Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)-Related Deaths in French Long-Term Care Facilities: The “Confinement Disease” Is Probably More Deleterious Than the Coronavirus Disease-2019 (COVID-19) Itself

To the Editor:

To date, coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected 2.2 million people and has killed more than 150,000.¹ The population groups most susceptible to severe and fatal coronavirus disease-2019 (COVID-19) are older adults and those with chronic underlying chronic medical disorders. The residents of long-term care facilities (LTCFs) typically combine those 2 features and are, thus, particularly at risk. In France, 9.4% of the population is over age 75 years and nearly 600,000 people currently reside in LTCFs for older dependent individuals. To date, more than 60% of the French LTCFs have reported at least 1 case of COVID-19 among their residents.

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

We intervened in 1 LTCF located in the Southern Île-de-France region that had registered more than 24 deaths related to COVID-19 among the 140 residents in 5 days. No acute respiratory distress syndrome was observed, and mortality was mainly due to hypovolemic shock. Most of the victims had been left alone in their rooms for confinement settings for many days without help because of the lack of protective masks and the work overload for caregivers affected by a 40% staff absenteeism rate. The dependent infected residents were confined and no longer received the usual assistance for drinking and eating. In addition, general practitioners stopped their physical examination visits, limiting their interventions to telemedicine, which proved unsuitable whenever feasible at all.

With appropriate resources lacking, the “disease linked to confinement” thus proved more fatal than COVID-19 itself. We did not observe this phenomenon in other LCTFs where healthcare staff and physicians were physically present in full force.

A task force team intervened as soon as the fifth death was reported. Adapted infusion to restore hydroelectrolytic balance as well as oxygen therapy per World Health Organization guidelines led to a rapid improvement of this high mortality trend.^{3 , 4}

Disproportionate mortality because of COVID-19 in LTCFs is not a fatality. Continuous provision of pragmatic medicine and wellness care will limit the devastating impact of this infection in dependent older people.