50% of Belgium’s Covid deaths were in care homes as of 6/20/20. “64% of all deaths linked to COVID-19 in Belgium would have been of care home residents.”…. “Hospitals always had space. Even at the peak of the pandemic, 1,100 of the nation’s 2,400 intensive care beds were free….Paramedics had been instructed by their referral hospital not to take patients over a certain age, often 75 but sometimes as low as 65.”
p. 6: “The reported % of deaths in care homes has increased since the first date these data were published, from 42% on the 11th April to 50% on 20th June. The weekly bulletin12 of the 19th June reports estimates that in total, there had been 6,213 deaths of care home residents, including 1,353 deaths in hospital and 15 in other locations, 21.8% of care home residents had died in hospital. Based on this, 64% of all deaths linked to COVID-19 in Belgium would have been of care home residents.“…6/26/20, ..”ltccovid.org | “Mortality associated with COVID-19 outbreaks in care homes: early international evidence,” International Long Term Care Policy Network
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Added: Belgium “has not one but nine health ministers, who answer to six parliaments….So even when officials realized the threat posed by Covid-19, they could not act decisively. “We needed several weeks to figure out who was responsible,” Pedro Facon, a top federal health official, testified this month [August 2020]….”“Paramedics had been instructed by their referral hospital not to take patients over a certain age, often 75 but sometimes as low as 65,” Médecins Sans Frontières said in a July report.”..Belgian national health minister said, “We can be proud” we never ran out of hospital beds.
8/8/20, “When Covid 19 hit, many elderly were left to die,” NY Times, Brussels. Print Edition Sunday, August 9, page A1
“Even at the height of the outbreak in April, when Ms. Balducci was turned away, intensive-care beds were no more than about 55 percent full.
“They wouldn’t accept old people,” Ms. Doyen said. “They had space, and they didn’t want them.”…
Nursing homes were left waiting for proper masks and gowns. When masks did arrive from the government, they came late and were sometimes defective.…
The country has not one but nine health ministers, who answer to six parliaments. The federal government takes a coordinating role in a pandemic, but nursing homes are the purview of regional authorities.
So even when officials realized the threat posed by Covid-19, they could not act decisively.
“We needed several weeks to figure out who was responsible,” Pedro Facon, a top federal health official, testified this month [August 2020]….
Caregivers were advised to reuse masks, withhold them from administrative staff members, and scrounge for gear from nearby hospitals….
Worsening the problem, Belgium was unable to test even a fraction of those infected. So the health authorities decided to test severely ill, hospitalized patients. Everyone else was told to recover at home.
That meant leaving contagious people inside crowded, understaffed, underequipped nursing homes.…
The Belgian authorities were aware of such problems, according to internal documents. “Some patients have returned from the hospital infected,” a government emergency committee wrote on March 25. “Several hot spots have been caused this way.”
The committee recommended testing nursing-home residents and establishing locations to house Covid-19 patients who would otherwise be returned to homes.
But national and regional authorities could not agree on those recommendations, and the country remained a hodgepodge of policies.
For another two weeks, even as the government expanded its testing capability, health advisers resisted adding nursing homes to the national testing priority list. They worried that even the newfound capacity would be unable to meet the demand under the broadened criteria, according to documents and government officials.
“The federal government had tests. Hospitals had tests,” said Dr. Emmanuel André, a virologist who was tapped as a top government adviser and who advocated for broader federal testing. “But nursing homes? There were no tests allowed.”…
As the testing debate unfolded in late March and early April, hospitals quietly stopped taking infected patients from nursing homes.
The policy–officially it was just advice–took shape in a series of memos from Belgian geriatric specialists.
“Unnecessary transfers are a risk for ambulance workers and emergency rooms,” read an early memo, signed by the Belgian Society for Gerontology and Geriatrics and two major hospitals.
Extremely frail patients and the terminally ill should receive palliative care and not be hospitalized, the memo said. The document offered a complex flowchart for deciding when to hospitalize nursing-home residents.
The gerontology society says that its advice--drafted in case of an overwhelmed hospital system–was misunderstood. The society is not a government agency, doctors there note, and it never intended to deny hospital care for the elderly.
But that is what happened….
It is impossible to know how many deaths were preventable. But hospitals always had space. Even at the peak of the pandemic, 1,100 of the nation’s 2,400 intensive care beds were free, according to Niel Hens, a government adviser and University of Antwerp professor.
“Paramedics had been instructed by their referral hospital not to take patients over a certain age, often 75 but sometimes as low as 65,” Médecins Sans Frontières said in a July report….
Ms. De Block, the national health minister, declined to be interviewed and did not respond to written questions. In interviews, senior hospital doctors defended their policies. They said that nursing-home staff sought hospital care for terminally ill patients who needed to be comforted into death, not dragged to the hospital….
“At a certain point, there was an implicit age limit,” said Marijke Verboven of Orpea group, which owns 60 homes around Belgium.
Mr. Moreels, whose nursing home, Val des Roses, also had an intervention from a Médecins Sans Frontières team, agreed. “The ambulance wouldn’t take them,” he said. “There was no detailed consultation. They just said ‘Why did you even call us?’”
The Brussels ambulance service denied any policy of refusing to take nursing-home residents to the hospital. Yet even some doctors are skeptical.
“We learned that people from care homes believed it was not even worth calling an ambulance,” said Dr. Charlotte Martin, the chief epidemiologist at Saint-Pierre Hospital in central Brussels. “They should have been the first ones to get in the pipeline. And instead they were just forgotten.”…
Today, Ms. De Block, Belgium’s national health minister, speaks about the nursing homes as if they were an unfortunate footnote in a story of a successful government response. She notes with pride that Belgium never ran out of hospital beds.
“We took measures at the right moment,” she said in an interview, adding, “We can be proud.””
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Added: “Positive Tests” and “new tests” rise together:
Oct. 30, 2020, “COVID-19 Belgium Epidemiological Situation,” Sciensano, datastudio.google.com
Magic: “Positive Tests” and “new tests” rise together:
Below, Rt estimate of contagiousness: Rt estimates “depend on many decisions made as part of the modeling process. They must be interpreted with caution.”
Above, Rt: “Rt is an estimate of contagiousness that is a function of human behaviour at a given time and biological characteristics of pathogens. An epidemic should continue if Rt is >1 and decrease if Rt is <1.The values of Rt are estimated from a mathematical model (in this case the model is based on the number of hospitalizations), and the estimated values depend on many decisions made as part of the modeling process. They must be interpreted with caution.”
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