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Europe's nursing homes in spotlight for uncounted virus dead

ROME – Italian authorities said Tuesday they were investigating the country’s biggest nursing home where 70 residents died last month, in a stark reminder of the difficulties Europe faces in accurately counting its pandemic victims, particularly among the elderly

Lombardy regional Gov. Attilio Fontana said he had opened a commission of inquiry into the deaths at Milan’s Pio Albergo Trivulzio home, given published claims by a doctor and a union leader that management downplayed the risk of infection and wrongly attributed the causes of death. La Repubblica newspaper said Milan prosecutors had opened a criminal investigation.

The Trivulzio home, which has 1,000 residents, disputed the Repubblica report, saying it had abided by all health care precautions, that COVID-19 tests simply weren’t available for its sick residents, and that the number of dead was in line with its 2019 toll.

Nursing home deaths have come to represent a significant hidden toll from the pandemic in Europe, since many elderly were never tested for the coronavirus, were never hospitalized and their deaths were never counted in official virus tolls.

“There is an underestimate of deaths in nursing homes, it’s futile to deny it,’’ said Dr. Giovanni Rezza, head of infectious disease at Italy’s National Institutes of Health.

He dodged questions about why residents weren’t being tested en masse, but acknowledged that entire clusters of infection had been traced to nursing homes, including at three facilities in central Lazio, far from Europe's main epicenter in the north.

It's not just Italy. Authorities in the Madrid region, where more than 3,300 elderly have died at nursing homes, enacted an emergency response plan last month which included sending troops to disinfect buildings. In late March, they made a shocking discovery, finding residents living in squalor among the infectious bodies of people suspected of having died of COVID-19.

In a normal month about 1,000 deaths are reported at Madrid regional nursing homes but now the rate is around 3,000, said regional president Isabel Díaz Ayuso, though she noted it is “very difficult” to know whether they died of the virus or something else.

Catalonia has also been hit hard, with 909 deaths reported at nursing homes by Monday.

The Italian Health Ministry’s deputy minister, Pierpaolo Sileri, told Radio Capitale that inspectors backed by the Carabinieri’s health care squad would gather documentation from the Milan facility as well as other nursing homes that have seen huge numbers of dead during the pandemic.

“One thing is certain, where there are fragile people and critical situations in nursing homes, there are more risks and it’s correct to go and check,” Sileri said. “Milan isn’t the only case in Italy; there have been similar situations near Catanzaro, in Sicily and in Lazio. I’m not identifying only one place, we’re checking across the board.”

The toll has been so high that Italy's National Institutes of Health launched a specific study for nursing homes nationwide to try to get a handle on what went wrong. Preliminary data released last week, based on responses from 236 of the 4,629 eldercare facilities in Italy, found a 9.4 percent death rate in February and March, with only a fraction of them classified as COVID-19.

The survey found 87% of the responding facilities reported a lack of protective equipment for medical personnel and that 36% were suffering from staffing problems because so many staff were infected. Another 23% reported having no information about how to contain the virus in the facility.

The association of doctors in the hard-hit Lombardy region estimated that 600 of the 6,000 elderly in residential facilities in Bergamo province alone had died — an astonishing 10% toll.

Fontana, the Lombardy governor, said he had authorized a commission to investigate the “real situation" in all the region's nursing homes, which are run by a combination of public, private, and religious entities. A separate commission was created for the Trivulzio home.

Despite the heavy toll at the Milan facility and nursing homes nationwide, Italy’s new infection rate continued to slow Tuesday with the lowest number of new cases since mid-March, bringing the official total to 135,586. Another 604 people died, bringing the world’s highest toll to 17,127.

Italy’s commissioner for the virus, Domenico Arcuri, welcomed the easing on new infections. But he warned Italians not to think that they can now put aside stay-at-home orders, particularly with Easter weekend coming.

“Be careful with illusions and mirages,” he said. “We are not at few steps from the exit of the emergency, we are not close to that hypothetical X hour that will quickly bring us back to the previous situation. Nothing could be more wrong than fantasizing about an imminent moment.”

Spain on Tuesday, meanwhile, saw a slight rise in the number of recorded deaths and coronavirus infections to 13,800 and 140,000 respectively. Health officials attributed the uptick to a backlog of reporting new data over the weekend.

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AP writers Barry Hatton in Lisbon, Portugal, Aritz Parra in Madrid and Frances D'Emilio in Rome contributed.