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The protective effect of the vaccine did not lift all restrictions



The cry comes from the heart. “Ah la la, it’s a joy, you can’t know!” I was starting to feel like I was in prison! “ Behind his mask, Jean, 82, lives again. For a few days now, in his Ehpad in Val-de-Marne, residents have once again had the right to mingle, to discuss, regardless of the floor where they live. “My room is at 2e, explains Jean. But I have friends at 3e and for several months, we have not seen each other! “The fault of the tight sanitary protocol, practiced in the establishment, to avoid the mixing of people.

But the “Total depression” (the expression is from Jean), it was before. Before 93% of the residents of his retirement home had been vaccinated against Covid-19. Before the Council of State orders, in an opinion issued on March 3, to suspend “Total ban” exit for nursing home residents, introduced nationally by the Ministry of Health on January 24.

In its judgment, the high administrative authority judges this ban “Disproportionate”. The Ministry of Health has engaged and promised an easing of restrictions in the 7,000 residences welcoming the elderly.

Explaining this development involves talking about numbers. As of March 3, 82% of nursing home residents had received a dose of vaccine and more than 50% the second injection. With encouraging first results. During its last weekly update, on March 4, Public Health France noted a “Improvement of all indicators among people aged 75 and over and nursing home residents”. The share of the latter in new contaminations, admissions to hospital or intensive care units, and deaths has decreased, reflecting “The protective effect of the level of vaccination coverage in this population. “

So everything would be better for the elderly, freed, never isolated again? Not that easy. The relaxed protocols are still, for the moment, the exception, and many of the 600,000 nursing home residents are still subject to restrictions. If the activities, the games, in small groups, the meals in the refectory, resumed, well before the decision of the Council of State, “Outings, room visits, entertainment for more than six people are still hypothetical for a lot of residents”, underlines Florence Arnaiz-Maumé, general delegate of Synerpa, the National Union of establishments and residences for the elderly.

The fear that some nursing home managers continue to experience prevents greater freedom, despite the vaccine. “Vaccine protection is not 100%. It avoids serious forms, of course, but does not prevent contamination ”, argues a director in the south of France. However, faced with the recommendations of the authorities, each director has room for maneuver. “The Council of State suggests making it more flexible on a case-by-case basis. My region is in a risk zone. So I’m not changing anything, for the moment ”, continues the same director.

” It’s unbearable “, laments Annette Debeda, whose father has declined so much since the spring that he spends the days “Look at the ceiling”. She visits him behind a plexiglass, in a room fitted out as a visiting room. “We are told that barrier gestures are not respected by all families. But sometimes the caregivers themselves don’t wear masks. After a year, you’ll have to learn to trust. “

In the absence of clear national guidelines, the easing risks turning into a balancing act. “We have reintroduced room visits and outings in the village”, says Émilie Jourdan, director of a retirement home near Rennes. ” But we won’t take the same precautions for a half-hour outing or a half-day family getaway. “

Because then, how to proceed, the return? Should the resident be isolated? Allow participation in collective activities? It is up to each establishment to adapt according to the local epidemic context, the specific situation (percentage of vaccinated, architecture, etc.). As a result, disparities between establishments and a feeling of injustice, among certain families.

In the “liberated” nursing homes, the easing is not, however, a relaxation. “The barrier gestures are maintained and in the event of positive residents, isolation measures can again be taken”, assures Émilie Jourdan.

During the consultation organized on March 5 with professionals of the elderly (federations of establishments, geriatricians, ethicists), Brigitte Bourguignon, Minister for Autonomy, indicated that the application of the flexibility measures should be “Progressive”, recalling that the vaccination campaign is not over and that the full effects of vaccination are not visible until two to three weeks after the 2e dose. “The reversibility of the easing measures must be able to be anticipated” in case of deterioration of the epidemic situation, she added.

“Some points also remain unresolved, says Florence Arnaiz-Maumé, from Synerpa. The difference in treatment between vaccinated and unvaccinated residents, for example. ” The National Consultative Ethics Committee has been referred to this matter and an opinion from the High Council for Public Health is expected in the coming days.

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