Why some countries suffer more from coronavirus: Israeli prof blames care homes
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Why some countries suffer more from coronavirus: Israeli prof blames care homes

European countries experiencing high COVID-19 death rates have something in common, finds ‘stunned’ Tel Aviv University researcher; it’s where they house their elderly

Illustrative: An aid worker talks to an elderly woman before a test at a nursing home in Barcelona, Spain, April 1, 2020. (AP Photo/Santi Palacios)
Illustrative: An aid worker talks to an elderly woman before a test at a nursing home in Barcelona, Spain, April 1, 2020. (AP Photo/Santi Palacios)

There are more COVID deaths in countries where the elderly tend to live in care facilities, an Israeli professor has found, saying this provides an explanation for why countries are affected so differently by the virus.

“Old-age homes, the way they exist currently, cause deaths,” Neil Gandal told The Times of Israel. “Many fewer would have died if they had been living at home.”

He crunched numbers for all 32 European countries for which they were available, and found a correlation between the use of care homes for the elderly and the number of coronavirus deaths. “We were stunned by this,” said Gandal, a Tel Aviv University economics professor.

The countries in his study with the highest death rates, including the UK, Italy, Spain and Belgium, all have high numbers of nursing home beds in proportion to population size. By contrast, countries with relatively low fatalities, including Greece and Albania, have low numbers of such beds.

Israel wasn’t included in the study, but was added in to a graph provided to The Times of Israel, and shown to have a relatively low number of care home beds, and a relatively low number of deaths.

Graph from Neil Gandal’s research paper, “Long-Term Care Facilities as a Risk Factor for Death Due to COVID-19.” (CEPR DP #14844, Gandal, N., Yonas, M., Feldman, M., Pauzner, A., and Tabbach, A., 2020.)

Gandal stressed that he isn’t claiming that the popularity of care homes fully explains the variation of deaths, but, using a mathematical model assessing the impact of other factors, he estimated that it accounts for 28 percent of the variation.

Tel Aviv University economist Neil Gandal (courtesy)

All of his findings were based on statistics from mid-May, adjusted to account for the varying size of elderly populations in different countries.

It is well known that many COVID-19 deaths happen in care homes. According to the latest official figures, one in two coronavirus deaths in the UK is a care home resident.

However, it has been unclear whether this is simply because residents are fragile and vulnerable, or because the homes are environments where the virus flourishes.

“It was well known that people were dying in these facilities, but some thought they ‘would have died anyway,’” Gandal said, arguing that his research suggests that many wouldn’t have died had they not been institutionalized.

As accurate data on the percentage of deaths in care homes was unavailable for many countries, Gandal examined whether there was a correlation on the basis of the number of care home beds.

He said that he saw a clear pattern, with fewer deaths in countries where elderly people tend to live with families, and high mortality rates in countries that heavily rely on care homes. “In countries like Greece the older people are not necessarily in good health but they are at home, and the families were able to take care of them,” he added.

Servpro cleaning workers are sprayed as they exit the Life Care Center in Kirkland, Washington, March 12, 2020, at the end of a day spent cleaning inside the facility near Seattle. (AP Photo/Ted S. Warren)

In Israel, rates of retirement home use and coronavirus deaths are low, said Gandal. There are 2,200 beds per million residents, and there were 26 COVID deaths per million Israelis as of mid-May when figures for the report were compiled.

Emil Agha, immunologist and infectious diseases supervisor at the Galilee Medical Center in Nahariya (courtesy of Emil Agha)

There has already been speculation among Arabs Israelis that their community’s low use of elder care facilities compared to other Israelis has contributed to its lower COVID death rates. “In the Arab sectors we don’t really have retirement homes,” Emil Agha, epidemiologist and infectious diseases supervisor at the Galilee Medical Center in Nahariya, told The Times of Israel last month, suggesting that their absence in the community had benefited elderly Arabs. “People live at the family home and this makes a difference.”

Gandal doesn’t know what happens inside care homes to prompt so many deaths there, but hopes that his research causes governments to commission detailed studies analyzing their working practices and hygiene standards.

Such analysis may find that simple steps, such as increasing testing, serving meals in rooms instead of dining areas, or having more staff so that each worker interacts with fewer residents, may save many lives. This research should be considered key preparation for further spikes in cases, he said.

“Now we have time, let’s be ready for a second wave,” he urged.

Gandal added: “My first reaction upon seeing the figures I produced was a little sadness, because these people didn’t have to die. But my next reaction was that if there’s a second wave, maybe there’s something we can do.”

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