(QCOSTARICA) “May God protect us if we get a positive case of COVID-19! It would be a slaughter”. That is the fear of Maritza Jiménez Calvo, administrator of the Nursing Home in Palmar Sur de Osa, who is very clear that the virus is the greatest risk facing elderly care centers at this time, since its population is vulnerable by age and other diseases.
But the threat is greater. A report by La Nacion states that the severe acute respiratory syndrome type 2 coronavirus, or SARS-CoV-2, would cause chaos if it manages to penetrate the nursing homes, the 20 prisons with almost 16,000 inmates and the 35,000 plus coffee pickers of the next coffee harvest that begins in a few weeks.
The warning is made by Guiselle Guzmán Saborío, head of the Collective Health Area, of the Caja Costarricense de Seguro Social (CCSS), who believes it necessary, in these moments of community transmission, to focus on the most vulnerable populations.
“What are we going to do when we do not have the capacity to follow this virus transmission route? Focus on nursing homes, daycare centers, correctional facilities. In densely populated groups with a high prevalence of chronic diseases. If I am reaching the capacity edge, I prioritize vulnerable populations and places with a higher risk of mortality,” she said.
The worry of nursing homes is based on international data. According to the World Health Organization (WHO) half of the deaths in Europe occurred in nursing homes. The data was confirmed in June by the long term care website LTCcovid.com in a report from 26 countries: almost half (47%) of coronavirus deaths are tied to long-term care facilities.
In the United States, data compiled by the Kaiser Family Foundation (KFF) from 35 states, in May 2020, showed that nursing home residents accounted for 34.6% of the deaths recorded in that country.
The CCSS teams, therefore, have spent several weeks working on testing seniors in nursing homes and their caregivers.
In Costa Rica there are 76 nursing homes, known as long-stay centers, providing housing for 24,000 seniors. In addition, there are 56 day-care centers that serve 1,500 people over 65 years of age.
The red de cuidos – care network – takes care of 15,000 seniors and 15 shelters are looking out for the needs of another 1,000 in a condition of abandonment, according to records from the National Council of the Elderly (Conapam).
In April, a resident of the Carlos María Ulloa Home in Goicoechea was infected with the virus, but he was treated as a priority and the 198 residents were immediately tested, which ruled out more cases.
In another nursing home, in Heredia, the spread that started when a nurse infected two seniors caught in time. The residents live in separate houses, which made it easier to control and prevent other elderly people from becoming infected.
So far, the majority of those killed by coronaviruses are older than 65 years. Of the 28 who died in a four-month pandemic, 58% are seniors.
In Costa Rica, 35% of the population is made up of seniors.
Demographer and curator Luis Rosero Bixby advises health teams to be alert to an eventual and even more intense spread in the metropolitan area, in San José.
In this area, he said, areas with precarios and cuarterías – shantytowns and flophouses – are especially sensitive, where the inhabitants have no chance of maintaining physical distancing recommended.
According to 2017 data from the Housing Development Foundation (Fuprovi), in Costa Rica there are 400 precarios.
The San Jose district of Pavas, in of the most populous areas in the country, with some 88,000 inhabitants, and one of the areas with the highest number of shantytowns, 17.
In that district, on the west side of San Jose, 12.5% of its population lives in zinc and cardboard housing, crowded together and with few basic services, such as electricity and water and solid waste collection.
Pavas is one of the areas with massive testing in the past week, followed by canton of Alajuelita, in the south of San José.
Dr. Guzmán also points to the coffee pickers. The next grain harvest will begin in August in the so-called lower parts, such as the cantons of Coto Brus, Pérez Zeledón and Turrialba in the south part of the country. This is where she predicts that the spread of the virus will also head.
In areas of medium height, such as Valle Central and Valle Occidental, harvesting intensifies between October and December; while in higher lands, such as Los Santos, the season usually starts in November and runs until March or April, according to the Costa Rican Coffee Institute (Icafé).
On the radar is also the indigenous population, ethnic groups such as Bribri and Cabécar, for whom the so-called “whites”, says Guzmán, become the source of contagion.
In Costa Rica, there are 24 indigenous territories with more than 100,000 inhabitants, according to the 2011 census.
The impact is not expected to be great there, in view of its natural confinement. However, several health teams have traveled to these territories to review the health condition of their inhabitants.
Dr. Guiselle Guzmán confirmed that the interest is to identify, stop, and contain simultaneous outbreaks in many places after it was recognized that the installed capacity is insufficient to follow up on contacts.
“I don’t know how to answer this. I do not have all the information to evaluate it,” the specialist replied when asked if the health teams dealt late with situations that have been for years, such as the marginality of the cross-border population, or the precarios and cuarterias of the capital.
“Yes, that has always been there, but since this has been so new (the pandemic) we did not know where it was going to move. At one point, it was thought that everything would be as in the first cases, but the risk that came was not visualized because we did not see how fast it would reach the (marginal) population.
“Whether the actions were timely or not, I don’t know. What happened is that it was not visualized that it would hit so fast. Everything unleashed from one moment to the next. The virus moved faster than the measures,” admitted Guzmán.