Every day dozens of people continue to die in Spain from covid. It is difficult to quantify the exact number due to delays in notifications, but if you look at the statistics from two weeks ago, now that these figures are consolidating, they exceeded fifty per day. ICU occupancy is at a minimum since the pandemic began, but the same is not true of deaths. How is it explained? In part, because deaths are increasingly concentrated in the very elderly and vulnerable who, due to their frailty, are not usually admitted to intensive care and whose death is multifactorial, but not always directly (or only) attributable to the coronavirus, despite be covid positive.
It is not that more elderly people die than at other times of the epidemic. Upside down. Vaccines have protected the entire population and have prevented thousands of deaths: especially among the elderly, who have been the hardest hit by covid. But the lower impact on younger people has accentuated the statistics: if until now the number of deaths over 80 years old accounted for 62.8% of the total, in the last two months it has risen to 69.1% of all deaths , according to data from the Carlos III Health Institute. If he takes the zoom to those over 90, the increase is higher (in relative terms): they go from 23.4% to almost a third of deaths (31.7%).
“With all the boosters of the vaccine and the characteristics of the virus, severe illness hardly affects young people. Among the elderly, the condition also decreases, but to a lesser extent, ”summarizes Ana María García, professor of Public Health at the University of Valencia. This would explain why this group occupies a higher percentage of mortality. “There are fewer and fewer cases going through the ICU. The deceased are now mainly elderly people or people with significant comorbidities. Among the few people without these factors who die, there are striking cases of unvaccinated people, ”says Ignacio Rosell, epidemiologist and coordinator of the covid-19 expert committee in Castilla y León.
There are still deaths because the virus maintains a high circulation. Despite the downward trend in cases for almost a month, after a small rebound that came after the sixth wave, the 14-day incidence is 586.7 cases per 100,000 inhabitants among those over 60 years of age, the only group in which it is still measured. Before vaccines and omicron, this was considered an extreme transmission risk. Now the situation has changed: the disease is mild for the vast majority. But among the most fragile it can continue to complicate, even if they have been vaccinated, although the puncture greatly reduces the possibilities.
Proof of this is that this May has registered an excess mortality of 3,233 people with respect to what was expected, something completely exceptional at that time of year, according to Carlos III. There was also excess mortality this winter, with the sixth wave; but it was similar to, or even lower than, some years before the pandemic. Every winter season there is an uptick in deaths from respiratory diseases (especially the flu) and this has been no exception (this time due to covid). However, since the beginning of 2022, the excess mortality (8,636) is lower than the average of the years prior to the pandemic (11,500).
What is happening very often is that covid is being the disease that breaks the balance in people who were already in what doctors call the “end phase of life”. Jose Augusto García Navarro, president of the Spanish Society of Geriatrics, explains that they are elderly people with basic pathologies and a lot of frailty, who probably had a life expectancy of less than a year. “These cases are a few among very old people; in them, any interrecurrent disease can precipitate death: it can be pneumonia, a urine infection, a fall, the flu or, now, the coronavirus. They are so fragile and unstable, that any small event that another person would easily overcome, is the end for them, ”he explains.
The Health statistics, on which the entire analysis of this report is based, do not specify whether covid has been the main cause of deaths, nor how many people have died having tested positive, but for a reason that is not directly the coronavirus. . The ministry itself acknowledges that covid is not the main cause of death in all cases, and that in most of the elderly it is “multifactorial”. “In the cases of hospitalized patients, it is clear that the deaths that are computed have been due to covid, generally due to pneumonia caused by the virus; but outside these realms, it is not always clear. Many deaths are computed in the statistics that have tested positive, but in which the coronavirus has not played a relevant role, ”says García Navarro.
Deaths at home or in nursing homes are very common. Despite the fact that the informative focus of the pandemic has often concentrated on the Intensive Care Units, which have been the thermometer to take measures due to the terrible consequences that their collapse may have, the vast majority of deaths have not occurred in they. “As long as it is possible, in their own environment it is much better for them, for their quality of life. You have to put yourself in the shoes of a very old person, with five or six diseases; a hospital is an inhospitable terrain for them. In addition, putting them in an ICU would be mistreating them, ”adds the president of the geriatricians.
Something different is what happened in the first wave, in the spring of 2020. In many cases, especially in the Community of Madrid, where there was one of the main outbreaks, the elderly who died in the residences did not do so because it was the best option, but because there was no room for them in hospitals. Or not, at least, in the eyes of the regional government, which vetoed his entry. It was a time that has left “a trauma” in the survivors, in the words of Javier Oliveira, secretary of the Spanish Society of Psychogeriatrics. “On the one hand, it is a generation, the post-war generation, very resilient, which to a large extent accepted that they were the ones sacrificed. But knowing that you are getting older and you don’t have access to services has tremendous psychological effects.”
Many older people, says Oliveira, continue to panic about becoming infected. They know that they are the most vulnerable and those with the most chance of suffering a serious condition, despite the fact that vaccines have reduced the chances of this happening. He continues to see very serious patients in the covid area of his hospital, in Huesca. “They are generally very old people, with many pathologies and psychological affectation, with a previous vulnerability that the covid has come to aggravate,” he ditches.
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