OUR SCREAM

According to the World Health Organization, today we have more than half a million confirmed cases of COVID 19 (510,108 on 03/26) that have increased 100,000 cases in two days and 22,993 deaths from coronavirus, however, the death rate among older people is older compared to other age groups, and within the elderly segment itself, it appears to be even higher among older adults (≥ 75 years).

In Brazil, despite all efforts to contain the pandemic, to flatten the growth curve of cases, the confirmation of 2,915 cases and 77 deaths was registered on 03/26/2020. In SP 1,052 cases with 58 deaths. Despite these alarming figures, little attention has been paid to long-term care institutions for the elderly (ILPI). In these institutions, previously called “nursing homes”, reside elderly people, most of whom are 80 years of age or older, with multi morbidities (two or more simultaneous chronic diseases) and frail, which constitutes an extremely high risk group for contract the disease and die.

 It is not yet clear how many institutions there are in the country. A census carried out by IPEA in 2010 indicated the existence of around 90,000 older people living in the country’s 3,600 institutions, which correspond, at that time, to almost 1% of the country’s population of older people. Most of the ILPI (65%) were philanthropic. A national survey conducted between 2016 and 2018 showed that approximately 51 thousand older people lived in public and philanthropic institutions in the country, 65% of whom were semi-dependent or dependent and, therefore, fragile. Today that number reaches 78 thousand older people.

The ILPI represent the place of residence of the elderly and are Social Assistance teams, therefore, they do not have the structure or the human resources to offer specific medical care to their residents. The current operating rules for these services do not include health professionals on their staff. They only contemplate the obligation of two professionals with higher education, the technical manager and a professional in the leisure area, in addition to the caregivers of older people, these without any specific training.

Knowing this situation and very apprehensive with the advance of the pandemic in our environment, professionals in the field of gerontology of the most diverse specialties developed orientation materials focused on the prevention of COVID 19 in ILPIs.

The Sanitary Surveillance of some states and ANVISA itself also produced materials on the prevention and control of COVID 19 in these places. These rules provide for the isolation of older people with suspicion or confirmation of COVID 19, however, most institutions do not have a physical structure or trained personnel to care for people in these conditions. Furthermore, and very alarmingly, most ILPIs do not have or have difficulty finding personal protective equipment, such as masks, gloves, glasses, hats, aprons or waterproof boots for the protection of their workers. How will it be possible to guarantee the protection of these older people with these conditions?

The state of São Paulo has around 1500 LTCI, most of them with the conditions described above and a similar image in most of the Brazilian states. In some way, without taking into account the responsible actions that public agencies have implemented, It is urgent that health authorities, state and municipal health and social care professionals, politicians and society itself direct their attention to the most vulnerable among those considered vulnerable, including this team. in the epidemic contingency plans, providing PPE for the protection of the elderly and workers, establishing a hospital referral system for the occurrence of more serious cases to prevent the occurrence of what we have seen in these institutions in other countries, such as For example, in Spain, where many older people were abandoned and found dead in their beds.

Some reflections are needed so that they can inspire immediate action: in detecting an elderly person contaminated in an ILPI with few resources, the entire community of residents will be at risk and will be considered as a contact. What steps will be taken? How to protect them? Will this institution be isolated or will its residents be referred to hospitals if their condition worsens? Will we get to the situation in Italy where we will have to choose who to serve and use the age criteria for that?

The purpose of this letter is to draw attention to this reality and to prevent the occurrence of cruel and inhuman gerontocides, which even developed nations have experienced. It is necessary that the authorities and the media come together and help uncover this reality that, although present, is hidden and unknown to the majority of the population.

We are screaming for the attention of these people who, for the most part, can no longer scream for help and are forgotten in these places. Immediate action is needed as they have no reserve to resist unaided.

This is especially the case in small institutions, many of them illegal and unknown. They exist across the country and need to be seen and helped at this time.

In some municipalities, such as SP, there are socio-sanitary teams for the elderly, also called hybrid teams, that are administered by the municipality, not including other institutions such as philanthropic or private ones (RESOLUTION No. 001/2020-SMS-SMADS) that are being monitored and, at the moment, at least half of them report that they can face the demands presented. And the other 50%?

REFLECTIONS:

1.  How to make material and protective supplies available to professionals and the elderly without overburdening institutions with limited financial resources to manage services?
2. Who is responsible for providing such materials?
3. What is the reference network in the health area that this team can count on to provide adequate care against COVID 19?
4. How will this flow of care / referral of suspected cases be carried out, if necessary?

Without such urgently implemented measures, the most vulnerable, with further deterioration of their health, can become victims of the risk of death, which already reaches 15% in the population of frail elderly contaminated by serious cases of COVID-19.