Since March 2020, 328 nursing home residents have died from covid-19, out of the 749 total coronavirus deaths nationally. Altogether 53 clusters, with 1,660 residents who have tested positive for covid-19, have also been recorded in care facilities in the grand duchy. It is a situation that prompted opposition MPs to demand the resignation of family minister Corinne Cahen (DP) in the Chamber of Deputies on Thursday 1 April, after criticising her handling of the health crisis in care homes.
Could these 328 deaths have been avoided? According to Marc Fischbach, board president of Copas, a trade association representing most care homes in Luxembourg, “it is difficult to answer this question. We certainly could have done better, but I don’t know how. The problem with this virus is that today we are faced with a situation that may change tomorrow, and we have to constantly react to new facts and to adapt.”
A “more vulnerable” population
While vaccination in nursing homes began in January, “and 90%-95% of residents are now vaccinated”, Fischbach points out that external workers--such as cleaners, catering staff, physiotherapists and podiatrists--have not been vaccinated. “The government preferred to base [the vaccination strategy] on the status of the person (employee or subcontractor), and not on their function (administrative or in direct contact with residents), which has given rise to the situation we now see: salaried administrative staff were vaccinated, while subcontracted staff, who are in daily contact with residents, were excluded.”
And while he recognises that the number of deaths is worrisome, the Copas chairman defends the 54 members of the organisation: “We are facing the third wave of covid-19, the whole country is affected. Care homes followed the recommendations from the Ministry of Health, we have been involved in the crisis unit since March 2020. We have done everything to avoid this tragedy, but we are dealing with residents with an average age of 80-85 years, so they are more vulnerable.”
Isolation is not the solution
“And the death rate in the country’s retirement homes due to covid-19 is much lower than that of other countries in the Greater Region. A pandemic is not just any event, we have not been able to bring it under control, there are so many elements at stake, such as vaccination, the availability of vaccines, new variants of the virus, their resistance to vaccines, etc. ”
“Those who criticise the sector for not managing this crisis better are also those who were against the idea of isolating elderly people by limiting visits and intervention by external providers.” Fischbach recalled that “there were also cases of covid-19 during the first confinement, which was strict, so isolating care homes does not prevent contamination, and the virus from circulating. On the contrary, it has an impact on the mental health of residents.”
A “dependence” on cross-border personnel
Health director Jean-Claude Schmit said at a recent press briefing that it is difficult to know the cause of any specific cluster.
“In a care home, we can, for example, suspect the ventilation system, which could be faulty and which could cause the spread of the virus", observed Fischbach, who says he is “less worried than a few weeks ago, with the almost total vaccination of residents”. One cluster was notably recorded in an establishment “where, out of the fifteen infected people, most were asymptomatic. So if the vaccine doesn’t stop the virus from spreading, as many virologists predicted, it does limit complications.”
What this crisis has shown, “and in a brutal way, is our dependence on cross-border personnel”, he pointed out. “We need to do a lot more to encourage young people to work in our health professions, we also need to review the entire training offer in the country.”