By Emma Farge

GENEVA (Reuters) – More attention needs to be given to COVID-19 patients outside of hospitals where care workers are often poorly-equipped and the sick are dying alone, representatives from Medicins Sans Frontieres (MSF) in Italy and Spain said on Monday.

Infection rates of the respiratory disease are beginning to slow in two of the worst-hit countries which have together accounted for more than 20% of over 1.2 million cases in the global pandemic, according to World Health Organization data.

Staff for the medical charity said the slight easing in the case-load was allowing them to begin to grapple with the scale of the contagion and deaths at nursing homes and individual homes which are often not covered by official figures.

“We suffered very much because of over-inflated attention to hospitals,” Dr Chiara Lepora, MSF project coordinator in Italy’s Lodi province in Lombardy told journalists in Geneva in a briefing about “challenges from the field”.

“When the number of cases is overwhelming compared to resources, it is necessary to put in place and develop and sustain a number of alternatives.”

She said it was not yet possible to say how many had died outside of hospitals, but added more than half of suspected COVID-19 patients in some areas never went there.

Of the nursing homes MSF visited, there was a mortality rate of 10-30% among residents, she said. While it has not been possible to confirm what they died of amid test shortages, this matched the COVID-19 mortality rate for those age groups.

Staff infection rates in the same facilities were 30-50%. It was not immediately clear how that percentage compares with hospitals. More than 4,000 Italian health workers have contracted the virus.

“We really, really call for every other (place) … that has not yet seen this tragedy unfolding to be more prepared and protect the staff working in nursing homes,” she said.

MSF has about 30 staff in Italy and is helping the government.

“We need to focus on nursing homes where people have no training and there is not the same level of medical care,” said MSF’s Luis Encinas, medical coordinator for its 65-person Spanish mission. Spain has over 12,000 infected health workers.

“Old people are dying alone in hospitals but also in nursing homes without the company of loved ones and in terms of dignity that is one of the key lessons learned,” he said.

Processes also need to be adapted immediately to allow loved ones to say goodbye to COVID-19 patients under protocols to reduce infection risks, he said.

(Reporting by Emma Farge; Editing by Mark Potter)