France's President Emmanuel Macron talked with staff during a visit to a Paris nursing home in March.
Photo: ludovic marin/Agence France-Presse/Getty ImagesPARIS—When President Emmanuel Macron entered the Péan nursing home on March 6 to raise public awareness about the dangers coronavirus posed to older people, the French leader brought along a group of officials and journalists.
“I know it’s heartbreaking, but as much as possible, we must avoid visiting our elderly,” Mr. Macron told the group.
Like many leaders at the time, Mr. Macron didn’t fully grasp just how vulnerable nursing homes were to the disease. Five days later France banned all visits to the facilities, but it was too late. Since then, the virus has taken hold in the French facility Mr. Macron visited and ravaged others around the world—including the U.S.—as health authorities failed to protect a segment of the population most vulnerable to the disease.
Nowhere is that failure more apparent than in France. Home to a vaunted public health-care system, France’s breakdown began with an absence of sufficient measures to safeguard the facilities against infection and deepened as some emergency services systematically refused hospital care to nursing-home residents, according to medical staff.
More than 10,000 nursing-home residents have died from Covid-19 in France inside the facilities and in hospitals, according to the government, one of the highest official nursing-home death tolls of any country world-wide. That includes seven deaths at the Péan facility.
Mr. Macron, the son of two physicians, mobilized France’s hospitals to prepare for a wave of Covid-19 patients the government feared would overwhelm hospital capacity. He requisitioned masks and other protective gear from stores and businesses across the country to protect nurses and doctors working on the front lines. And his government equipped the nation’s high-speed trains to zip patients from hard-hit regions to hospitals with open beds.
The hospitals survived the onslaught, but they didn’t bear the full brunt of the virus.
Instead, the virus slipped into France’s national network of nursing homes. The facilities lacked testing kits to detect the virus’ arrival as well as masks and protective equipment to stop it from spreading. Many staff who caught it remained asymptomatic while residents fell ill and died in the shadows.
Paris during lockdown. President Macron said France wasn’t properly prepared for the crisis.
Photo: joel saget/Agence France-Presse/Getty ImagesIn regions hit hardest by the virus, emergency services refused to take some nursing-home residents to the hospital as younger and less frail patients were given priority, according to medical personnel. One chart in circulation among nursing-home staff, which was viewed by The Wall Street Journal, listed being over the age of 70 as a comorbidity—having two conditions at once.
Some personnel said they were given a decision flow chart with a narrow window of action: Residents must be sick enough to warrant a hospital transfer but not so frail that they have little chance of recovery. Residents often succumb before action is taken, said Tatiana Dubuc, an assistant nurse and union leader in one of the country’s largest nursing homes in Le Havre, in Northern France.
“It feels like we are letting our old people die,” she said.
Over a 10-day period beginning on March 15, emergency services in badly hit regions began systematically refusing nursing-home patients, said Dr. Gaël Durel, president of MCoor, a national association of nursing home doctors. First responders tasked with ferrying people to intensive-care units were also unaware that the government, in canceling elective surgeries, had created a reserve of empty beds in other hospital areas as well as in private clinics, he said.
As of April 20, nursing-home residents accounted for just 8.5% of total French coronavirus hospitalizations, despite representing 36% of all confirmed and suspected infections.
“Some deaths could have been avoided,” Dr. Durel said.
In a televised address from the Élysée Palace last week, Mr. Macron said France wasn’t properly prepared for the crisis. “We were not able to distribute as many masks as we would have liked to for health workers and staff looking after our seniors,” he said.
Health authorities are setting up hotlines to allow nursing homes to reach out directly to hospitals, according to Jérôme Salomon, director of public health, and transfer patients without having to go through emergency services.
“Some nursing homes reported difficulties to contact local hospitals,” Mr. Salomon said this past week, adding that the difficulties were rare. “This is something that we want to fight.”
Health Minister Olivier Véran has pledged to test the staff and residents of all nursing homes across the country, but doctors and staff say nursing homes are still waiting for tests in western France and other parts of the country.
The sluggish response stems in part from authorities’ struggle to measure the impact of Covid-19 on nursing homes. That is a blind spot that countries around the world are only beginning to confront.
In the U.S., more than 10,000 people have died in nursing homes in at least 35 states, according to a Wall Street Journal survey. At least 4,800 facilities across the country have recorded infections, and more than 53,000 residents and staff have been infected.
U.K. authorities have registered 1,043 coronavirus deaths in nursing homes in England and Wales; Italy’s national health institute estimates that 40% of the 7,000 deaths that occurred in nursing homes up to April 15 involved a confirmed or suspected coronavirus infection. Officials in both countries warn the toll may end up being much greater. In Belgium, health authorities estimate that more than half of the 5,828 people who died from coronavirus through April 20 were at nursing homes.
In France, more than 8,000 people have died in nursing homes as of Friday, more than a third of the national death toll.
The coronavirus outbreak arrived in France during a time of crisis for its health system. Recent budget cuts had forced hospitals to slash their number of beds and cut staff, and the country’s health minister quit in February to become Mr. Macron’s candidate for Paris mayor.
Many nursing homes still don’t have medical staff at night. Only two thirds have a resident doctor. Few are well enough equipped to deal with seriously ill patients. Their respirators typically deliver oxygen at two to three times lower than ones in hospitals.
On March 4, Mr. Macron convened his cabinet. Culture Minister Franck Riester—who would test positive for Covid-19 five days later after developing symptoms—attended the meeting.
Mr. Macron met with nursing home residents in Paris in March.
Photo: Ludovic Marin/Associated PressOn March 6 Mr. Macron and his team visited Péan, where the president joined residents at their lunch tables. Nine days later, the nursing home registered its first confirmed coronavirus case. Romy Lasserre, the director of the nursing home, contacted all the families of the 94 residents to tell them.
“There were four families who said that they had the virus, and that without a doubt they had it when they visited their parents a little more than a week before,” Ms. Lasserre said.
A spokeswoman for Mr. Macron didn’t respond to questions about the president’s visit to the nursing home.
During Mr. Macron’s visit, Ms. Lasserre said that journalists were kept at distance from the residents, and that Mr. Macron didn’t shake people’s hands. “We didn’t feel invaded,” she said.
After France banned visitors to nursing homes on March 11, doctors, nurses and other staff continued to come in and out of the facilities homes without getting tested for the virus. Hamstrung by limited capacity, France was focused on testing people with acute breathing problems.
Amid national shortages, few wore masks until the second half of March as they cared for residents, helping them eat, bathe or walk. Most nursing homes didn’t have any protective gear in stock, and when they did, management often asked their staff not to use it until cases of the virus appeared, they added.
When the country went under lockdown on March 17, life inside many nursing homes still went on as usual: residents gathered for meals, to play cards or watch television together.
Alarmed, Dr. Frédéric Maraval, a doctor in western France, urged nursing homes where he worked to shut down their restaurant. One director refused, saying he had received no such order from local health authorities. “I had to threaten to quit,” Dr. Maraval says.
On March 22, French health authorities ordered nursing homes to keep residents inside their rooms. They also sent masks and other protective equipment to nursing homes across the country. By then, the virus had already spread to several thousand homes.
Denis Grably, a doctor from the Paris region, said he had to fight to get his 81-year-old brother, a nursing home resident, transferred to a hospital.
“If I had not intervened, my brother would probably have died in this nursing home,” said Dr. Grably. His brother was in a critical condition when he was finally admitted at the hospital this month, three weeks after he started developing symptoms, said Dr. Grably. He is now slowly recovering.
—Giovanni Legorano, Valentina Pop and Jason Douglas contributed to this article.
Write to Noemie Bisserbe at noemie.bisserbe@wsj.com and Matthew Dalton at Matthew.Dalton@wsj.com
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