Luis Encinas, the medical coordinator for MSF's mission in Spain, said the situation in that country, where the virus has killed more than 13,000 people, was especially worrying for the elderly.
“Old people are dying alone in hospitals but as well as nursing homes, without the company of loved ones,” he told reporters in a virtual briefing.
“Procedures need to definitely be adapted immediately to allow these people to be comfortable at the end of their lives,” he said.
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He urged countries to heed the lessons learned during the Ebola outbreak in west Africa that killed more than 11,000 people between 2013 and 2016.
Early on in that crisis, those taken sick were whisked away by people in protective suits often to die alone and be buried with no family present amid concerns of contagion.
The effect was that people balked and refused to follow safety instructions, putting themselves and others at risk.
It quickly became apparent that families and communities needed to be involved in decisions around end-of-life care and to be present for burials that were not only safe but also dignified.
'Find a balance'
Encinas insisted the same was true during the ongoing coronavirus pandemic, insisting that while safety must be a top concern, “we need to find a balance.”
“If you just focus on pure protection… and do not really involve family members, you really can provoke… no support of your decisions,” he said.
He pointed to a project in Barcelona, where authorities have called for the creation of “comfort hotels” for COVID-19 patients with little time left to live, providing them a space where they can safely interact with family members.
The idea is to equip hotels left during the crisis with proper infection prevention control and with the staff needed to keep patients comfortable, “and all the things related to the dignity, medical and psychological support for the patient and for the family,” Encinas said.
He stressed that there was a huge need for such a system, pointing out that Spain's official count of more than 135,000 cases was surely far lower than the actual number.
“We are seeing only the tip of the iceberg. We don't have a clear picture of what is going on,” said Encinas.
His colleague Chiara Lepora, who coordinates MSF's operations in Italy's hard-hit Lodi province southeast of Milan, said the same was true in Italy, which has the world's highest death count in the pandemic at 15,877.
She said it was unclear how many people were dying with or from COVID-19 outside of hospital settings, but said many municipalities in Lodi were seeing higher overall mortality rates.
“In the nursing homes we visited (in the province), we encountered between 10 and 30 percent mortality rate of the patient population,” she told the virtual briefing.
“Those numbers correspond to the lethality rate for COVID-19 in those age groups, but is nonetheless a tragedy in a confinement situation.”
MSF staff had also found that between 30 and 50 percent of all staff in the various nursing homes they visited were infected with the new coronavirus, she said.