The hecatomb of disabled people in the Lombard hospices (and not only): a tragedy in the tragedy culpably passed in silence

(To David Rossi)

This article will make you shiver: stop here if you are sensitive people. With it, we have tried, like many others, to answer the question of why most of the victims of COVID-19 died in Lombardy and why the pandemic has caused much, but much lesser damage in the South. The answer, indirect but very authoritative, comes to us from abroad, as we will see shortly, and sounds more or less like this: Lombardy has more than a quarter of the hundreds of thousands of disabled people assisted by the health system1 and probably well over half of the deaths from COVID-19 occurred among them, in a way that we will soon describe. And that will leave you indignant.

Jérôme Salomon, general director of the French health service, in our sister nation, France, is a celebrity, perhaps more than the various Gauls, Burioni, Borrelli and Capua from us. It was up to him to admit, ten days ago, that Paris took into account the COVID-19 deaths that occurred inside the hospitals only, while in reality "The two main places of death are the hospital and the hospice". To dispel this gray area, Salomon announced the establishment of "daily mortality monitoring in institutions for the elderly"2. In a few days the statistics recorded more than two thousand deaths in these institutions, almost a third of the deaths in France. The figure is growing rapidly.

"Almost never - underlines Gaël Durel, president of the national association of coordinating nursing home doctors - there is room in the hospital for those who need hospitalization. We call, but more and more we are told: there are not enough beds, find a way to keep them "3.

The fact is that this pandemic has frightening numbers when it comes to ICU admissions4 and carries risks for many. For others, it is a death sentence, because if you are old and not self-sufficient you are certainly not among the candidates for assisted ventilation. It doesn't matter if you were an entrepreneur, a partisan or a trade unionist when you were young, if you have a family or if you are alone in the world: you are doomed. Yes why it is the Istituto Superiore di Sanità (ISS) that reports the figures of a real holocaust5: it does so in a report of these days to which neither the daily press conferences of the institutions of the Italian Republic nor the great experts mentioned by the media have given the importance it deserves.

Let's start with the figures: in Italy we have 2.554 public or private nursing homes (RSA) in agreement. What are RSAs? First of all, they are neither hospitals nor rest homes: they are health care structures, which host for a period ranging from a few weeks to an indefinite period, people who are not self-sufficient, who cannot be assisted at home and who need specific medical care more specialists and an articulated health care6,7. In Italy, they host something like 300.000 people8, all affected by serious disabilities Out of 2.554 structures, 1.634 were contacted by the ISS (64%): of these, only 236 deigned to answer (14% of those contacted, but just 9% of the total). The picture that emerges makes us shiver, especially if we allow ourselves, in a non-scientific but very logical and ethical way, to criticize certain conclusions, as we will soon see. The silence of 90,8% of the managers of these institutes will deserve the utmost attention in the continuation and end of the coronavirus crisis.

I state that we are talking about environments in which mortality is normally quite high, even if not comparable to oncology centers or intensive care units: guests are often over 1930 years old and with important disabilities, even if not always with pathologies whose outcome is fatal. In short, the grandfather born in XNUMX hospitalized today with symptoms of senile dementia could live up to a hundred years, because he has no diseases that can lead to rapid death, apart from old age itself.

That said, the figures are still pitiless: between February 31 and March 2020, 19,2, 10,2% of the guests in Lombardy, 6,2% in the Marche and 4,5% in Veneto died. In the rest of the country the deaths were around 26,4%. It is interesting to note that in Lombardy, a region that alone hosts 17% of all RSAs in Italy (although with less than 1.130% of the inhabitants), almost two thirds of all the deaths recorded in the Italian RSAs have occurred. transparent (1.845 out of 35) and that of these only 19 have been registered as COVID-528 cases. Conversely, according to the ISS report, XNUMX deaths were recorded as due to seasonal flu.

We ask ourselves: will not be the case to review said diagnosis ?! We talk about the death of thousands of people: therefore, it cannot be answered in bureaucrat. Given that both the flu strains and the coronavirus almost never kill directly but through the complications and considering that these are very similar, maybe the ISS would do well to investigate these cases, perhaps also providing to exhume the bodies, in the hope that not have all been cremated.

But how many infected and especially COVID-19 deaths among the elderly who are not self-sufficient in Italy? The figures say that 50,2% of coronavirus positive deaths are over 80 years old9: almost 8.000, until April 5. The chronicles leave no room for doubt:

600 deaths in RSA in the Bergamo area (Ansa)

Lodi, 52 the elderly who died in Santa Chiara in March (Il Cittadino)

32 died in RSA Bresciana

We stop here. It seems all too evident that - beyond the hundreds of deaths promptly communicated by a few Lombard RSAs to the ISS - we are facing the largest massacre in Upper Italy - and beyond - since the times of the Second World War. The numbers, eventually, perhaps describe the extermination of a tenth of the patients.

The figures do not tell how many daytime guests (i.e. non-residents), visiting relatives, doctors and paramedics, administrators and cleaners have been infected and have died. The chronicles report many testimonies that often end up in the newspapers in the sixth or seventh page.

Rightly, disabled RSA guests have been banned from visiting their loved ones since the second weekend of March: if a case of positivity to COVID-19 had manifested itself in a structure, this measure has become a real health cord among the outside and inside. In practice, when a guest was found to be infected, relatives / visitors were also placed in quarantine.

The alienation of these derelicts must have been total: “The massacre of the elderly - according to Agnese Pini of La Nazione - reaches its peak in the social and health scandal that is taking place in the RSA, in nursing homes, in rehabilitation centers for the disabled or for the elderly. From North to South ... those structures that are transformed into prisons - the relatives who cannot enter, the patients who cannot leave, the difficulty of knowing, of telling, of caring - ... while the directors of the residences and the personal, they are left helpless and alone "10.

A testimony on all: “A few days before the death (my mother's), which took place on March 25, they contacted me to ask me if I wanted to hospitalize her, and in that case to put it in writing. An inhuman choice, because I couldn't understand what was really better to do, who could assure her the best assistance. An unspeakable suffering ". I recommend reading all the testimonies on the Mediglia case, listed in this article. Damn bureaucracy: asks for the written form of a death sentence for not taking responsibility for patients who did not get sick going to a concert but while they were guests at your own facilities.

Then, when the infected elderly person was left on the shoulders of the family, the situation became, if possible, even worse. A family from Prato testified recently11 how they are "Been left alone" and getting alone "Palliative care assistance but only the last week" before the old woman's death. Other than machines for ventilation and home assistance: the family had to do everything "Without adequate protection, only a duster on, gloves and mask", living at the same time as "Inmates at home" and "It's much worse than prison because at least they feed you". The disarming conclusion, in a certain sense, does not rage on institutions but shows their naked reality: “I think they are all in full confusion. They no longer know how to move ". To say it with the local mayors, they missed "Proper care and support"12 for thousands of patients.

And don't think that RSA are just places for old people. A testimony from Piedmont makes the chills come: Daniele, 33 years old, guest of an RSA, is autistic serious and from March 22 he has the coronavirus cleared. His mom Deborah can't go to see him, because he's in isolation after coming into contact with his son, positive. Let's hear the mother13, which could be any of us: “By now alone since March 7, Daniele started having a high fever that they only cure with antibiotics. I made phone calls and looked for anyone ... The problem is that from March 22 no one has been heard for a check, the swab or the therapy (to Daniele) ... I am desperate ".

Large-scale swabs were not performed to limit the danger. Yes, Jérôme Salomon (photo) is right when he says that "You die in hospitals and hospices". Unfortunately, the latter die without the hope of a more serious and not just palliative treatment. Without having moved the elderly to even distant structures, because using them for the logistics of the Regions and the State was not a sensible investment. If you look at the statistics of neighboring Switzerland, the number of cases is proportionally the same as in Lombardy, but the results in terms of deaths are less than 100 times: this is because in addition to making a huge number of tampons, all the public force was employed ( and private) to move the sick with respiratory problems and the elderly in serious conditions from the cantons where the system was most under pressure (Ticino, Geneva, Zurich) to the others and to Germany. With us, we let the day go by. Except that the dead didn't make it. Was it fate? Or our usual indifference, this time with results from eugenic selection?

We said, at the beginning, of the Mezzogiorno. In the South, this type of structure, unfortunately or unfortunately, is much rarer: the disabled and the elderly who are not self-sufficient often remain in families, for which they are an important burden but to whose budget they contribute with the pension. Well, the slaughter was avoided just like that: not by concentrating the grandparents and the most fragile in structures without anti-epidemic safety plans, but by keeping them within the friendly walls.

Let's face it: with the RSA dead (and in part in rest homes and rehabilitation centers) removed, the Italian numbers are much, much less fearful. And if security plans had been prepared, perhaps the world today would not have been horrified by the effects of the pandemic in Italy (but also in Spain and France). Do you want to see that this is the "secret" of those countries with many infections and proportionally few deaths?

It sounds tragically mocking, even if scientifically flawless and to follow, the conclusion of the ISS that recommends "Adopt special attention in prevention and control". It is not known how many RSA had prepared risk management plans: from the summary of the report, it seems to understand not many ...

The advice, though serious, recalls the story of the stable which is closed when the oxen have already run away. Many of the thousands of critical cases are other elderly and disabled people, who will ultimately bring the contribution of these poor Christs to the war against COVID-19 in the tens of thousands. Cannon fodder, they would have once said, in a real war. Too bad that, if by now hopelessly disabled, these elders had "made Italy" between the post-war period and the years of Milan to drink, almost all men had served in the Armed Forces, at least during the military period: they did not deserve to die thus, perhaps brought by trucks of the same Armed Forces to the crematoria in a hurry and without even the flag of Italy on the side of the vehicle to pay homage to them. Italy, this time, was really a stepmother.

Readers in uniform who participated in these sad processions towards the crematoria, can you let us know if at least the crates have been covered with the symbols of Italy? If not, please do it yourself.

1 Directly or in agreement.

4 1.317 people in Lombardy alone, referring to April 5.


Photo: Salvatore Cuda (opening image), Civil Protection Department, Twitter, Ministère des Solidarités et de la Santé, web