PARIS – One by one, elderly residents of French nursing homes are going into forced isolation into their rooms. Their caregivers are walling themselves in as well. They are running out of body bags.
But no one knows for sure how many people have become sick. Governments in Europe's hardest-hit countries — Italy, Spain and France — are not routinely testing for coronavirus among elderly residents who fall ill in nursing homes or even those who eventually die there, including those who suffered from symptoms of the disease.
The three countries together make up around a third of the global pandemic's confirmed cases, and the lack of testing leaves hundreds, potentially thousands, of victims of the disease uncounted as health authorities try to trace its path.
The heavy dependency upon hospitals to count coronavirus fatalities poses particular problems for evaluating the spread of COVID-19 among the oldest citizens. Hospitals are increasingly reluctant to admit elderly coronavirus patients judged to have little chance of successful treatment.
Indications are they have paid a steep toll in anonymity. In France, the two regions hit earliest by the pandemic reported an over 30% increase in the number of deaths from March 1-16 compared to the previous year, according to the national statistics agency, which released the figures for the Haut-Rhin and southern Corsica regions late last week. Spain and Italy have not yet released initial death statistics for the month.
In Madrid, one of the most affected cities in Europe, a leading regional official acknowledged that the coronavirus infection of one elderly woman was confirmed after her death only because the nursing home’s physician “insisted.” Around the Italian city of Bergamo, the epicenter of the country's outbreak, 400 people died in a single week in early March — four times the number who died the same week the previous year, according to the Bergamo mayor’s office. Only 91 of those had tested positive for the virus.
In France, once two residents of the same nursing home test positive, any other residents who fall sick and ultimately succumb to the disease are “assumed” to have the illness, but they are not actually tested or counted among the national toll, which so far only includes those who have sought care in a hospital. The government has promised to include nursing home residents early this week but has yet to implement widespread testing of residents. The supply of body bags is dwindling, according to Marc Bourquin of the French hospital federation, an umbrella organization for half of the country’s 7,000 nursing homes.
The challenge of tracking deaths is not unique to COVID-19. Many of the world’s fatal illnesses are not counted individually. For example, U.S. influenza death tallies are drawn from mathematical models that rely on data taken at a network of hospitals. In the developing world, such estimates can be even cruder. About half of the 60 million people who die in the world each year have no death certificates or other records describing what killed them.