Let’s release now the constraints imposed in sheltered home for elderly dependent persons (EHPAD)!
Press Release of the French National Academy of Medicine
12 March 2021
Since the beginning of the Covid-19 pandemic, the population of elderly and dependent people living in medico-social establishments proved to be at high risk of morbidity and mortality, accounting for more than one third of deaths attributable to this infection. A strict isolation plan was rapidly implemented in EHPADs to avoid the exposure of their residents to SARS-CoV2. Despite their undeniable effectiveness, these morally demanding measures, difficult to maintain over time, were often thwarted by the occurrence of epidemic outbreaks (clusters).
Initiated on December 2, 2020, the national vaccination campaign aimed to immunize, as a priority, the 750,000 elderly people living in EHPADs or long-term care units (USLD) by the end of February. Despite the very gradual start of this campaign , this objective has been partially achieved, with 85% of people living in one of the 7200 EHPADs in France having received at least one injection of messenger RNA vaccine and 63% both doses. On the other hand, only 33% of the nursing staff working in these establishments, also a priority in this first phase, are currently vaccinated (first dose) and 13% (two doses). However, the first results of the vaccination campaign are already perceptible, with the daily number of deaths in EHPADs having fallen by more than 50% over the last month, this post-vaccination protection complementing a variable degree of collective immunity shared by the residents of establishments where clusters have appeared.
This undeniable progress calls into question the legitimacy of restrictions on travel and visits, which are more or less rigorously applied from one residence to another. Doesn’t the maintenance of these constraints, whose deleterious effects have been well documented , involve greater risks than the Covid-19 itself? How much longer must EHPADs that have vaccinated the majority of their residents and staff limit visits, prohibit outings and prevent the conviviality of community life?
While maintaining a strict compliance with barrier measures, it is possible to gradually lift isolation measures that may now appear arbitrary, if not “prison-like”. It is time to restore social links with the population living in EHPAD by completing its immune coverage. This approach towards these fragile people, who have already been deprived of one year of quality of life, is not only humanitarian and benevolent, but also preventive by avoiding aggravating their vulnerability and compromising their mobility when it is still possible. As the average life expectancy for a resident of an EHPAD aged over 85 is less than 3 years, the time has come to reduce the measures limiting the freedom of our elderly, to allow them to receive their loved ones and to maintain their emotional ties, that is to say to preserve their well-being.
Taking into account the progress of the national vaccination campaign against Covid-19, the French “Académie nationale de médecine” recommends:
– to lift the strict containment measures inside the EHPADs when the vaccination coverage rate reaches 80% of their residents;
– to encourage residents, who are, as well as their families, still hesitant, to be vaccinated in order to restore unrestricted visits;
– to make vaccination against Covid-19 compulsory for all health professionals working in EHPADs and USLDs ;
– to promote a normal community life in all medico-social establishments while respecting barrier gestures.
 Press release of the National Academy of Medicine “Vaccination anti-Covid: no longer time to wait”, December 31, 2020
 Press release of the National Academy of Medicine “Caring for elderly adults with cognitive impairment in containement”, April 24, 2020
 Press release of the National Academy of Medicine “Vaccination of caregivers against Covid-19 must become mandatory”, March 9, 2021