Medicine is a social science: COVID-19 and the tragedy of residential care facilities in high-income countries

In the context of the pandemic spread of COVID-19, the majority of high-income countries have witnessed an extraordinary high death toll of people living in residential care facilities.

Social epidemiology makes an important contribution to better understand this phenomenon, attributable to the biological impact of the pathogen on vulnerable high-risk populations and to the place of care as a decisive social determinant of health.

The tragedy of COVID-19 related deaths in nursing homes is primarily due to its iatrogenic spread and aggravated by socioeconomic circumstances.

Current isolation and confinement policies, including the prolonged separation of residents from their loved ones have failed to show their effectiveness in preventing these developments and are therefore disproportionate. They have to be replaced by policies that respect both the needs of safety of all residents and basic human rights.

In addition to the questionable effectiveness, these policies bear considerable opportunity costs, as they negatively affect quality of life and health outcomes of isolated residents.

Seen through the lens of medicine as a social science and of social epidemiology in particular, the COVID-19 crisis provides opportunities to better understand and fundamentally improve framework conditions within residential care facilities as well as other ‘large households’ all over the globe and to build safer institutions for all people in need of continuous care.