Isolation kills
It is sometimes more deadly than COVID-19, according to a large U.S. study
Seniors' shelters that have applied COVID-19 health measures the most rigorously have been more effective in limiting outbreaks within their walls in the first weeks of the pandemic. But these results hide an important blind spot: residents of these facilities have died over the months more likely to die for other reasons, possibly related to isolation and loneliness, reveals a new American study.
"Preventing COVID-19 cases and associated deaths comes with a cost" in shelters, say two researchers from the University of Notre Dame whose study, published in the Journal of Health Economics, was funded by the National Institute of Health.
These researchers analyzed data on COVID-19 cases and deaths at more than 15,000 U.S. shelters. In the United States, the quality of these centers is rated on a scale of 1 to 5 stars according to specific criteria by the Centers for Medicare and Medicaid. Establishments classified as "5 stars" have better staff-to-resident ratios, report fewer falls and fewer pressure ulcers.
Seniors' shelters that have applied COVID-19 health measures the most rigorously have been more effective in limiting outbreaks within their walls in the first weeks of the pandemic. But these results hide an important blind spot: residents of these facilities have died over the months more likely to die for other reasons, possibly related to isolation and loneliness, reveals a new American study.
"Preventing COVID-19 cases and associated deaths comes with a cost" in shelters, say two researchers from the University of Notre Dame whose study, published in the Journal of Health Economics, was funded by the National Institute of Health.
These researchers analyzed data on COVID-19 cases and deaths at more than 15,000 U.S. shelters. In the United States, the quality of these centers is rated on a scale of 1 to 5 stars according to specific criteria by the Centers for Medicare and Medicaid. Establishments classified as "5 stars" have better staff-to-resident ratios, report fewer falls and fewer pressure ulcers.
In the first months of the pandemic, "5-star" establishments were quicker to apply COVID-19 prevention measures. Like the lower quality centres, they have failed to prevent the virus from entering their walls. But they have been much more effective in limiting internal transmission. In particular, they experienced fewer staff shortages, facilitated screening and more rigorously applied the isolation of residents. Shortages of protective equipment were also less severe.
As a result, from January 2020 to September 2020, 5-star centres recorded 15% fewer COVID-19-related deaths than lower quality centres. A gap that narrowed in the months that followed.
Many, however, questioned whether precautions to contain COVID-19 "don't come with a cost," the University of Notre Dame researchers report. "There is ample evidence to suggest that residents' lack of contact with their loved ones has not only created a sense of loneliness, isolation and despair, but has also possibly accelerated some deaths," they write. And the data seems to prove them right. At the end of April 2021, U.S. 5-star shelters had an average of 8.4% more deaths (all causes) than 1-star facilities, and 15% more non-COVID-19 deaths.
QuestioningPhilippe Voyer, a researcher at the Centre d'excellence sur le vieillissement du Québec and a professor in the Faculty of Nursing at Université Laval, brought the American study to the attention of La Presse. According to him, "good quality facilities have performed so well to prevent COVID-19 by isolating patients, reducing leisure activities, visits, not allowing residents to eat together, that the total mortality rate is higher in the 5 stars than in the 1 star. Because people have died from the side effects of isolation. These residents have died from various causes, such as undernutrition, cognitive loss or the consequences of reduced access to health services, among others.
In Philippe Voyer's opinion, this study provides an answer to the many Quebec caregivers who contacted him in April and May 2020 and who were concerned about the effect of isolation on their residents. "We didn't have any data on that at the time
," says Voyer, who says "we can't go back."
But for him, this new study should lead governments to "question our ways of doing things".
As a result, from January 2020 to September 2020, 5-star centres recorded 15% fewer COVID-19-related deaths than lower quality centres. A gap that narrowed in the months that followed.
Many, however, questioned whether precautions to contain COVID-19 "don't come with a cost," the University of Notre Dame researchers report. "There is ample evidence to suggest that residents' lack of contact with their loved ones has not only created a sense of loneliness, isolation and despair, but has also possibly accelerated some deaths," they write. And the data seems to prove them right. At the end of April 2021, U.S. 5-star shelters had an average of 8.4% more deaths (all causes) than 1-star facilities, and 15% more non-COVID-19 deaths.
QuestioningPhilippe Voyer, a researcher at the Centre d'excellence sur le vieillissement du Québec and a professor in the Faculty of Nursing at Université Laval, brought the American study to the attention of La Presse. According to him, "good quality facilities have performed so well to prevent COVID-19 by isolating patients, reducing leisure activities, visits, not allowing residents to eat together, that the total mortality rate is higher in the 5 stars than in the 1 star. Because people have died from the side effects of isolation. These residents have died from various causes, such as undernutrition, cognitive loss or the consequences of reduced access to health services, among others.
In Philippe Voyer's opinion, this study provides an answer to the many Quebec caregivers who contacted him in April and May 2020 and who were concerned about the effect of isolation on their residents. "We didn't have any data on that at the time
," says Voyer, who says "we can't go back."
But for him, this new study should lead governments to "question our ways of doing things".
By wanting too much to prevent COVID, we create something else. For the first waves of the pandemic,
we had to be more restrictive. But today, we need another approach.
Philippe Voyer, researcher at the Centre d'excellence sur le vieillissement du Québec
Member of the board of directors of the Community of Practice of Physicians in CHSLDs, Dr. Andrée Robillard notes that some studies report the harmful effects of confinement in CHSLDs. "But we will never be able to know what would have happened without this measure," she says. In the opinion of Dr. Robillard, "it is the exceptional duration of the confinement that has had so many deleterious effects" on the seniors housed. Mortality rates must also be carefully analyzed, according to Dr. Robillard. Because shelters, some of which are "less well off", can transfer their patients at the end of life to hospitals more significantly rather than accompanying
them until their death, which can affect their mortality rate.
Dr. Robillard also urges caution before concluding that the U.S. study automatically applies to Quebec. In particular, because American nursing homes are more like Quebec's intermediate resources than CHSLDs. She still notes that what emerges from the study is "the importance of the human factor and links for elderly patients".
Upcoming flexibilities in QuebecThis study is published at a time when Quebec announces relaxation of health measures in CHSLDs and private seniors' residences.
As of Saturday, visits to seniors' residences and CHSLDs will no longer be limited to caregivers. However, all visitors will need to show their vaccination passport. A maximum of two visitors per day, one at a time, will be allowed in CHSLDs. In seniors' residences, a maximum of four visitors per day, two at a time, will be permitted. "Seniors need to have visits," said Premier François Legault.
Other relaxations could also come, suggested the acting national director of public health of Quebec, Dr. Luc Boileau. "The whole issue of everything called infection prevention and control in living environments, whether CHSLDs or RPAs, is being actively worked on. We are on this issue with the ministerial teams, the teams of experts also to find a way to alleviate these conditions, while managing the risks of contagion, and to bring us with a rapid progress towards a more normal management of how we must live with the virus. »
we had to be more restrictive. But today, we need another approach.
Philippe Voyer, researcher at the Centre d'excellence sur le vieillissement du Québec
Member of the board of directors of the Community of Practice of Physicians in CHSLDs, Dr. Andrée Robillard notes that some studies report the harmful effects of confinement in CHSLDs. "But we will never be able to know what would have happened without this measure," she says. In the opinion of Dr. Robillard, "it is the exceptional duration of the confinement that has had so many deleterious effects" on the seniors housed. Mortality rates must also be carefully analyzed, according to Dr. Robillard. Because shelters, some of which are "less well off", can transfer their patients at the end of life to hospitals more significantly rather than accompanying
them until their death, which can affect their mortality rate.
Dr. Robillard also urges caution before concluding that the U.S. study automatically applies to Quebec. In particular, because American nursing homes are more like Quebec's intermediate resources than CHSLDs. She still notes that what emerges from the study is "the importance of the human factor and links for elderly patients".
Upcoming flexibilities in QuebecThis study is published at a time when Quebec announces relaxation of health measures in CHSLDs and private seniors' residences.
As of Saturday, visits to seniors' residences and CHSLDs will no longer be limited to caregivers. However, all visitors will need to show their vaccination passport. A maximum of two visitors per day, one at a time, will be allowed in CHSLDs. In seniors' residences, a maximum of four visitors per day, two at a time, will be permitted. "Seniors need to have visits," said Premier François Legault.
Other relaxations could also come, suggested the acting national director of public health of Quebec, Dr. Luc Boileau. "The whole issue of everything called infection prevention and control in living environments, whether CHSLDs or RPAs, is being actively worked on. We are on this issue with the ministerial teams, the teams of experts also to find a way to alleviate these conditions, while managing the risks of contagion, and to bring us with a rapid progress towards a more normal management of how we must live with the virus. »
