an increase in mortality during January, and the current decline is believed to be partly due to a simple return to normal. “

In part only because more than a specific factor, Mahmoud Zureik believes that this drop in deaths linked to Covid-19 in nursing homes could well have all these causes. Without ruling out the least optimistic possibility: a simple problem of data reporting, the nursing homes having suffered several errors when announcing the death reports of the coronavirus.

If it is not about that, and that the nursing homes are well and well gradually out of the woods thanks to the mass vaccination, it will be necessary to temper the enthusiasm concerning the rest of the country and the situation in the hospital services . “Nursing home residents participated little in the saturation of hospitals, since they were particularly too fragile to be admitted to intensive care,” says Michaël Rochoy. However, if one of the most-at-risk populations turned out to be out of danger, this would be a very positive sign concerning the fight against Covid-19. A glimmer of hope that nobody wants to save, on the eve of probable local reconfigurations.

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