HomeThe COVID-19 pandemic and people at risk of greater vulnerability and fragility: problems observed and proposals for action.

The COVID-19 pandemic and people at risk of greater vulnerability and fragility: problems observed and proposals for action.


We live in strange times. Situations that we never imagined could happen. But they do happen. They happen and they place us before an unknown reality, a reality for which we were not prepared and which moves us to collaborate in the search for solutions. And all of this in the face of an uncertain scenario, but not without the responsibility of providing an adequate response. The present document is the result of a reflection that, from the perspective of rights, we have carried out with a group of people linked to Entities that have the aim of supporting dependent people and those at risk of greater vulnerability and fragility.
The COVID 19 pandemic affects people from all walks of life, but not all of them equally. As the characteristics of the virus and its spread become better known, the existence of situations that favour the spread of the disease has become evident and / or aggravate pre-existing situations such as dependence on other people to carry out daily activities, overcrowding and economic fragility. A particularly vulnerable group is made up of elderly dependents, people in residential homes or the socially disadvantaged. 
The institutional and social response to the pandemic has serious difficulties in adequately addressing the needs of these sectors. This text does not intend to underestimate the effort of political and institutional representatives. Nor is it intended to be indiscriminate in its criticism. However, it is possible to think that attitudes that generate division in society are detrimental to dealing adequately and effectively with the serious problems that have arisen. In this regard, we call for unity of action among all political and social sensibilities in order to improve the care of the most vulnerable sectors of our society.
The problems facing our society are enormous. The efforts to be made are enormous. The members of this reflection group intend to contribute with some proposals to the improvement of social and health actions against the COVID-19 virus.
1- Discrimination based on chronological age criteria. 
Age does not predetermine people's situation, except for those who have judicially modified capacity, so that older people enjoy the condition of full citizenship and, therefore, their political and social rights must be respected, just like those of any other population group. 
The scarcity of socio-health resources that may exist should not be an argument in favour of discriminating against sectors that are disadvantaged by illness or poverty. In this sense, the risk of "social alienation" of the elderly, or that the end of their lives happens in loneliness or in bad socio-health conditions, must be considered.
Decisions affecting helpless people should not be taken exclusively by health professionals or institutions. A broader social consensus is needed that takes into account the opinion, needs and values of these particularly vulnerable people. 
Proposals for action:
- Inform society in general, and the sick and their families in particular, of the current capacity of care resources. 
- To avoid loneliness and isolation - both at home and in the care centres - through innovative, imaginative and effective measures, taking into account the families and the staff who care for dependent elderly people in residential centres.
- To promote the deliberation of the representatives of the civil society with the institutions and with the health professionals, on the rational use of the resources, taking into account the plural values of our society and the vital and functional prognosis of the affected people.
- To make possible in all cases dignified palliative care, with the resources deemed appropriate to achieve this end.

2- Protocols that are applied generally and indiscriminately.

The protocols aim to establish a series of criteria and actions that guarantee health and social action that reduces errors and allows the benefits obtained from experience and scientific knowledge to be extended. However, if they are applied without adequate knowledge of the situation in residential centres and of the people who use these centres and those who are cared for in their homes, the protocols can become a source of problems and negative actions with elderly dependents.
Proposal for action:
- To detect and accompany elderly people who live alone in their homes and need support and/or assistance.
- To individualise the care of people, taking into account the values expressed by them or their families. In the case that they have signed an Advance Directives, contact the person or persons designated as representatives. 

3- Shortage of staff in direct care for dependent elderly people and those with dementia.
Dependent elderly people, and/or those with mental health problems and dementias, require a coordinated set of health and social support interventions that guarantee their permanence in the community and respect for their condition as full citizens.
Proposal for action: 
- Develop and manage adequate and sufficient resources of social support with a multidisciplinary vision.
- Collaborate in the implementation and training of volunteer groups. 
- To offer training courses, inform and guide unemployed people and carers of dependent people without the necessary qualifications to obtain the Certificate of Professionalism in Social and Health Care for Dependent People in Institutions and/or at home. This would contribute to maintaining and increasing employability as well as improving the quality of care. 

4- Worsening of the generation gap
The idea that the lives of older people are less valuable than those of young people is gaining ground in our society. There is a view of older people as a burden, a source of expense. The same is true for people with disabilities or mental disorders. 
Proposal of action: 
- To prevent the "generation gap" from widening further with actions and activities, both educational and informative, aimed at increasing the relationship, solidarity and mutual knowledge of the problems of the different generations.
- Develop initiatives and programmes to promote citizen support and accompaniment networks. 
- To inform and raise awareness among the youngest people about the potential and work of the active elderly group. 

5- The role of information and communication
Information and communication by political and health authorities can and must serve to improve knowledge of the reality we face. It is possible that the information provided so far by the competent bodies has not achieved some of the objectives pursued and, consequently, awareness and participation of some sectors of the public in the recommendations of the political and health authorities has not been achieved. 
Proposal for action:
- Assess its impact on society and, if necessary, revise the communication policy, preserving transparency and the right to accurate information.
- To place greater emphasis on information and training measures that offer the possibility of participation to sectors that are usually far from citizen collaboration and cooperation.
6- Access to and appropriate use of masks.
All scientific consensus documents advocate the correct and widespread use of masks. The universal use of the mask is beneficial for health and for the country's economy. There is a lack of continuous and persuasive information and training measures. Economic fragility - actual or perceived - should not be a factor in preventing the supply of masks to the general and especially vulnerable population.
Proposal for action: 
- Continuous training and information policy on the use of masks that favours a generalised and adequate use. 
- Continuous and free delivery of surgical masks to the population through municipal services, pharmacies, institutions. Special protection must be given to the most vulnerable sectors due to their socio-economic situation or risk - the elderly, the chronically ill, etc.
7- Actions and behaviours that confuse and divide society 
It is worrying to observe attitudes and behaviour that can contribute to confusing and dividing society. With these guidelines, we will be further and further away from solving some problems, and may even increase some pre-existing inequalities.
For this reason, it is particularly important that the sectors involved whose decisions are relevant to the control of the pandemic face the serious challenge we are facing together.
Proposal for action:
- Search for a minimum consensus between the authorities and political and social representatives on the necessary actions in the socio-health field.
- Monitoring and generalised evaluation by all the authorities and agents concerned in the implementation of the measures to be adopted, taking into account the scientific advances that are taking place.
- Where appropriate, and given that the situation we are experiencing is changeable and unpredictable, explain and clarify the causes with regard to decisions which may be contradictory.
Group for the Observation of the Rights of Dependent Persons and those at risk of greater vulnerability and fragility: José Agustín Arrieta (AGIJUPENS), Koldo Aulestia (Afagi), Martin Auzmendi (Aubixa Fundazioa), Eduardo Clavé (Expert in Bioethics), José Luis de la Cuesta and José Luis Marañón (Hurkoa) and Pura Díaz Veiga (Matia Institute)