Shirley Doyen was exhausted. The Christalain nursing home, which she ran with her brother in an affluent neighborhood in Brussels, was buckling from Covid-19. Eight residents had died in three weeks. Some staff members had only gowns and goggles from Halloween doctor costumes for protection.
Nor was help coming. Doyen had begged hospitals to collect her infected residents. They refused. Sometimes she was told to administer morphine and let death come. Once she was told to pray.
Then, in the early morning of April 10, it all got worse.
First, a resident died at 1:20 a.m. Three hours later, another died. At 5:30 a.m., still another. The night nurse had long since given up calling ambulances.
Doyen arrived after dawn and discovered Addolorata Balducci, 89, in distress from Covid-19. Balducci’s son, Franco Pacchioli, demanded that paramedics be called and begged them to take his mother to the hospital. Instead, they gave her morphine.
“Your mother will die,” the paramedics responded, Pacchioli recalled. “That’s it.”
The paramedics left. Eight hours later, Balducci died.
Runaway coronavirus infections, medical gear shortages and government inattention are woefully familiar stories in nursing homes around the globe. But Belgium’s response offers a gruesome twist: Paramedics and hospitals sometimes flatly denied care to elderly people, even as hospital beds sat unused.
Weeks earlier, the virus had overwhelmed hospitals in Italy. Determined to prevent that from happening in Belgium, the authorities shunned and all but ignored nursing homes. But while Italian doctors said they were forced to ration care to the elderly because of shortages of space and equipment, Belgium’s hospital system never came under similar strain.
Even at the height of the outbreak in April, when Balducci was turned away, intensive-care beds were no more than about 55% full.
“They wouldn’t accept old people,” Doyen said. “They had space, and they didn’t want them.”
Belgian officials say denying care for the elderly was never their policy. But in the absence of a national strategy, and with regional officials bickering about who was in charge, officials now acknowledge that some hospitals and emergency responders relied on vague advice and guidelines to do just that.
The situation was so dire that the charity Doctors Without Borders, known in French as Médecins Sans Frontières, dispatched teams of experts more accustomed to working in war-hardened countries. On March 25, when a team arrived at Val des Fleurs, a public nursing home a few miles from European Union headquarters, they were greeted by the stale smell of disinfectant and an eerie stillness, pierced only by the song of a caged canary.
Seventeen people had died there in the past 10 days. There was no protective equipment. Oxygen was running low. Half the staff was infected. Others showed signs of trauma common in disaster zones, a psychologist from the medical charity concluded.
The director and her deputy were sick with Covid-19, and the acting chief collapsed in a chair, crying, as soon as the team met her.
“I never thought I would work with MSF in my own country. That’s crazy. We are a rich country,” said Marine Tondeur, a Belgian nurse who has worked in South Sudan and Haiti.
Tondeur was horrified at her country’s response.
“I feel a bit ashamed, actually, that we forgot those homes.”
<strong>Test, Return, Infect</strong>
Belgium went into lockdown on March 18. Dozens of nursing-home residents had already died. Three days later, Jacqueline Van Peteghem, a 91-year-old resident at the Christalain home, was sent to UZ Brussel, a nearby hospital, where she was tested for Covid-19. Within days, her test came back positive.
The Doyens assumed Van Peteghem would remain hospitalized for treatment and to prevent the disease from spreading to scores of other residents. But her symptoms had stabilized, and Steve Doyen, Christalain’s co-owner, said that a hospital doctor declared her healthy enough to return home.
So, on March 27, paramedics in hazmat suits delivered Van Peteghem, on a stretcher, to the door of Christalain.
Steve Doyen greeted them wearing a surgical mask.
“Is this mask all you have?” the paramedics asked, he recalled.
“Yes,” he said.
“Good luck,” they responded.
No one can be certain if Van Peteghem’s return was the reason, but Covid-19 infections in the home increased. Residents began dying. Van Peteghem, who initially survived the virus, died last month.
By late March and early April, hospitals quietly stopped taking infected patients from nursing homes.
The policy — officially it was just advice — took shape in a series of memos from Belgian geriatric specialists.
“Unnecessary transfers are a risk for ambulance workers and emergency rooms,” read an early memo, signed by the Belgian Society for Gerontology and Geriatrics and two major hospitals.
The gerontology society says that its advice — drafted in case of an overwhelmed hospital system — was misunderstood. The society is not a government agency, doctors there note, and it never intended to deny hospital care for the elderly.
But that is what happened.
It is impossible to know how many deaths were preventable. But hospitals always had space. Even at the peak of the pandemic, 1,100 of the nation’s 2,400 intensive care beds were free, according to Niel Hens, a government adviser and University of Antwerp professor.
Maggie De Block, Belgium’s national health minister, declined to be interviewed and did not respond to written questions. In interviews, senior hospital doctors defended their policies. They said that nursing-home staff sought hospital care for terminally ill patients who needed to be comforted into death, not dragged to the hospital.
If nursing-home residents were denied admission, they say, it was because a doctor determined that they were unlikely to survive.
Nursing-home administrators are adamant that was not the case.
“At a certain point, there was an implicit age limit,” said Marijke Verboven of Orpea group, which owns 60 homes around Belgium.
The Doctors Without Borders teams concluded their nursing-home missions in Belgium in mid-June. Some members returned to developing countries. Others now work in another rich nation in crisis: the United States.
Today, De Block speaks about the nursing homes as if they were an unfortunate footnote in a story of a successful government response. She notes with pride that Belgium never ran out of hospital beds.
“We took measures at the right moment,” she said in an interview, adding, “We can be proud.”