key: cord-325128-r53up0ug
authors: Diamantis, Sylvain; Noel, Coralie; Vignier, Nicolas; Gallien, Sébastien
title: SARS-cov-2 related deaths in French long-term care facilities: the “confinement disease” is probably more deleterious than the COVID-19 itself
date: 2020-05-03
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2020.04.023
sha: 
doc_id: 325128
cord_uid: r53up0ug

nan

To date coronavirus SARS-cov-2 has infected 2.2 million people and has killed more than 5 150,000. 1 The population groups most susceptible to severe and fatal COVID-19 are older 6 adults and those with chronic underlying chronic medical disorders. The residents of long-7 term care facilities (LTCFs) typically combine those two features and are thus particularly at 8 risk. In France, 9.4% of the population is over 75, and nearly 600,000 people currently reside 9

in LTCFs for elderly dependent individuals. To date, more than 60% of the French LTCFs have 10 reported at least one case of COVID-19 among their residents. 11

Estimated overall mortality among COVID-19 patients is 10% in France, but reaches up to 12 30% in LTCFs. There are however substantial differences in mortality rates between the 13 different LTCFs. 2 What explains these differences? 14

We intervened in one LTCF located in the Southern Île-de-France region that had registered 15 more than 24 deaths related to COVID-19 among the 140 residents in 5 days. No acute 16 respiratory distress syndrome were observed and mortality was mainly due to hypovolemic 17

shock. Most of the victims had been left alone in their rooms for confinement settings for 18 many days without help, due to the lack of protective masks and the work overload for 19 caregivers, affected by a 40% staff absenteeism rate. The dependent infected residents were 20 confined and no longer received the usual assistance for drinking and eating. In addition, 21 general practitioners stopped their physical examination visits, limiting their interventions to 22 telemedicine which proved unsuitable whenever feasible at all. fatal than COVID-19 itself. We did not observe this phenomenon in other LCTFs where health 25 care staff and physicians were physically present in full force. 26

A task force team intervened as soon as the fifth death was reported. Adapted infusion to 27 restore hydroelectrolytic balance as well as oxygen therapy per WHO guidelines led to a 28 rapid improvement of this high mortality trend. 3,4 29

Disproportionate mortality due to COVID-19 in LTCFs is not a fatality. Continuous provision 30 of pragmatic medicine and wellness care will limit the devastating impact of this infection in 31 dependent elderly people. 32

The authors declare that there is no conflict of interest regarding the publication of this 34 article. 35

An interactive web-based dashboard to track COVID-19 in real 38 time

Clinical management of severe acute respiratory 43 infection (SARI) when COVID-19 disease is suspected: Interim guidance V