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Collingridge Moore D, Garner A, Cotterell N, Harding AJE, Preston N. Long term care facilities in England during the COVID-19 pandemic-a scoping review of guidelines, policy and recommendations. BMC Geriatr 2024; 24:394. [PMID: 38702669 PMCID: PMC11069159 DOI: 10.1186/s12877-024-04867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/04/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The disproportionate effect of COVID-19 on long term care facility (LTCF) residents has highlighted the need for clear, consistent guidance on the management of pandemics in such settings. As research exploring the experiences of LTCFs during the pandemic and the implications of mass hospital discharge, restricting staff movement, and limiting visitation from relatives are emerging, an in-depth review of policies, guidance and recommendations issued during this time could facilitate wider understanding in this area. AIMS To identify policies, guidance, and recommendations related to LTCF staff and residents, in England issued by the government during the COVID-19 pandemic, developing a timeline of key events and synthesizing the policy aims, recommendations, implementation and intended outcomes. METHOD A scoping review of publicly available policy documents, guidance, and recommendations related to COVID-19 in LTCFs in England, identified using systematic searches of UK government websites. The main aims, recommendations, implementation and intended outcomes reported in included documents were extracted. Data was analysed using thematic synthesis following a three-stage approach: coding the text, grouping codes into descriptive themes, and development of analytical themes. RESULTS Thirty-three key policy documents were included in the review. Six areas of recommendations were identified: infection prevention and control, hospital discharge, testing and vaccination, staffing, visitation and continuing routine care. Seven areas of implementation were identified: funding, collaborative working, monitoring and data collection, reducing workload, decision making and leadership, training and technology, and communication. DISCUSSION LTCFs remain complex settings, and it is imperative that lessons are learned from the experiences during COVID-19 to ensure that future pandemics are managed appropriately. This review has synthesized the policies issued during this time, however, the extent to which such guidance was communicated to LTCFs, and subsequently implemented, in addition to being effective, requires further research. In particular, understanding the secondary effects of such policies and how they can be introduced within the existing challenges inherent to adult social care, need addressing.
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Affiliation(s)
| | - Alex Garner
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | | | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, UK
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Burton JK, McMinn M, Vaughan JE, Nightingale G, Fleuriot J, Guthrie B. Analysis of the impact of COVID-19 on Scotland's care-homes from March 2020 to October 2021: national linked data cohort analysis. Age Ageing 2024; 53:afae015. [PMID: 38342752 PMCID: PMC10859243 DOI: 10.1093/ageing/afae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/14/2023] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND The impact of the COVID-19 pandemic on long-term care residents remains of wide interest, but most analyses focus on the initial wave of infections. OBJECTIVE To examine change over time in: (i) The size, duration, classification and pattern of care-home outbreaks of COVID-19 and associated mortality and (ii) characteristics associated with an outbreak. DESIGN Retrospective observational cohort study using routinely-collected data. SETTING All adult care-homes in Scotland (1,092 homes, 41,299 places). METHODS Analysis was undertaken at care-home level, over three periods. Period (P)1 01/03/2020-31/08/2020; P2 01/09/2020-31/05/2021 and P3 01/06/2021-31/10/2021. Outcomes were the presence and characteristics of outbreaks and mortality within the care-home. Cluster analysis was used to compare the pattern of outbreaks. Logistic regression examined care-home characteristics associated with outbreaks. RESULTS In total 296 (27.1%) care-homes had one outbreak, 220 (20.1%) had two, 91 (8.3%) had three, and 68 (6.2%) had four or more. There were 1,313 outbreaks involving residents: 431 outbreaks in P1, 559 in P2 and 323 in P3. The COVID-19 mortality rate per 1,000 beds fell from 45.8 in P1, to 29.3 in P2, and 3.5 in P3. Larger care-homes were much more likely to have an outbreak, but associations between size and outbreaks were weaker in later periods. CONCLUSIONS COVID-19 mitigation measures appear to have been beneficial, although the impact on residents remained severe until early 2021. Care-home residents, staff, relatives and providers are critical groups for consideration and involvement in future pandemic planning.
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Affiliation(s)
- Jennifer Kirsty Burton
- Academic Geriatric Medicine, School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, GlasgowG31 2ER, UK
| | - Megan McMinn
- Public Health Scotland, Glasgow G2 6QE, UK
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - James E Vaughan
- School of Informatics, University of Edinburgh, Edinburgh EH8 9AB, UK
| | - Glenna Nightingale
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AB, UK
| | - Jacques Fleuriot
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
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Krutikov M, Stirrup O, Fuller C, Adams N, Azmi B, Irwin-Singer A, Sethu N, Hayward A, Altamirano H, Copas A, Shallcross L. Built Environment and SARS-CoV-2 Transmission in Long-Term Care Facilities: Cross-Sectional Survey and Data Linkage. J Am Med Dir Assoc 2024; 25:304-313.e11. [PMID: 38065220 PMCID: PMC11139658 DOI: 10.1016/j.jamda.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES To describe the built environment in long-term care facilities (LTCF) and its association with introduction and transmission of SARS-CoV-2 infection. DESIGN Cross-sectional survey with linkage to routine surveillance data. SETTING AND PARTICIPANTS LTCFs in England caring for adults ≥65 years old, participating in the VIVALDI study (ISRCTN14447421) were eligible. Data were included from residents and staff. METHODS Cross-sectional survey of the LTCF built environment with linkage to routinely collected asymptomatic and symptomatic SARS-CoV-2 testing and vaccination data between September 1, 2020, and March 31, 2022. We used individual and LTCF level Poisson and Negative Binomial regression models to identify risk factors for 4 outcomes: incidence rate of resident infections and outbreaks, outbreak size, and duration. We considered interactions with variant transmissibility (pre vs post Omicron dominance). RESULTS A total of 134 of 151 (88.7%) LTCFs participated in the survey, contributing data for 13,010 residents and 17,766 staff. After adjustment and stratification, outbreak incidence (measuring infection introduction) was only associated with SARS-CoV-2 incidence in the community [incidence rate ratio (IRR) for high vs low incidence, 2.84; 95% CI, 1.85-4.36]. Characteristics of the built environment were associated with transmission outcomes and differed by variant transmissibility. For resident infection incidence, factors included number of storeys (0.64; 0.43-0.97) and bedrooms (1.04; 1.02-1.06), and purpose-built vs converted buildings (1.99; 1.08-3.69). Air quality was associated with outbreak size (dry vs just right 1.46; 1.00-2.13). Funding model (0.99; 0.99-1.00), crowding (0.98; 0.96-0.99), and bedroom temperature (1.15; 1.01-1.32) were associated with outbreak duration. CONCLUSIONS AND IMPLICATIONS We describe previously undocumented diversity in LTCF built environments. LTCFs have limited opportunities to prevent SARS-CoV-2 introduction, which was only driven by community incidence. However, adjusting the built environment, for example by isolating infected residents or improving airflow, may reduce transmission, although data quality was limited by subjectivity. Identifying LTCF built environment modifications that prevent infection transmission should be a research priority.
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Affiliation(s)
- Maria Krutikov
- Institute of Health Informatics, University College London, London, UK.
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - Chris Fuller
- Institute of Health Informatics, University College London, London, UK
| | - Natalie Adams
- Institute of Health Informatics, University College London, London, UK
| | - Borscha Azmi
- Institute of Health Informatics, University College London, London, UK
| | - Aidan Irwin-Singer
- Surveillance Testing and Immunity, UK Health Security Agency, London, UK
| | - Niyathi Sethu
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Hector Altamirano
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
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Bakare RA, Mulcahy JF, Pullen MF, Demmer RT, Cox SL, Thurn JA, Galdys AL. Patient-facing job role is associated with SARS-CoV-2 positivity among healthcare workers in long term care facilities in Minnesota, August-December, 2020. Infect Control Hosp Epidemiol 2023; 44:1467-1471. [PMID: 36912330 PMCID: PMC10507513 DOI: 10.1017/ice.2022.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Healthcare workers (HCWs) in long-term care facilities (LTCFs) are disproportionately affected by severe acute respiratory coronavirus virus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). To characterize factors associated with SARS-CoV-2 positivity among LTCF HCWs, we performed a retrospective cohort study among HCWs in 32 LTCFs in the Minneapolis-St Paul region. METHODS We analyzed the outcome of SARS-CoV-2 polymerase chain reaction (PCR) positivity among LTCF HCWs during weeks 34-52 of 2020. LTCF and HCW-level characteristics, including facility size, facility risk score for resident-HCW contact, and resident-facing job role, were modeled in univariable and multivariable generalized linear regressions to determine their association with SARS-CoV-2 positivity. RESULTS Between weeks 34 and 52, 440 (20.7%) of 2,130 unique HCWs tested positive for SARS-CoV-2 at least once. In the univariable model, non-resident-facing HCWs had lower odds of infection (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.36-0.70). In the multivariable model, the odds remained lower for non-resident-facing HCW (OR, 0.50; 95% CI, 0.36-0.71), and those in medium- versus low-risk facilities experienced higher odds of testing positive for SARS-CoV-2 (OR, 1.47; 95% CI, 1.08-2.02). CONCLUSIONS Our findings suggest that COVID-19 cases are related to contact between HCW and residents in LTCFs. This association should be considered when formulating infection prevention and control policies to mitigate the spread of SARS-CoV-2 in LTCFs.
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Affiliation(s)
| | - John F. Mulcahy
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | | | - Ryan T. Demmer
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Sara L. Cox
- M Health Fairview Health System, Minneapolis, Minnesota
| | | | - Alison L. Galdys
- University of Minnesota School of Medicine, Minneapolis, Minnesota
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Said D, Sin MA, Zanuzdana A, Schweickert B, Eckmanns T. [Long-term care facilities-the COVID-19 pandemic as an urgent call: infection prevention, control measures, and factors influencing the health of residents]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:248-255. [PMID: 36750471 PMCID: PMC9904872 DOI: 10.1007/s00103-023-03657-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/12/2023] [Indexed: 02/09/2023]
Abstract
The COVID-19 pandemic once again highlighted the vulnerability of residents of long-term care facilities due to their increased risk of a severe or fatal course of COVID-19. To protect the residents in the face of high incidences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) in the general population, a number of measures for infection protection were recommended, which led to a decrease of COVID-19 case numbers and deaths in the facilities during the pandemic. However, factors in the facilities that hampered the implementation of these measures and represented a significant impact on the health of the residents also became visible.The challenges concern working conditions (e.g., lack of staff, both in general and with corresponding competencies, and work-related stress), the care of residents (e.g., medical and psychosocial), and structural as well as facility-related factors (e.g., facility size).Approaches to these problems indicate that a successful implementation of infection control measures should be part of a concept for redesigning the work and living conditions of the staff and residents of the facilities. It is important to note that infection control should not be planned exclusively with regard to future pandemics, but is of relevance for health risks that already exist in the facilities, such as healthcare-associated infections, antibiotic resistances, or influenza.
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Affiliation(s)
- Dunja Said
- Fachgebiet 37 - Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland.
- Institut für Hygiene und Umweltmedizin, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - Muna Abu Sin
- Fachgebiet 37 - Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Arina Zanuzdana
- Fachgebiet 37 - Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Birgitta Schweickert
- Fachgebiet 37 - Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Tim Eckmanns
- Fachgebiet 37 - Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
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Čokić V, Popovska Z, Lijeskić O, Šabić L, Djurković-Djaković O. Three Outbreaks of COVID-19 in a Single Nursing Home over Two Years of the SARS-CoV-2 Pandemic. Aging Dis 2023; 14:99-111. [PMID: 36818555 PMCID: PMC9937707 DOI: 10.14336/ad.2022.0624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Older people in nursing homes (NH) have been hit particularly hard by the COVID-19 pandemic. We conducted a retrospective study of three outbreaks of COVID-19, occurring during the waves of the initial pre-Alpha, Delta and Omicron SARS-CoV-2 variants, in one NH in suburban Belgrade, Serbia. All staff and 95% residents were vaccinated in February 2021, mostly with BBIBP-CorV, and two thirds were boosted with a third dose in August 2021. COVID-19 was diagnosed by positive PCR and/or antigen test. After the first outbreak, 80 affected individuals were tested for SARS-CoV-2 specific antibodies. The first outbreak involved 64/126 (50.8%) residents and 45/64 (70.3%) staff, the second 22/75 (29.3%) residents and 3/40 (7.5%) staff, and the third involved 36/110 (32.7%) residents and 19/56 (33.9%) staff. Clinical presentation ranged from asymptomatic to severe, with severe cases referred to hospital ICUs. Deaths occurred only in residents, and the case fatality rate was 31.2%, 9.1% and 0%, respectively in outbreaks 1, 2 and 3. Specific IgG antibodies were detected in all 35 residents and 44 of the 45 staff, and higher IgG levels were detected in the residents (417.3±273.5) than in the staff (201.9±192.9, p<0.0001) despite a double difference in age (79.0±7.4 vs. 40.1±11.5 years). Outbreaks 2 and 3 involved four and 23 breakthrough infections, respectively. Older individuals mounted a good immunological response to SARS-CoV-2 infection and vaccination, which prevented significant mortality and severe morbidity in the subsequent outbreaks, despite a significant number of breakthrough infections.
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Affiliation(s)
- Vladan Čokić
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | | | - Olivera Lijeskić
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | | | - Olgica Djurković-Djaković
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia,Correspondence should be addressed to: Dr. Olgica Djurković-Djaković, Center of Excellence for Food- and Vector-borne Zoonoses, Institute for Medical Research, University of Belgrade, Belgrade, Serbia. e-mail address: .
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Zhang J, Yu Y, Petrovic M, Pei X, Tian QB, Zhang L, Zhang WH. Impact of the COVID-19 pandemic and corresponding control measures on long-term care facilities: a systematic review and meta-analysis. Age Ageing 2023; 52:6987654. [PMID: 36668818 DOI: 10.1093/ageing/afac308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/04/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks. OBJECTIVE To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staff. METHOD We conducted a systematic search of six databases for articles published between December 2019 and 5 November 2021, and performed meta-analyses and subgroup analyses to identify the impact of COVID-19 on LTCFs and the association between control measures and infection rate. RESULTS We included 108 studies from 19 countries. These studies included 1,902,044 residents and 255,498 staff from 81,572 LTCFs, among whom 296,024 residents and 36,807 staff were confirmed SARS-CoV-2 positive. The pooled infection rate was 32.63% (95%CI: 30.29 ~ 34.96%) for residents, whereas it was 10.33% (95%CI: 9.46 ~ 11.21%) for staff. In LTCFs that cancelled visits, new patient admissions, communal dining and group activities, and vaccinations, infection rates in residents and staff were lower than the global rate. We reported the residents' hospitalisation rate to be 29.09% (95%CI: 25.73 ~ 32.46%), with a case-fatality rate of 22.71% (95%CI: 21.31 ~ 24.11%) and mortality rate of 15.81% (95%CI: 14.32 ~ 17.30%). Significant publication biases were observed in the residents' case-fatality rate and the staff infection rate, but not in the infection, hospitalisation, or mortality rate of residents. CONCLUSION SARS-CoV-2 infection rates would be very high among LTCF residents and staff without appropriate control measures. Cancelling visits, communal dining and group activities, restricting new admissions, and increasing vaccination would significantly reduce the infection rates.
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Affiliation(s)
- Jun Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium.,The Research Center for Medical Sociology, Tsinghua University, 100084 Beijing, China
| | - Yushan Yu
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Xiaomei Pei
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 050017 Shijiazhuang, Hebei, China
| | - Qing-Bao Tian
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, 710061 Xi'an, Shaanxi, China
| | - Lei Zhang
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne 3053, Australia.,Central Clinical School, Faculty of Medicine, Monash University, Melbourne 3800, Australia.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 450001 Zhengzhou, Henan, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium.,School of Public Health, Université libre de Bruxelles (ULB), Bruxelles 1070, Belgium
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Tut G, Lancaster T, Krutikov M, Sylla P, Bone D, Spalkova E, Bentley C, Amin U, Jadir A, Hulme S, Kaur N, Tut E, Bruton R, Wu MY, Harvey R, Carr EJ, Beale R, Stirrup O, Shrotri M, Azmi B, Fuller C, Baynton V, Irwin-Singer A, Hayward A, Copas A, Shallcross L, Moss P. Strong peak immunogenicity but rapid antibody waning following third vaccine dose in older residents of care homes. NATURE AGING 2023; 3:93-104. [PMID: 37118525 PMCID: PMC10154221 DOI: 10.1038/s43587-022-00328-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/03/2022] [Indexed: 04/30/2023]
Abstract
Third-dose coronavirus disease 2019 vaccines are being deployed widely but their efficacy has not been assessed adequately in vulnerable older people who exhibit suboptimal responses after primary vaccination series. This observational study, which was carried out by the VIVALDI study based in England, looked at spike-specific immune responses in 341 staff and residents in long-term care facilities who received an mRNA vaccine following dual primary series vaccination with BNT162b2 or ChAdOx1. Third-dose vaccination strongly increased antibody responses with preferential relative enhancement in older people and was required to elicit neutralization of Omicron. Cellular immune responses were also enhanced with strong cross-reactive recognition of Omicron. However, antibody titers fell 21-78% within 100 d after vaccine and 27% of participants developed a breakthrough Omicron infection. These findings reveal strong immunogenicity of a third vaccine in one of the most vulnerable population groups and endorse an approach for widespread delivery across this population. Ongoing assessment will be required to determine the stability of immune protection.
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Affiliation(s)
- Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Tara Lancaster
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Panagiota Sylla
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - David Bone
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Eliska Spalkova
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Christopher Bentley
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Umayr Amin
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Azar Jadir
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Samuel Hulme
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Nayandeep Kaur
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Elif Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Rachel Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Mary Y Wu
- Covid Surveillance Unit, The Francis Crick Institute, London, UK
| | - Ruth Harvey
- Worldwide Influenza Centre, The Francis Crick Institute London, London, UK
| | | | - Rupert Beale
- The Francis Crick Institute, London, UK
- Genotype-to-Phenotype UK National Virology Consortium (G2P-UK), London, UK
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK
| | | | | | | | | | | | | | | | | | | | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
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Shenkin SD, Johnston L, Hockley J, Henderson DAG. Developing a care home data platform in Scotland: a mixed methods study of data routinely collected in care homes. Age Ageing 2022; 51:6931853. [PMID: 36580390 PMCID: PMC9799192 DOI: 10.1093/ageing/afac265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/07/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND care homes collect extensive data about their residents, and their care, in multiple ways, for multiple purposes. We aimed to (i) identify what data are routinely collected and (ii) collate care home managers' views and experiences of collecting, using and sharing data. METHODS we examined data collected in six care homes across Lothian, Scotland. We extracted the meta-data, cross-referenced definitions and assessed the degree of harmonisation between care homes and with data sets currently in use in Scotland and internationally. We interviewed care home managers about their views and experiences of collecting, using and sharing data. RESULTS we identified 15 core data items used routinely, with significant heterogeneity in tools and assessments used, and very limited harmonisation. Two overarching themes were identified of importance to the development of a care home data platform: (i) the rationale for collecting data, including to (a) support person-centred care, (b) share information, (c) manage workforce and budget and (d) provide evidence to statutory bodies and (ii) the reality of collecting data, including data accuracy, and understanding data in context. DISCUSSION considerable information is collected by care home staff, in varied formats, with heterogeneity of scope and definition, for range of reasons. We discuss the issues that should be considered to ensure that individual resident-level form the strong foundations for any data platform for care homes, which must also include, robust infrastructure and clear interoperability, with appropriate governance. It must be co-produced by academics, policy makers and sector representatives, with residents, their families and care staff.
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Affiliation(s)
- Susan D Shenkin
- Address correspondence to: Susan D. Shenkin, Ageing and Health Research Group and Advanced Care Research Centre, Usher Institute, University of Edinburgh, Room F1425B, Royal Infirmary of Edinburgh, Edinburgh EH16 4SB, UK.
| | | | - Jo Hockley
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David A G Henderson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK,Centre for Population Health Sciences, Usher Insitute, University of Edinburgh, Edinburgh, UK
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10
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Dujmovic M, Roederer T, Frison S, Melki C, Lauvin T, Grellety E. COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study. BMJ Open 2022; 12:e060276. [PMID: 36127110 PMCID: PMC9490301 DOI: 10.1136/bmjopen-2021-060276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment. METHODS A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021. RESULTS The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff. CONCLUSION Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents' and caregivers' overall well-being and mental health.
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Affiliation(s)
- Morgane Dujmovic
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Thomas Roederer
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Severine Frison
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Carla Melki
- Emergency Cell, Médecins Sans Frontières, Paris, France
| | - Thomas Lauvin
- Emergency Cell, Médecins Sans Frontières, Paris, France
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11
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Incidence, Hospitalization, Mortality and Risk Factors of COVID-19 in Long-Term Care Residential Homes for Patients with Chronic Mental Illness. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:391-401. [PMID: 36417246 PMCID: PMC9620926 DOI: 10.3390/epidemiologia3030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
Long-term care residential homes (LTCRH) for patients with chronic mental illness have suffered the enormous impact of COVID-19. This study aimed to estimate incidence, hospitalization, mortality, and risk factors of COVID-19 to prevent future epidemics. From March 2020 to January 2021 and before vaccination anti-SARS-CoV-2 begins, cumulate incidence rate (CIR), hospitalization rate (HR), mortality rate (MR), and risk factors of COVID-19 in the 11 LTCRH of two Health Departments of Castellon (Spain) were studied by epidemiological surveillance and an ecological design. Laboratory tests confirmed COVID-19 cases, and multilevel Poisson regression models were employed. All LTCRH participated and comprised 346 residents and 482 staff. Residents had a mean age of 47 years, 40% women, and suffered 75 cases of COVID-19 (CIR = 21.7%), five hospitalizations (HR = 1.4%), and two deaths (MR = 0.6%) with 2.5% fatality-case. Staff suffered 74 cases of the disease (CIR = 15.4%), one hospitalization (HR = 0.2%), and no deaths were reported. Risk factors associated with COVID-19 incidence in residents were private ownership, severe disability, residents be younger, CIR in municipalities where LTCRH was located, CIR in staff, and older age of the facilities. Conclusion: COVID-19 incidence could be prevented by improving infection control in residents and staff and modernizing facilities with increased public ownership.
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12
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Dyer AH, Fallon A, Noonan C, Dolphin H, O'Farrelly C, Bourke NM, O'Neill D, Kennelly SP. Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update. J Am Med Dir Assoc 2022; 23:1590-1602. [PMID: 35922016 PMCID: PMC9250924 DOI: 10.1016/j.jamda.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
Older adults in nursing homes are at greatest risk of morbidity and mortality from SARS-CoV-2 infection. Nursing home residents constituted one-third to more than half of all deaths during the early waves of the COVID-19 pandemic. Following this, widespread adaptation of infection prevention and control measures and the supply and use of personal protective equipment resulted in a significant decrease in nursing home infections and deaths. For nursing homes, the most important determinant of experiencing a SARS-CoV-2 outbreak in the first instance appears to be community-transmission levels (particularly with variants of concern), although nursing home size and quality, for-profit status, and sociodemographic characteristics are also important. Use of visitation bans, imposed to reduce the impact of COVID-19 on residents, must be delicately balanced against their impact on resident, friend or family, and staff well-being. The successful rollout of primary vaccination has resulted in a sharp decrease in morbidity and mortality from SARS-CoV-2 in nursing homes. However, emerging evidence suggests that vaccine efficacy may wane over time, and the use of a third or additional vaccine "booster" doses in nursing home residents restores protection afforded by primary vaccination. Ongoing monitoring of vaccine efficacy in terms of infection, morbidity, and mortality is crucial in this vulnerable group in informing ongoing SARS-CoV-2 vaccine boosting strategies. Here, we detail the impact of SARS-CoV-2 on nursing home residents and discuss important considerations in the management of nursing home SARS-CoV-2 outbreaks. We additionally examine the use of testing strategies, nonpharmacologic outbreak control measures and vaccination strategies in this cohort. Finally, the impact of SARS-CoV-2 on the sector is reflected on as we emphasize the need for adoption of universal standards of medical care and integration with wider public health infrastructure in nursing homes in order to provide a safe and effective long-term care sector.
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Affiliation(s)
- Adam H Dyer
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Aoife Fallon
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Claire Noonan
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Helena Dolphin
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Cliona O'Farrelly
- Comparative Immunology, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nollaig M Bourke
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland; Inflammageing Research Group, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Desmond O'Neill
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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13
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Tut G, Lancaster T, Sylla P, Butler MS, Kaur N, Spalkova E, Bentley C, Amin U, Jadir A, Hulme S, Ayodele M, Bone D, Tut E, Bruton R, Krutikov M, Giddings R, Shrotri M, Azmi B, Fuller C, Baynton V, Irwin-Singer A, Hayward A, Copas A, Shallcross L, Moss P. Antibody and cellular immune responses following dual COVID-19 vaccination within infection-naive residents of long-term care facilities: an observational cohort study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e461-e469. [PMID: 35813280 PMCID: PMC9252532 DOI: 10.1016/s2666-7568(22)00118-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Older age and frailty are risk factors for poor clinical outcomes following SARS-CoV-2 infection. As such, COVID-19 vaccination has been prioritised for individuals with these factors, but there is concern that immune responses might be impaired due to age-related immune dysregulation and comorbidity. We aimed to study humoral and cellular responses to COVID-19 vaccines in residents of long-term care facilities (LTCFs). Methods In this observational cohort study, we assessed antibody and cellular immune responses following COVID-19 vaccination in members of staff and residents at 74 LTCFs across the UK. Staff and residents were eligible for inclusion if it was possible to link them to a pseudo-identifier in the COVID-19 datastore, if they had received two vaccine doses, and if they had given a blood sample 6 days after vaccination at the earliest. There were no comorbidity exclusion criteria. Participants were stratified by age (<65 years or ≥65 years) and infection status (previous SARS-CoV-2 infection [infection-primed group] or SARS-CoV-2 naive [infection-naive group]). Anticoagulated edetic acid (EDTA) blood samples were assessed and humoral and cellular responses were quantified. Findings Between Dec 11, 2020, and June 27, 2021, blood samples were taken from 220 people younger than 65 years (median age 51 years [IQR 39-61]; 103 [47%] had previously had a SARS-CoV-2 infection) and 268 people aged 65 years or older of LTCFs (median age 87 years [80-92]; 144 [43%] had a previous SARS-CoV-2 infection). Samples were taken a median of 82 days (IQR 72-100) after the second vaccination. Antibody responses following dual vaccination were strong and equivalent between participants younger then 65 years and those aged 65 years and older in the infection-primed group (median 125 285 Au/mL [1128 BAU/mL] for <65 year olds vs 157 979 Au/mL [1423 BAU/mL] for ≥65 year olds; p=0·47). The antibody response was reduced by 2·4-times (467 BAU/mL; p≤0·0001) in infection-naive people younger than 65 years and 8·1-times (174 BAU/mL; p≤0·0001) in infection-naive residents compared with their infection-primed counterparts. Antibody response was 2·6-times lower in infection-naive residents than in infection-naive people younger than 65 years (p=0·0006). Impaired neutralisation of delta (1.617.2) variant spike binding was also apparent in infection-naive people younger than 65 years and in those aged 65 years and older. Spike-specific T-cell responses were also significantly enhanced in the infection-primed group. Infection-naive people aged 65 years and older (203 SFU per million [IQR 89-374]) had a 52% lower T-cell response compared with infection-naive people younger than 65 years (85 SFU per million [30-206]; p≤0·0001). Post-vaccine spike-specific CD4 T-cell responses displayed single or dual production of IFN-γ and IL-2 were similar across infection status groups, whereas the infection-primed group had an extended functional profile with TNFα and CXCL10 production. Interpretation These data reveal suboptimal post-vaccine immune responses within infection-naive residents of LTCFs, and they suggest the need for optimisation of immune protection through the use of booster vaccination. Funding UK Government Department of Health and Social Care.
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Affiliation(s)
- Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Tara Lancaster
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Panagiota Sylla
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Megan S Butler
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Nayandeep Kaur
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Eliska Spalkova
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Christopher Bentley
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Umayr Amin
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Azar Jadir
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Samuel Hulme
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Morenike Ayodele
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - David Bone
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Elif Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Rachel Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Maria Krutikov
- Institute of Health Informatics, University College London, London, UK
| | - Rebecca Giddings
- Institute of Health Informatics, University College London, London, UK
| | - Madhumita Shrotri
- Institute of Health Informatics, University College London, London, UK
| | - Borscha Azmi
- Institute of Health Informatics, University College London, London, UK
| | | | | | | | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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14
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The Impact of Long-Term Care Home Ownership and Administration Type on All-Cause Mortality from March to April 2020 in Madrid, Spain. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:323-336. [PMID: 36417241 PMCID: PMC9620910 DOI: 10.3390/epidemiologia3030025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
Our aim is to assess whether long-term care home (LTCH) ownership and administration type were associated with all-cause mortality in 470 LTCHs in the Community of Madrid (Spain) during March and April 2020, the first two months of the COVID-19 pandemic. There are eight categories of LTCH type, including various combinations of ownership type (for-profit, nonprofit, and public) and administration type (completely private, private with places rented by the public sector, administrative management by procurement, and completely public). Multilevel regression was used to examine the association between mortality and LTCH type, adjusting for LTCH size, the spread of the COVID-19 infection, and the referral hospital. There were 9468 deaths, a mortality rate of 18.3%. Public and private LTCHs had lower mortality than LTCHs under public-private partnership (PPP) agreements. In the fully adjusted model, mortality was 7.4% (95% CI, 3.1-11.7%) in totally public LTCHs compared with 21.9% (95% CI, 17.4-26.4%) in LTCHs which were publicly owned with administrative management by procurement. These results are a testimony to the fatal consequences that pre-pandemic public-private partnerships in long-term residential care led to during the first months of the COVID-19 pandemic in the Community of Madrid, Spain.
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15
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Orlando S, Mazhari T, Abbondanzieri A, Cerone G, Ciccacci F, Liotta G, Mancinelli S, Marazzi MC, Palombi L. Characteristics of nursing homes and early preventive measures associated with risk of infection from COVID-19 in Lazio region, Italy: a retrospective case-control study. BMJ Open 2022; 12:e061784. [PMID: 35667726 PMCID: PMC9170802 DOI: 10.1136/bmjopen-2022-061784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To understand which organisational-structural characteristics of nursing homes-also referred to as long-term care facilities (LTCFs)-and the preventative measures adopted in response to the pandemic are associated with the risk of a COVID-19 outbreak. SETTING LTCFs in Lazio region in Italy. DESIGN The study adopts a case-control design. PARTICIPANTS We included 141 facilities and 100 provided information for the study. Cases were defined as facilities reporting a COVID-19 outbreak (two or more cases) in March-December 2020; controls were defined as LTCFs reporting one case or zero. The exposures include the structural-organisational characteristics of the LTCFs as reported by the facilities, preventative measures employed and relevant external factors. RESULTS Twenty facilities reported an outbreak of COVID-19. In binary logistic regression models, facilities with more than 15 beds were five times more likely to experience an outbreak than facilities with less than 15 beds OR=5.60 (CI 1.61 to 25.12; p value 0.002); admitting new residents to facilities was associated with a substantially higher risk of an outbreak: 6.46 (CI 1.58 to 27.58, p value 0.004). In a multivariable analysis, facility size was the only variable that was significantly associated with a COVID-19 outbreak OR= 5.37 (CI 1.58 to 22.8; p value 0.012) for larger facilities (>15 beds) versus smaller (<15 beds). Other characteristics and measures were not associated with an outbreak. CONCLUSION There was evidence of a higher risk of COVID-19 in larger facilities and when new patients were admitted during the pandemic. All other structural-organisational characteristics and preventative measures were not associated with an outbreak. This finding calls into question existing policies, especially where there is a risk of harm to residents. One such example is the restriction of visitor access to facilities, resulting in the social isolation of residents.
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Affiliation(s)
- Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Tuba Mazhari
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Alessio Abbondanzieri
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
- Prevention department, public health services, ASL Roma 5, Tivoli, Lazio, Italy
| | - Gennaro Cerone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
- Prevention department, public health services, ASL Roma 5, Tivoli, Lazio, Italy
| | - Fausto Ciccacci
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
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16
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Robust heterologous immune responses in older adult survivors of COVID-19. NATURE AGING 2022; 2:473-474. [PMID: 37118450 DOI: 10.1038/s43587-022-00235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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17
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Tut G, Lancaster T, Butler MS, Sylla P, Spalkova E, Bone D, Kaur N, Bentley C, Amin U, Jadir AT, Hulme S, Ayodel M, Dowell AC, Pearce H, Zuo J, Margielewska-Davies S, Verma K, Nicol S, Begum J, Jinks E, Tut E, Bruton R, Krutikov M, Shrotri M, Giddings R, Azmi B, Fuller C, Irwin-Singer A, Hayward A, Copas A, Shallcross L, Moss P. Robust SARS-CoV-2-specific and heterologous immune responses in vaccine-naïve residents of long-term care facilities who survive natural infection. NATURE AGING 2022; 2:536-547. [PMID: 37118449 PMCID: PMC10154219 DOI: 10.1038/s43587-022-00224-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/14/2022] [Indexed: 04/30/2023]
Abstract
We studied humoral and cellular immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 152 long-term care facility staff and 124 residents over a prospective 4-month period shortly after the first wave of infection in England. We show that residents of long-term care facilities developed high and stable levels of antibodies against spike protein and receptor-binding domain. Nucleocapsid-specific responses were also elevated but waned over time. Antibodies showed stable and equivalent levels of functional inhibition against spike-angiotensin-converting enzyme 2 binding in all age groups with comparable activity against viral variants of concern. SARS-CoV-2 seropositive donors showed high levels of antibodies to other beta-coronaviruses but serostatus did not impact humoral immunity to influenza or other respiratory syncytial viruses. SARS-CoV-2-specific cellular responses were similar across all ages but virus-specific populations showed elevated levels of activation in older donors. Thus, survivors of SARS-CoV-2 infection show a robust and stable immunity against the virus that does not negatively impact responses to other seasonal viruses.
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Affiliation(s)
- Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
| | - Tara Lancaster
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Megan S Butler
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Panagiota Sylla
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Eliska Spalkova
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - David Bone
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Nayandeep Kaur
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Christopher Bentley
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Umayr Amin
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Azar T Jadir
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Samuel Hulme
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Morenike Ayodel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Alexander C Dowell
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Hayden Pearce
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jianmin Zuo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Kriti Verma
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Samantha Nicol
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jusnara Begum
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Elizabeth Jinks
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Elif Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Rachel Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | | | | | | | | | | | | | | | | | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
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18
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Arendse T, Cowper B, Cohen C, Masha M, Tempia S, Legodu C, Singh S, Ratau T, Geffen L, Heymans A, Coetzer D, Blumberg L, Jassat W. SARS-CoV-2 cases reported from long-term residential facilities (care homes) in South Africa: a retrospective cohort study. BMC Public Health 2022; 22:1035. [PMID: 35606732 PMCID: PMC9126632 DOI: 10.1186/s12889-022-13403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/06/2022] [Indexed: 12/15/2022] Open
Abstract
Background Globally, long-term care facilities (LTCFs) experienced a large burden of deaths during the COVID-19 pandemic. The study aimed to describe the temporal trends as well as the characteristics and risk factors for mortality among residents and staff who tested positive for SARS-CoV-2 in selected LTCFs across South Africa. Method We analysed data reported to the DATCOV sentinel surveillance system by 45 LTCFs. Outbreaks in LTCFs were defined as large if more than one-third of residents and staff had been infected or there were more than 20 epidemiologically linked cases. Multivariable logistic regression was used to assess risk factors for mortality amongst LTCF residents. Results A total of 2324 SARS-CoV-2 cases were reported from 5 March 2020 through 31 July 2021; 1504 (65%) were residents and 820 (35%) staff. Among LTCFs, 6 reported sporadic cases and 39 experienced outbreaks. Of those reporting outbreaks, 10 (26%) reported one and 29 (74%) reported more than one outbreak. There were 48 (66.7%) small outbreaks and 24 (33.3%) large outbreaks reported. There were 30 outbreaks reported in the first wave, 21 in the second wave and 15 in the third wave, with 6 outbreaks reporting between waves. There were 1259 cases during the first COVID-19 wave, 362 during the second wave, and 299 during the current third wave. The case fatality ratio was 9% (138/1504) among residents and 0.5% (4/820) among staff. On multivariable analysis, factors associated with SARS-CoV-2 mortality among LTCF residents were age 40–59 years, 60–79 years and ≥ 80 years compared to < 40 years and being a resident in a LTCF in Free State or Northern Cape compared to Western Cape. Compared to pre-wave 1, there was a decreased risk of mortality in wave 1, post-wave 1, wave 2, post-wave 2 and wave 3. Conclusion The analysis of SARS-CoV-2 cases in sentinel LTCFs in South Africa points to an encouraging trend of decreasing numbers of outbreaks, cases and risk for mortality since the first wave. LTCFs are likely to have learnt from international experience and adopted national protocols, which include improved measures to limit transmission and administer early and appropriate clinical care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13403-6.
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Affiliation(s)
- Tracy Arendse
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa. .,Right to Care, Johannesburg, South Africa.
| | | | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Maureen Masha
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.,Right to Care, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Civil Legodu
- National Department of Social Development, Pretoria, South Africa
| | - Sandhya Singh
- National Department of Health, Pretoria, South Africa
| | | | - Leon Geffen
- Samson Institute for Ageing Research, Cape Town, South Africa.,Albertina & Walter Sisulu Institute of Ageing in Africa, Geriatrics Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ansie Heymans
- South African Council for Social Workers, Pretoria, South Africa
| | - Dane Coetzer
- South African Nursing Council, Pretoria, South Africa
| | - Lucille Blumberg
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.,Right to Care, Johannesburg, South Africa
| | - Waasila Jassat
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.,Right to Care, Johannesburg, South Africa
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19
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Geeraedts F, Luttje M, Visschedijk J, van Hattem M, Hasper HJ, Kohnen R, Loman R, de Goede R, Jansen D, Hess D, Al Naiemi N. Low-Threshold Testing for SARS-CoV-2 (COVID-19) in Long-Term Care Facilities Early in the First Pandemic Wave, the Twente Region, the Netherlands: A Possible Factor in Reducing Morbidity and Mortality. J Appl Gerontol 2022; 41:1802-1811. [PMID: 35543170 PMCID: PMC9127376 DOI: 10.1177/07334648221093050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
During the first wave of the COVID-19 pandemic, there was a shortage of
SARS-CoV-2 diagnostic tests, and testing patients with mild symptoms
(low-threshold testing) was not recommended in the Netherlands. Despite these
guidelines, to protect those who were most at risk, low-threshold testing was
advocated and offered to the majority of long-term care institutions in the
Twente region. In this manner, 144 healthcare workers and
96 residents tested SARS-CoV-2-positive and were isolated before the same
service was provided nationwide by public health services. Strikingly, excess
mortality rate in the Twente region 1 month after the
introduction of this strategy was found to be 62%–89% lower than that in
neighboring regions, which may be explained by this divergent testing strategy.
In an emerging pandemic, early implementation of a liberal testing policy may be
more effective than restricted testing in settings with a high death rate.
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Affiliation(s)
- Felix Geeraedts
- Laboratory for Medical Microbiology and Public Health, Hengelo, the Netherlands
| | - Mariska Luttje
- Carintreggeland Nursing Homes and Home Care, Hengelo, the Netherlands
| | - Jan Visschedijk
- Carintreggeland Nursing Homes and Home Care, Hengelo, the Netherlands
| | | | - Henk-Jan Hasper
- Trivium Meulenbelt Zorg Nursing Homes and Home Care, Almelo, the Netherlands
| | - Roy Kohnen
- Livio Nursing Homes and Home Care, Enschede, the Netherlands
| | - Rene Loman
- Zorggroep Sint Maarten Nursing Homes and Home Care, Denekamp, the Netherlands
| | - Rudi de Goede
- Liberein Nursing Homes and Home Care, Enschede, the Netherlands
| | - Desiré Jansen
- De Posten Nursing Homes and Home Care, Enschede, the Netherlands
| | - Dorine Hess
- Laboratory for Medical Microbiology and Public Health, Hengelo, the Netherlands
| | - Nashwan Al Naiemi
- Laboratory for Medical Microbiology and Public Health, Hengelo, the Netherlands
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20
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Walsh B, Connolly S, Wren MA, Hill L. Supporting sustainable long-term residential care in Ireland: a study protocol for the Sustainable Residential Care (SRC) project. HRB Open Res 2022; 5:30. [PMID: 35571226 PMCID: PMC9086518 DOI: 10.12688/hrbopenres.13543.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/20/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic brought to the fore deficiencies in the long-term residential care (LTRC) sector, including issues of governance, funding and staffing. Many of these issues pre-dated the pandemic and have contributed to concerns around the sustainability of the current model of LTRC in Ireland. The aim of the project detailed in this protocol is to provide an evidence base to help ensure the sustainability of the LTRC sector in Ireland within a new wider model of care for older people. The project includes three key objectives: (i) to describe and analyse the characteristics of LTRC homes across Ireland; (ii) to examine the association between LTRC home characteristics and COVID-19 outbreaks and deaths and (iii) to identify challenges to the sustainability of the LTRC sector within a COVID-19 environment and beyond. Bringing together the findings from these three objectives, the project will identify approaches and strategies which will help ensure the sustainability of LTRC that meets the needs of residents. The proposed research incorporates quantitative analyses and a review. Combining data from a variety of administration sources and using a variety of statistical techniques, the project will include a retrospective observational analysis of COVID-19 in LTRC homes in Ireland. Subsequently, a review will examine the current funding model of LTRC in Ireland, as well as the regulations and governance structure that underlie the system. The review will also examine international practices in these areas. Bringing together the findings from the quantitative analysis and the review and working with the knowledge users on the project, the project will build upon recent work in the area to identify the current challenges to the system of LTRC and possible solutions.
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Affiliation(s)
- Brendan Walsh
- Economic and Social Research Institute, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - Sheelah Connolly
- Economic and Social Research Institute, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - Maev-Ann Wren
- Economic and Social Research Institute, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - Leonie Hill
- Economic and Social Research Institute, Dublin, Ireland
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21
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COVID-19 prevalence and mortality in longer-term care facilities. Eur J Epidemiol 2022; 37:227-234. [PMID: 35397704 PMCID: PMC8994824 DOI: 10.1007/s10654-022-00861-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/04/2022] [Indexed: 12/11/2022]
Abstract
This essay considers the factors that have contributed to very high COVID-19 mortality in longer-term care facilities (LTCFs). We compare the demographic characteristics of LTCF residents with those of community-dwelling older adults, and then we review the evidence regarding prevalence and infection fatality rates (IFRs), including links to frailty and some comorbidities. Finally, we discuss policy measures that could foster the physical and mental health and well-being of LTCF residents in the present context and in potential future pandemics.
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22
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Arnedo-Pena A, Romeu-Garcia MA, Gascó-Laborda JC, Meseguer-Ferrer N, Safont-Adsuara L, Prades-Vila L, Flores-Medina M, Rusen V, Tirado-Balaguer MD, Sabater-Vidal S, Gil-Fortuño M, Pérez-Olaso O, Hernández-Pérez N, Moreno-Muñoz R, Bellido-Blasco J. Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes. EPIDEMIOLOGIA 2022; 3:179-190. [PMID: 36417250 PMCID: PMC9620907 DOI: 10.3390/epidemiologia3020014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/14/2022] Open
Abstract
During the period from March 2020 to January 2021, we performed an analysis of incidence, mortality, and risk factors of COVID-19 in nursing homes (NHs) in two health departments (HDs) of Castellon (Spain) 2021 through epidemiological surveillance and an ecological design. Laboratory-confirmed COVID-19 cases, cumulative incidence rate (CIR), and mortality rate (MR) of 27 NHs were collected. Information of residents, staff, and facilities was obtained by questionnaire. Multilevel Poisson regression models were applied. All NHs in the HDs participated with 2229 residents (median: 83 years old, 67.3% women) and 1666 staff. Among residents, 815 cases (CIR: 34.8 per 100) and 202 deaths (MR: 8.7 per 100, case fatality 21.0%) were reported and, among staff, 296 cases (CIR: 19.2 per 100) without deaths. Residents' CIR and MR increased with staff CIR, age of the building, residents/staff ratios, occupancy rate, and crowding index; CIR increased with private NH ownership, large NH size, large urban area, and the percentage of women residents; and MR was associated with residents' severe disabilities. In conclusion, several risk factors of COVID-19 incidence and mortality can be prevented by improving infection and quality controls, ameliorating residents/staff ratios, improving structural facilities, and increasing NH public ownership to avoid new outbreaks.
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Affiliation(s)
- Alberto Arnedo-Pena
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
- Public Health and Epidemiology (CIBERESP), 28029 Madrid, Spain
- Department of Health Science, Public University of Navarra, 31006 Pamplona, Spain
| | - Maria Angeles Romeu-Garcia
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Juan Carlos Gascó-Laborda
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Noemi Meseguer-Ferrer
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Lourdes Safont-Adsuara
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Laura Prades-Vila
- Health Programs, Public Health Center, 12003 Castelló de la Plana, Spain; (L.P.-V.); (M.F.-M.)
| | - Matilde Flores-Medina
- Health Programs, Public Health Center, 12003 Castelló de la Plana, Spain; (L.P.-V.); (M.F.-M.)
| | - Viorica Rusen
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | | | - Susana Sabater-Vidal
- Microbiology Laboratory, Universitary General Hospital, 12004 Castelló de la Plana, Spain; (M.D.T.-B.); (S.S.-V.)
| | - Maria Gil-Fortuño
- Clinical Analysis and Microbiology Laboratory, Universitary Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (O.P.-O.); (N.H.-P.)
| | - Oscar Pérez-Olaso
- Clinical Analysis and Microbiology Laboratory, Universitary Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (O.P.-O.); (N.H.-P.)
| | - Noelia Hernández-Pérez
- Clinical Analysis and Microbiology Laboratory, Universitary Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (O.P.-O.); (N.H.-P.)
| | - Rosario Moreno-Muñoz
- Department of Epidemiology, School of Medicine, Jaume I University, 12006 Castelló de la Plana, Spain;
| | - Juan Bellido-Blasco
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
- Public Health and Epidemiology (CIBERESP), 28029 Madrid, Spain
- Department of Epidemiology, School of Medicine, Jaume I University, 12006 Castelló de la Plana, Spain;
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23
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COVID-19 pandemic and mortality in nursing homes across USA and Europe up to October 2021. Eur Geriatr Med 2022; 13:705-709. [PMID: 35299261 PMCID: PMC8929245 DOI: 10.1007/s41999-022-00637-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/08/2022] [Indexed: 11/10/2022]
Abstract
Purpose We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level. Methods The total number of COVID-19 cases and COVID-19-related deaths in all NHs as well as the total number of NHs and NH beds were provided by representatives of 14 countries. The population level respective figures in each country were provided up to October 2021. Results There was a wide variation in prevalence of COVID-19 cases and deaths between countries. We observed a significant correlation between COVID-19 deaths in NHs and that of the total population and between the mean size of NHs and COVID-19 deaths. Conclusion Side-by-side comparisons between countries allow international sharing of good practice to better enable future pandemic preparedness.
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24
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Soldevila L, Prat N, Mas MÀ, Massot M, Miralles R, Bonet-Simó JM, Isnard M, Expósito-Izquierdo M, Garcia-Sanchez I, Rodoreda-Noguerola S, Moreno N, Badia E, López G, Sevilla J, Estrada O, Vallès X. The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents. BMC Geriatr 2022; 22:123. [PMID: 35164680 PMCID: PMC8842505 DOI: 10.1186/s12877-022-02779-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality. METHODS We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death. RESULTS A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). CONCLUSIONS Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.
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Affiliation(s)
- Laura Soldevila
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain
| | - Núria Prat
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Miquel À Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mireia Massot
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Ramón Miralles
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Josep M Bonet-Simó
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Mar Isnard
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | | | - Irene Garcia-Sanchez
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Sara Rodoreda-Noguerola
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Nemesio Moreno
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Esther Badia
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Genís López
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Javier Sevilla
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Oriol Estrada
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Xavier Vallès
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain.
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.
- Institut per la Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
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25
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Feathers L, Hinde T, Bale T, Hyde J, Bird PW, Holmes CW, Tang JW. Outbreak of SARS-CoV-2 at a hospice: terminated after the implementation of enhanced aerosol infection control measures. Interface Focus 2022; 12:20210066. [PMID: 35261730 PMCID: PMC8831080 DOI: 10.1098/rsfs.2021.0066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/08/2021] [Indexed: 12/17/2022] Open
Abstract
Outbreaks of COVID-19 in hospices for palliative care patients pose a unique and difficult situation. Staff, relatives and patients may be possible sources and recipients of infection. We present an outbreak of COVID-19 in a hospice setting, during the UK's first pandemic wave. During the outbreak period, 26 patients and 30 staff tested SARS-CoV-2 positive by laboratory-based RT-PCR testing. Most infected staff exhibited some mild, non-specific symptoms so affected staff members may not have voluntarily self-isolated or had themselves tested on this basis. Similarly, for infected patients, most became symptomatic and were then isolated. Additional, enhanced aerosol infection control measures were implemented, including opening of all windows where available; universal masking for all staff, including in non-clinical areas and taking breaks separately; screening for asymptomatic infection among staff and patients, with appropriate isolation (at home for staff) if infected; performing a ventilation survey of the hospice facility. After these measures were instigated, the numbers of COVID-19 cases decreased to zero over the following three weeks. This outbreak study demonstrated that an accurate understanding of the routes of infection for a new pathogen, as well as the nature of symptomatic versus asymptomatic infection and transmission, is crucial for controlling its spread.
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Affiliation(s)
| | | | | | - Jo Hyde
- LOROS Hospice Care, Leicester, UK
| | - Paul W. Bird
- Clinical Microbiology, University of Leicester Hospitals, 5/F Sandringham Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK
| | - Christopher W. Holmes
- Clinical Microbiology, University of Leicester Hospitals, 5/F Sandringham Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK
| | - Julian W. Tang
- Clinical Microbiology, University of Leicester Hospitals, 5/F Sandringham Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK
- Respiratory Sciences, University of Leicester, Leicester, UK
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26
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Zhu X, Lee H, Sang H, Muller J, Yang H, Lee C, Ory M. Nursing Home Design and COVID-19: Implications for Guidelines and Regulation. J Am Med Dir Assoc 2022; 23:272-279.e1. [PMID: 34990585 PMCID: PMC8702402 DOI: 10.1016/j.jamda.2021.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/11/2021] [Accepted: 12/16/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Nursing homes (NHs) are important health care and residential environments for the growing number of frail older adults. The COVID-19 pandemic highlighted the vulnerability of NHs as they became COVID-19 hotspots. This study examines the associations of NH design with COVID-19 cases, deaths, and transmissibility and provides relevant design recommendations. DESIGN A cross-sectional, nationwide study was conducted after combining multiple national data sets about NHs. SETTING AND PARTICIPANTS A total of 7785 NHs were included in the study, which represent 50.8% of all Medicare and/or Medicaid NH providers in the United States. METHODS Zero-inflated negative binomial models were used to predict the total number of COVID-19 resident cases and deaths, separately. The basic reproduction number (R0) was calculated for each NH to reflect the transmissibility of COVID-19 among residents within the facility, and a linear regression model was estimated to predict log(R0 - 1). Predictors of these models included community factors and NHs' resident characteristics, management and rating factors, and physical environmental features. RESULTS Increased percentage of private rooms, larger living area per bed, and presence of a ventilator-dependent unit are significantly associated with reductions in COVID-19 cases, deaths, and transmissibility among residents. After setting the number of actual residents as the exposure variable and controlling for staff cases and other variables, increased number of certified beds in the NH is associated with reduced resident cases and deaths. It also correlates with reduced transmissibility among residents when other risk factors, including staff cases, are controlled. CONCLUSIONS AND IMPLICATIONS Architectural design attributes have significant impacts on COVID-19 transmissions in NHs. Considering the vulnerability of NH residents in congregated living environments, NHs will continue to be high-risk settings for infection outbreaks. To improve safety and resilience of NHs against future health disasters, facility guidelines and regulations should consider the need to increase private rooms and living areas.
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Affiliation(s)
- Xuemei Zhu
- Department of Architecture, Center for Health Systems & Design, Texas A&M University, College Station, TX, USA.
| | - Hanwool Lee
- Department of Landscape Architecture and Urban Planning, Center for Health Systems & Design, Texas A&M University, College Station, TX, USA
| | - Huiyan Sang
- Department of Statistics, Texas A&M University, College Station, TX, USA
| | - James Muller
- Muller Consulting & Data Analytics, LLC, Washington, DC, USA
| | - Haoyue Yang
- Department of Landscape Architecture and Urban Planning, Center for Health Systems & Design, Texas A&M University, College Station, TX, USA
| | - Chanam Lee
- Department of Landscape Architecture and Urban Planning, Center for Health Systems & Design, Texas A&M University, College Station, TX, USA
| | - Marcia Ory
- Department of Environmental and Occupational Health, Center for Population Health & Aging, Texas A&M University, College Station, TX, USA
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27
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Akhtar-Danesh N, Baumann A, Crea-Arsenio M, Antonipillai V. COVID-19 excess mortality among long-term care residents in Ontario, Canada. PLoS One 2022; 17:e0262807. [PMID: 35051237 PMCID: PMC8775534 DOI: 10.1371/journal.pone.0262807] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/05/2022] [Indexed: 12/03/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) has had devastating consequences worldwide, including a spike in global mortality. Residents of long-term care homes have been disproportionately affected. We conducted a retrospective cohort study to determine the scale of pandemic-related deaths of long-term care residents in the province of Ontario, Canada, and to estimate excess mortality due to a positive COVID-19 test adjusted for demographics and regional variations. Crude mortality rates for 2019 and 2020 were compared, as were predictors of mortality among residents with positive and negative tests from March 2020 to December 2020. We found the crude mortality rates were higher from April 2020 to June 2020 and from November 2020 to December 2020, corresponding to Wave 1 and Wave 2 of the pandemic in Ontario. There were also substantial increases in mortality among residents with a positive COVID-19 test. The significant differences in excess mortality observed in relation to long-term care home ownership category and geographic region may indicate gaps in the healthcare system that warrant attention from policymakers. Further investigation is needed to identify the most relevant factors in explaining these differences.
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Affiliation(s)
- Noori Akhtar-Danesh
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Andrea Baumann
- Global Health, McMaster University, Hamilton, Ontario, Canada
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28
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Gordon AL, Bennett C, Goodman C, Achterberg WP. Making progress: but a way to go-the age and ageing care-home collection. Age Ageing 2022; 51:6399884. [PMID: 34661617 DOI: 10.1093/ageing/afab213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 11/14/2022] Open
Abstract
Care homes enable people with advanced physical and cognitive impairment to live well with 24-h support from staff. They are a feature of care systems in most countries. They have proved pivotal to the coronavirus disease 2019 (COVID-19) response. We searched Age and Ageing for care-home articles published since 2015. From these we collated 42 into the Age and Ageing care-home collection. This collection draws together important papers that show how Age and Ageing is helping to shape and grow care-home research. The collection outlines the technical issues that researchers face by grouping together important feasibility trials conducted in the sector. It looks at the challenges of measuring quality of life and working with routine data in care homes. It brings together observational studies considering loneliness, functional dependency, stroke outcomes, prescribing and acute deterioration. Health services research in care homes is represented by two studies that demonstrate realist evaluation as a way to make sense of service innovations. Papers are included that consider: non-pharmacological strategies for residents with dementia, end-of-life care, sexuality and intimacy and the care-home workforce. Given the importance of the COVID-19 pandemic in care homes, all of the care home COVID-19 papers published in Age and Ageing to date are included. Finally, a group of papers that present innovative approaches to research in care homes, each of which give voice to residents and/or staff, are collated and presented as a way of moving towards a more resident and care home centred research agenda.
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Affiliation(s)
- Adam L Gordon
- Unit of Injury, Inflammation and Recovery, School of Medicine, University of Nottingham, Nottingham UK
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
| | - Chloe Bennett
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
- NIHR Applied Research Collaboration East of England (ARC EoE), Cambridge, UK
| | - Wilco P Achterberg
- The Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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29
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Samsi K, Cole L, Orellana K, Manthorpe J. Is it worth it? Carers' views and expectations of residential respite for people living with dementia during and beyond the COVID-19 pandemic. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5680. [PMID: 35064684 PMCID: PMC9015269 DOI: 10.1002/gps.5680] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The Covid-19 pandemic has taken a heavy toll on many people living with dementia and carers. Caring for a person living with dementia at home with limited avenues for support and a break challenged many carers. Care homes in England closed to visitors, with very few offering opportunities for a short-stay. We investigated impact of Covid-19 on views and expectations of carers of people living with dementia about residential respite. METHODS/DESIGN Qualitative interviews with 35 carers were conducted March-December 2020: 30 women and 5 men, with ages ranging 30-83 years. Interviews explored experiences, views of residential respite, and expectations post-Covid. Data were thematically analysed and salient concepts were drawn out and discussed within the research team and study advisers. RESULTS Three themes were identified in transcripts, relating to impact of Covid-19 on views and expectations of respite: (1) Carers described regularly negotiating risks and stresses of Covid, weighing up how to prevent infection and changing family arrangements to facilitate caring; (2) Carers were balancing different needs, prioritising needs of their relatives while bearing the impact of cumulative caregiving responsibilities. (3) Uncertainty about future residential respite continued, in terms of availability, ongoing restrictions and trustworthy information sources. CONCLUSIONS Residential respite is a positive, acceptable option for some carers to get a break from caring. Covid-19 may have heighted some of caregiving stressors and there may be an increased need for a break. Views of care homes developed during the pandemic suggest that individual confidence to use respite may need to be rebuilt.
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Affiliation(s)
- Kritika Samsi
- NIHR Policy Research Unit in Health and Social Care WorkforceKing's College LondonLondonUK
| | - Laura Cole
- Geller Institute of Ageing and MemoryUniversity of West LondonLondonUK
| | - Katharine Orellana
- NIHR Policy Research Unit in Health and Social Care WorkforceKing's College LondonLondonUK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care WorkforceKing's College LondonLondonUK
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Delory T, Arino J, Haÿ PE, Klotz V, Boëlle PY. SARS-CoV-2 in Nursing Homes: Analysis of Routine Surveillance Data in Four European Countries. Aging Dis 2022; 14:325-330. [PMID: 37008047 PMCID: PMC10017157 DOI: 10.14336/ad.2022.0820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022] Open
Abstract
Transmission of SARS-CoV-2 in nursing homes is poorly documented. Using surveillance data of 228 European private nursing homes, we estimated weekly SARS-CoV-2 incidences among 21,467 residents and 14,371 staff members, compared to that in the general population, between August 3, 2020, and February 20, 2021. We studied the outcomes of "episodes of introduction" where one case was first detected and computed attack rates, reproduction ratio (R), and dispersion parameter (k). Out of 502 episodes of SARS-CoV-2 introduction, 77.1% (95%CI, 73.2%-80.6%) led to additional cases. Attack rates were highly variable, ranging from 0.4% to 86.5%. The R was 1.16 (95%CI, 1.11-1.22) with k at 2.5 (95%CI, 0.5-4.5). The timing of viral circulation in nursing homes did not mirror that in the general population (p-values<0.001). We estimated the impact of vaccination in preventing SARS-CoV-2 transmission. Before vaccination's roll-out, a cumulated 5,579 SARS-CoV-2 infections were documented among residents and 2,321 among staff. Higher staffing ratio and previous natural immunization reduced the probability of an outbreak following introduction. Despite strong preventive measures, transmission likely occurred, regardless of building characteristics. Vaccination started on January 15, 2021, and coverage reached 65.0% among residents, and 42.0% among staff by February 20, 2021. Vaccination yielded a 92% reduction (95%CI, 71%-98%) of outbreak probability, and lowered R to 0.87 (95%CI, 0.69-1.10). In the post-pandemic era, much attention will have to be paid to multi-lateral collaboration, policy making, and prevention plans.
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Affiliation(s)
- Tristan Delory
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, IPLESP, F-75012, Paris, France.
- Centre Hospitalier Annecy Genevois, France.
- Correspondence should be addressed to: Dr. Tristan Delory, DRCI, Centre Hospitalier Annecy Genevois, 1 avenue de l’hôpital, 74290 Epagny - Metz - Tessy, France. .
| | - Julien Arino
- Department of Mathematics, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | | | | - Pierre-Yves Boëlle
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, IPLESP, F-75012, Paris, France.
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Nightingale G, Laxton M, Illian JB. How does the community COVID-19 level of risk impact on that of a care home? PLoS One 2022; 16:e0260051. [PMID: 34972103 PMCID: PMC8719703 DOI: 10.1371/journal.pone.0260051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives To model the risk of COVID-19 mortality in British care homes conditional on the community level risk. Methods A two stage modeling process (“doubly latent”) which includes a Besag York Mollie model (BYM) and a Log Gaussian Cox Process. The BYM is adopted so as to estimate the community level risks. These are incorporated in the Log Gaussian Cox Process to estimate the impact of these risks on that in care homes. Results For an increase in the risk at the community level, the number of COVID-19 related deaths in the associated care home would be increased by exp (0.833), 2. This is based on a simulated dataset. In the context of COVID-19 related deaths, this study has illustrated the estimation of the risk to care homes in the presence of background community risk. This approach will be useful in facilitating the identification of the most vulnerable care homes and in predicting risk to new care homes. Conclusions The modeling of two latent processes have been shown to be successfully facilitated by the use of the BYM and Log Gaussian Cox Process Models. Community COVID-19 risks impact on that of the care homes embedded in these communities.
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Affiliation(s)
- Glenna Nightingale
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Megan Laxton
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
| | - Janine B. Illian
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
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Luzón Oliver L, Molina Pérez de Los Cobos E, Novoa Jurado A, Pérez Martínez E, Martínez Monreal D. [Patient safety in nursing homes. The experience of the Autonomous Community of the Region of Murcia]. Aten Primaria 2021; 53 Suppl 1:102228. [PMID: 34961574 PMCID: PMC8721345 DOI: 10.1016/j.aprim.2021.102228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/08/2021] [Indexed: 01/10/2023] Open
Abstract
La pandemia ha expuesto la vulnerabilidad de los centros residenciales y la fragilidad de la población que en ellos viven. En la Región de Murcia la atención a este grupo poblacional se convirtió en una prioridad y se elaboró un plan regional para atender las necesidades de los residentes desde el marco ético de la justicia procedimental. La inmediatez impuesta por la crisis sanitaria ha hecho que toda esta intervención no esté exenta de riesgos. A partir del modelo de Reason hemos realizado un análisis causal de los factores que llevaron a las residencias a sufrir un impacto devastador. La pandemia ha evidenciado la urgencia de fortalecer el modelo de cuidados que ofrecemos a nuestros mayores. Un modelo que garantice la cobertura de unas necesidades a unos pacientes extremadamente frágiles que van más allá de una atención sanitaria y biomédica y que tenga en cuenta sus preferencias y sus valores.
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Affiliation(s)
- Lourdes Luzón Oliver
- Grupo CORECAAS. Coordinación Regional para la Cronicidad Avanzada y la Atención Sociosanitaria, Murcia, España; IMIB: Instituto Murciano de Investigación Biosanitaria, Murcia, España; Medicina Familiar y Comunitaria, Murcia, España; Grupo de Trabajo de Seguridad del Paciente de semFYC, Murcia, España.
| | - Enrique Molina Pérez de Los Cobos
- Grupo CORECAAS. Coordinación Regional para la Cronicidad Avanzada y la Atención Sociosanitaria, Murcia, España; IMIB: Instituto Murciano de Investigación Biosanitaria, Murcia, España; Medicina Familiar y Comunitaria, Murcia, España
| | - Abel Novoa Jurado
- Grupo CORECAAS. Coordinación Regional para la Cronicidad Avanzada y la Atención Sociosanitaria, Murcia, España; IMIB: Instituto Murciano de Investigación Biosanitaria, Murcia, España; Medicina Familiar y Comunitaria, Murcia, España; CORECAAS, Murcia, España; Grupo de Trabajo de Bioética de semFYC, Murcia, España
| | - Eva Pérez Martínez
- Grupo CORECAAS. Coordinación Regional para la Cronicidad Avanzada y la Atención Sociosanitaria, Murcia, España; IMIB: Instituto Murciano de Investigación Biosanitaria, Murcia, España; DUE, Murcia, España
| | - Damián Martínez Monreal
- Grupo CORECAAS. Coordinación Regional para la Cronicidad Avanzada y la Atención Sociosanitaria, Murcia, España; IMIB: Instituto Murciano de Investigación Biosanitaria, Murcia, España; DUE, Murcia, España
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Liu KY, Howard R, Banerjee S, Comas‐Herrera A, Goddard J, Knapp M, Livingston G, Manthorpe J, O'Brien JT, Paterson RW, Robinson L, Rossor M, Rowe JB, Sharp DJ, Sommerlad A, Suárez‐González A, Burns A. Dementia wellbeing and COVID-19: Review and expert consensus on current research and knowledge gaps. Int J Geriatr Psychiatry 2021; 36:1597-1639. [PMID: 34043836 PMCID: PMC8237017 DOI: 10.1002/gps.5567] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES In response to a commissioned research update on dementia during the COVID-19 pandemic, a UK-based working group, comprising dementia researchers from a range of fields and disciplines, aimed to describe the impact of the pandemic on dementia wellbeing and identify priorities for future research. METHODS We supplemented a rapid literature search (including unpublished, non-peer reviewed and ongoing studies/reports) on dementia wellbeing in the context of COVID-19 with expert group members' consensus about future research needs. From this we generated potential research questions the group judged to be relevant that were not covered by the existing literature. RESULTS Themes emerged from 141 studies within the six domains of the NHS England COVID-19 Dementia Wellbeing Pathway: Preventing Well, Diagnosing Well, Treating Well, Supporting Well, Living Well and Dying Well. We describe current research findings and knowledge gaps relating to the impact on people affected by dementia (individuals with a diagnosis, their carers and social contacts, health and social care practitioners and volunteers), services, research activities and organisations. Broad themes included the potential benefits and risks of new models of working including remote healthcare, the need for population-representative longitudinal studies to monitor longer-term impacts, and the importance of reporting dementia-related findings within broader health and care studies. CONCLUSIONS The COVID-19 pandemic has had a disproportionately negative impact on people affected by dementia. Researchers and funding organisations have responded rapidly to try to understand the impacts. Future research should highlight and resolve outstanding questions to develop evidence-based measures to improve the quality of life of people affected by dementia.
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Affiliation(s)
- Kathy Y. Liu
- Division of PsychiatryUniversity College LondonLondonUK
| | - Robert Howard
- Division of PsychiatryUniversity College LondonLondonUK
| | | | - Adelina Comas‐Herrera
- Department of Health PolicyLondon School of Economics and Political ScienceCare Policy and Evaluation CentreLondonUK
| | - Joanne Goddard
- Economic and Social Research CouncilUK Research and InnovationSwindonUK
| | - Martin Knapp
- Department of Health PolicyLondon School of Economics and Political ScienceCare Policy and Evaluation CentreLondonUK
| | | | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care WorkforceKing's College LondonLondonUK
| | - John T. O'Brien
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - Ross W. Paterson
- Dementia Research CentreQueen Square UCL Institute of NeurologyUniversity College LondonLondonUK
| | - Louise Robinson
- Population Health Sciences InstituteFaculty of Medical SciencesNewcastle UniversityNewcastleUK
| | - Martin Rossor
- Dementia Research CentreQueen Square UCL Institute of NeurologyUniversity College LondonLondonUK
| | - James B. Rowe
- Medical Research Council Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK,Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - David J. Sharp
- Department of Brain SciencesImperial College LondonLondonUK,UK Dementia Research InstituteCare Research and Technology Centre, Imperial College LondonLondonUK
| | | | - Aida Suárez‐González
- Dementia Research CentreQueen Square UCL Institute of NeurologyUniversity College LondonLondonUK
| | - Alistair Burns
- Division of Neuroscience and Experimental PsychologyThe University of ManchesterManchesterUK
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García-Cabrera L, Pérez-Abascal N, Montero-Errasquín B, Rexach Cano L, Mateos-Nozal J, Cruz-Jentoft A. Characteristics, hospital referrals and 60-day mortality of older patients living in nursing homes with COVID-19 assessed by a liaison geriatric team during the first wave: a research article. BMC Geriatr 2021; 21:610. [PMID: 34715807 PMCID: PMC8553905 DOI: 10.1186/s12877-021-02565-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The infection by SARS-CoV-2 (COVID-19) has been especially serious in older patients. The aim of this study is to describe baseline and clinical characteristics, hospital referrals, 60-day mortality, factors associated with hospital referrals and mortality in older patients living in nursing homes (NH) with suspected COVID-19. METHODS A retrospective observational study was performed during March and April 2020 of institutionalized patients assessed by a liaison geriatric hospital-based team. Were collected all older patients living in 31 nursing homes of a public hospital catchment area assessed by a liaison geriatric team due to the suspicion of COVID-19 during the first wave, when the hospital system was collapsed. Sociodemographic variables, comprehensive geriatric assessment, clinical characteristics, treatment received including care setting, and 60-days mortality were recorded from electronic medical records. A logistic regression analysis was performed to analyze the factors associated with mortality. RESULTS 419 patients were included in the study (median age 89 years old, 71.6 % women, 63.7 % with moderate-severe dependence, and 43.8 % with advanced dementia). 31.1 % were referred to the emergency department in the first assessment, with a higher rate of hospital referral in those with better functional and mental status. COVID-19 atypical symptoms like functional decline, delirium, or eating disorders were frequent. 36.9% had died in the 60 days following the first call. According to multivariate logistic regression age (p 0.010), Barthel index <60 (p 0.002), presence of tachypnea (p 0.021), fever (p 0.006) and the use of ceftriaxone (p 0.004) were associated with mortality. No mortality differences were found between those referred to the hospital or cared at the nursing home. CONCLUSIONS AND IMPLICATIONS 31% of the nursing home patients assessed by a liaison geriatric hospital-based team for COVID-19 were referred to the hospital, being more frequently referred those with a better functional and cognitive situation. The 60-days mortality rate due to COVID-19 was 36.8% and was associated with older age, functional dependence, the presence of tachypnea and fever, and the use of ceftriaxone. Geriatric comprehensive assessment and coordination between NH and the hospital geriatric department teams were crucial.
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Affiliation(s)
- Lorena García-Cabrera
- Unidad de Cuidados Paliativos, Hospital Universitario Ramón y Cajal (IRYCIS), Carretera de Colmenar km 9,1, 28034, Madrid, Spain.
| | - Noelia Pérez-Abascal
- Servicio de Geriatría. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Lourdes Rexach Cano
- Unidad de Cuidados Paliativos, Hospital Universitario Ramón y Cajal (IRYCIS), Carretera de Colmenar km 9,1, 28034, Madrid, Spain
| | - Jesús Mateos-Nozal
- Servicio de Geriatría. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
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Frazer K, Mitchell L, Stokes D, Lacey E, Crowley E, Kelleher CC. A rapid systematic review of measures to protect older people in long-term care facilities from COVID-19. BMJ Open 2021; 11:e047012. [PMID: 34663652 PMCID: PMC8523961 DOI: 10.1136/bmjopen-2020-047012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 08/29/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities (LTCF) experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in LTCF to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff and visitors. SETTING Long-term care facilities. PARTICIPANTS Residents, staff and visitors of facilities. PRIMARY AND SECONDARY OUTCOME MEASURES Databases (PubMed, EMBASE, CINAHL, Cochrane Databases and repositories and MedRXiv prepublished database) were systematically searched from inception to 27 July 2020 to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. RESULTS The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2% to 85.4% in residents and 0.6% to 62.6% in staff. Mortality rates ranged from 5.3% to 55.3% in residents. CONCLUSIONS Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in LTCF. PROSPERO REGISTRATION NUMBER CRD42020191569.
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Affiliation(s)
- Kate Frazer
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Lachlan Mitchell
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Diarmuid Stokes
- Health Sciences Library, University College Dublin, Dublin, Ireland
| | - Ella Lacey
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Eibhlin Crowley
- Office for Health Affairs, College of Health and Agricultural Science, University College Dublin, Dublin, Ireland
| | - Cecily C Kelleher
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
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Stratil JM, Biallas RL, Burns J, Arnold L, Geffert K, Kunzler AM, Monsef I, Stadelmaier J, Wabnitz K, Litwin T, Kreutz C, Boger AH, Lindner S, Verboom B, Voss S, Movsisyan A. Non-pharmacological measures implemented in the setting of long-term care facilities to prevent SARS-CoV-2 infections and their consequences: a rapid review. Cochrane Database Syst Rev 2021; 9:CD015085. [PMID: 34523727 PMCID: PMC8442144 DOI: 10.1002/14651858.cd015085.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Starting in late 2019, COVID-19, caused by the novel coronavirus SARS-CoV-2, spread around the world. Long-term care facilities are at particularly high risk of outbreaks, and the burden of morbidity and mortality is very high among residents living in these facilities. OBJECTIVES To assess the effects of non-pharmacological measures implemented in long-term care facilities to prevent or reduce the transmission of SARS-CoV-2 infection among residents, staff, and visitors. SEARCH METHODS On 22 January 2021, we searched the Cochrane COVID-19 Study Register, WHO COVID-19 Global literature on coronavirus disease, Web of Science, and CINAHL. We also conducted backward citation searches of existing reviews. SELECTION CRITERIA We considered experimental, quasi-experimental, observational and modelling studies that assessed the effects of the measures implemented in long-term care facilities to protect residents and staff against SARS-CoV-2 infection. Primary outcomes were infections, hospitalisations and deaths due to COVID-19, contaminations of and outbreaks in long-term care facilities, and adverse health effects. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full texts. One review author performed data extractions, risk of bias assessments and quality appraisals, and at least one other author checked their accuracy. Risk of bias and quality assessments were conducted using the ROBINS-I tool for cohort and interrupted-time-series studies, the Joanna Briggs Institute (JBI) checklist for case-control studies, and a bespoke tool for modelling studies. We synthesised findings narratively, focusing on the direction of effect. One review author assessed certainty of evidence with GRADE, with the author team critically discussing the ratings. MAIN RESULTS We included 11 observational studies and 11 modelling studies in the analysis. All studies were conducted in high-income countries. Most studies compared outcomes in long-term care facilities that implemented the measures with predicted or observed control scenarios without the measure (but often with baseline infection control measures also in place). Several modelling studies assessed additional comparator scenarios, such as comparing higher with lower rates of testing. There were serious concerns regarding risk of bias in almost all observational studies and major or critical concerns regarding the quality of many modelling studies. Most observational studies did not adequately control for confounding. Many modelling studies used inappropriate assumptions about the structure and input parameters of the models, and failed to adequately assess uncertainty. Overall, we identified five intervention domains, each including a number of specific measures. Entry regulation measures (4 observational studies; 4 modelling studies) Self-confinement of staff with residents may reduce the number of infections, probability of facility contamination, and number of deaths. Quarantine for new admissions may reduce the number of infections. Testing of new admissions and intensified testing of residents and of staff after holidays may reduce the number of infections, but the evidence is very uncertain. The evidence is very uncertain regarding whether restricting admissions of new residents reduces the number of infections, but the measure may reduce the probability of facility contamination. Visiting restrictions may reduce the number of infections and deaths. Furthermore, it may increase the probability of facility contamination, but the evidence is very uncertain. It is very uncertain how visiting restrictions may adversely affect the mental health of residents. Contact-regulating and transmission-reducing measures (6 observational studies; 2 modelling studies) Barrier nursing may increase the number of infections and the probability of outbreaks, but the evidence is very uncertain. Multicomponent cleaning and environmental hygiene measures may reduce the number of infections, but the evidence is very uncertain. It is unclear how contact reduction measures affect the probability of outbreaks. These measures may reduce the number of infections, but the evidence is very uncertain. Personal hygiene measures may reduce the probability of outbreaks, but the evidence is very uncertain. Mask and personal protective equipment usage may reduce the number of infections, the probability of outbreaks, and the number of deaths, but the evidence is very uncertain. Cohorting residents and staff may reduce the number of infections, although evidence is very uncertain. Multicomponent contact -regulating and transmission -reducing measures may reduce the probability of outbreaks, but the evidence is very uncertain. Surveillance measures (2 observational studies; 6 modelling studies) Routine testing of residents and staff independent of symptoms may reduce the number of infections. It may reduce the probability of outbreaks, but the evidence is very uncertain. Evidence from one observational study suggests that the measure may reduce, while the evidence from one modelling study suggests that it probably reduces hospitalisations. The measure may reduce the number of deaths among residents, but the evidence on deaths among staff is unclear. Symptom-based surveillance testing may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain. Outbreak control measures (4 observational studies; 3 modelling studies) Separating infected and non-infected residents or staff caring for them may reduce the number of infections. The measure may reduce the probability of outbreaks and may reduce the number of deaths, but the evidence for the latter is very uncertain. Isolation of cases may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain. Multicomponent measures (2 observational studies; 1 modelling study) A combination of multiple infection-control measures, including various combinations of the above categories, may reduce the number of infections and may reduce the number of deaths, but the evidence for the latter is very uncertain. AUTHORS' CONCLUSIONS This review provides a comprehensive framework and synthesis of a range of non-pharmacological measures implemented in long-term care facilities. These may prevent SARS-CoV-2 infections and their consequences. However, the certainty of evidence is predominantly low to very low, due to the limited availability of evidence and the design and quality of available studies. Therefore, true effects may be substantially different from those reported here. Overall, more studies producing stronger evidence on the effects of non-pharmacological measures are needed, especially in low- and middle-income countries and on possible unintended consequences of these measures. Future research should explore the reasons behind the paucity of evidence to guide pandemic research priority setting in the future.
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Affiliation(s)
- Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Renke L Biallas
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Laura Arnold
- Academy of Public Health Services, Duesseldorf, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Tim Litwin
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Clemens Kreutz
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Anna Helen Boger
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Saskia Lindner
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ben Verboom
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Tut G, Lancaster T, Krutikov M, Sylla P, Bone D, Kaur N, Spalkova E, Bentley C, Amin U, Jadir AT, Hulme S, Butler MS, Ayodele M, Bruton R, Shrotri M, Azmi B, Fuller C, Irwin-Singer A, Hayward A, Copas A, Shallcross L, Moss P. Profile of humoral and cellular immune responses to single doses of BNT162b2 or ChAdOx1 nCoV-19 vaccines in residents and staff within residential care homes (VIVALDI): an observational study. THE LANCET. HEALTHY LONGEVITY 2021; 2:e544-e553. [PMID: 34430954 PMCID: PMC8376213 DOI: 10.1016/s2666-7568(21)00168-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Residents of long-term care facilities (LTCFs) have been prioritised for COVID-19 vaccination because of the high COVID-19 mortality in this population. Several countries have implemented an extended interval of up to 12 weeks between the first and second vaccine doses to increase population coverage of single-dose vaccination. We aimed to assess the magnitude and quality of adaptive immune responses following a single dose of COVID-19 vaccine in LTCF residents and staff. METHODS From the LTCFs participating in the ongoing VIVALDI study (ISRCTN14447421), staff and residents who had received a first dose of COVID-19 vaccine (BNT162b2 [tozinameran] or ChAdOx1 nCoV-19), had pre-vaccination and post-vaccination blood samples (collected between Dec 11, 2020, and Feb 16, 2021), and could be linked to a pseudoidentifier in the COVID-19 Data Store were included in our cohort. Past infection with SARS-CoV-2 was defined on the basis of nucleocapsid-specific IgG antibodies being detected through a semiquantitative immunoassay, and participants who tested positive on this assay after but not before vaccination were excluded from the study. Processed blood samples were assessed for spike-specific immune responses, including spike-specific IgG antibody titres, T-cell responses to spike protein peptide mixes, and inhibition of ACE2 binding by spike protein from four variants of SARS-CoV-2 (the original strain as well as the B.1.1.7, B.1.351, and P.1 variants). Responses before and after vaccination were compared on the basis of age, previous infection status, role (staff or resident), and time since vaccination. FINDINGS Our cohort comprised 124 participants from 14 LTCFs: 89 (72%) staff (median age 48 years [IQR 35·5-56]) and 35 (28%) residents (87 years [77-90]). Blood samples were collected a median 40 days (IQR 25-47; range 6-52) after vaccination. 30 (24%) participants (18 [20%] staff and 12 [34%] residents) had serological evidence of previous SARS-CoV-2 infection. All participants with previous infection had high antibody titres following vaccination that were independent of age (r s=0·076, p=0·70). In participants without evidence of previous infection, titres were negatively correlated with age (r s=-0·434, p<0·0001) and were 8·2-times lower in residents than in staff. This effect appeared to result from a kinetic delay antibody generation in older infection-naive participants, with the negative age correlation disappearing only in samples taken more than 42 days post-vaccination (r s=-0·207, p=0·20; n=40), in contrast to samples taken after 0-21 days (r s=-0·774, p=0·0043; n=12) or 22-42 days (r s=-0·437, p=0·0034; n=43). Spike-specific cellular responses were similar between older and younger participants. In infection-naive participants, antibody inhibition of ACE2 binding by spike protein from the original SARS-CoV-2 strain was negatively correlated with age (r s=-0·439, p<0·0001), and was significantly lower against spike protein from the B.1.351 variant (median inhibition 31% [14-100], p=0·010) and the P.1 variant (23% [14-97], p<0·0001) than against the original strain (58% [27-100]). By contrast, a single dose of vaccine resulted in around 100% inhibition of the spike-ACE2 interaction against all variants in people with a history of infection. INTERPRETATION History of SARS-CoV-2 infection impacts the magnitude and quality of antibody response after a single dose of COVID-19 vaccine in LTCF residents. Residents who are infection-naive have delayed antibody responses to the first dose of vaccine and should be considered for an early second dose where possible. FUNDING UK Government Department of Health and Social Care.
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Affiliation(s)
- Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Tara Lancaster
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Maria Krutikov
- UCL Institute of Health Informatics, University College London, London, UK
| | - Panagiota Sylla
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - David Bone
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Nayandeep Kaur
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Eliska Spalkova
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Christopher Bentley
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Umayr Amin
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Azar T Jadir
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Samuel Hulme
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Megan S Butler
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Morenike Ayodele
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Rachel Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Madhumita Shrotri
- UCL Institute of Health Informatics, University College London, London, UK
| | - Borscha Azmi
- UCL Institute of Health Informatics, University College London, London, UK
| | - Chris Fuller
- UCL Institute of Health Informatics, University College London, London, UK
| | | | | | - Andrew Copas
- UCL Institute for Global Health, University College London, London, UK
| | - Laura Shallcross
- UCL Institute of Health Informatics, University College London, London, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Dutey-Magni PF, Williams H, Jhass A, Rait G, Lorencatto F, Hemingway H, Hayward A, Shallcross L. COVID-19 infection and attributable mortality in UK care homes: cohort study using active surveillance and electronic records (March-June 2020). Age Ageing 2021; 50:1019-1028. [PMID: 33710281 PMCID: PMC7989651 DOI: 10.1093/ageing/afab060] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND epidemiological data on COVID-19 infection in care homes are scarce. We analysed data from a large provider of long-term care for older people to investigate infection and mortality during the first wave of the pandemic. METHODS cohort study of 179 UK care homes with 9,339 residents and 11,604 staff. We used manager-reported daily tallies to estimate the incidence of suspected and confirmed infection and mortality in staff and residents. Individual-level electronic health records from 8,713 residents were used to model risk factors for confirmed infection, mortality and estimate attributable mortality. RESULTS 2,075/9,339 residents developed COVID-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory-confirmed infections. The incidence of confirmed infection was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days in residents and staff, respectively. Sixty-eight percent (121/179) of care homes had at least one COVID-19 infection or COVID-19-related death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection.Out of 607 residents with confirmed infection, 217 died (case fatality rate: 35.7% [31.9%; 39.7%]). Mortality in residents with no direct evidence of infection was twofold higher in care homes with outbreaks versus those without (adjusted hazard ratio: 2.2 [1.8; 2.6]). CONCLUSIONS findings suggest many deaths occurred in people who were infected with COVID-19, but not tested. Higher occupancy and lower staffing levels were independently associated with risks of infection. Protecting staff and residents from infection requires regular testing for COVID-19 and fundamental changes to staffing and care home occupancy.
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Affiliation(s)
- Peter F Dutey-Magni
- Institute of Health Informatics, University College London, NW1 2DA, London, UK
| | | | - Arnoupe Jhass
- Institute of Health Informatics, University College London, NW1 2DA, London, UK
- Primary Care & Population Health, University College London, NW3 2PF, London, UK
| | - Greta Rait
- Primary Care & Population Health, University College London, NW3 2PF, London, UK
- NIHR Biomedical Research Centre, University College London Hospitals, W1T 7DN, London, UK
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, WC1E 7HB, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, NW1 2DA, London, UK
- NIHR Biomedical Research Centre, University College London Hospitals, W1T 7DN, London, UK
- Health Data Research UK, University College London, NW1 2DA, London, UK
| | - Andrew Hayward
- Institute of Epidemiology & Health Care, University College London, WC1E 7HB, London, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, NW1 2DA, London, UK
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Burton JK, McMinn M, Vaughan JE, Fleuriot J, Guthrie B. Care-home outbreaks of COVID-19 in Scotland March to May 2020: National linked data cohort analysis. Age Ageing 2021; 50:1482-1492. [PMID: 33963849 PMCID: PMC8136021 DOI: 10.1093/ageing/afab099] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND understanding care-home outbreaks of COVID-19 is a key public health priority in the ongoing pandemic to help protect vulnerable residents. OBJECTIVE to describe all outbreaks of COVID-19 infection in Scottish care-homes for older people between 01/03/2020 and 31/03/2020, with follow-up to 30/06/2020. DESIGN AND SETTING National linked data cohort analysis of Scottish care-homes for older people. METHODS data linkage was used to identify outbreaks of COVID-19 in care-homes. Care-home characteristics associated with the presence of an outbreak were examined using logistic regression. Size of outbreaks was modelled using negative binomial regression. RESULTS 334 (41%) Scottish care-homes for older people experienced an outbreak, with heterogeneity in outbreak size (1-63 cases; median = 6) and duration (1-94 days, median = 31.5 days). Four distinct patterns of outbreak were identified: 'typical' (38% of outbreaks, mean 11.2 cases and 48 days duration), severe (11%, mean 29.7 cases and 60 days), contained (37%, mean 3.5 cases and 13 days) and late-onset (14%, mean 5.4 cases and 17 days). Risk of a COVID-19 outbreak increased with increasing care-home size (for ≥90 beds vs <20, adjusted OR = 55.4, 95% CI 15.0-251.7) and rising community prevalence (OR = 1.2 [1.0-1.4] per 100 cases/100,000 population increase). No routinely available care-home characteristic was associated with outbreak size. CONCLUSIONS reducing community prevalence of COVID-19 infection is essential to protect those living in care-homes. More systematic national data collection to understand care-home residents and the homes in which they live is a priority in ensuring we can respond more effectively in future.
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Affiliation(s)
- Jennifer Kirsty Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G31 2ER, UK
| | - Megan McMinn
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - James E Vaughan
- School of Informatics, University of Edinburgh, Edinburgh EH8 9AB, UK
| | - Jacques Fleuriot
- School of Informatics, University of Edinburgh, Edinburgh EH8 9AB, UK
| | - Bruce Guthrie
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
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Schultze A, Bates C, Cockburn J, MacKenna B, Nightingale E, Curtis HJ, Hulme WJ, Morton CE, Croker R, Bacon S, McDonald HI, Rentsch CT, Bhaskaran K, Mathur R, Tomlinson LA, Williamson EJ, Forbes H, Tazare J, Grint DJ, Walker AJ, Inglesby P, DeVito NJ, Mehrkar A, Hickman G, Davy S, Ward T, Fisher L, Evans D, Wing K, Wong AYS, McManus R, Parry J, Hester F, Harper S, Evans SJW, Douglas IJ, Smeeth L, Eggo RM, Goldacre B. Identifying Care Home Residents in Electronic Health Records - An OpenSAFELY Short Data Report. Wellcome Open Res 2021; 6:90. [PMID: 34471703 PMCID: PMC8374378 DOI: 10.12688/wellcomeopenres.16737.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Care home residents have been severely affected by the COVID-19 pandemic. Electronic Health Records (EHR) hold significant potential for studying the healthcare needs of this vulnerable population; however, identifying care home residents in EHR is not straightforward. We describe and compare three different methods for identifying care home residents in the newly created OpenSAFELY-TPP data analytics platform. Methods: Working on behalf of NHS England, we identified individuals aged 65 years or older potentially living in a care home on the 1st of February 2020 using (1) a complex address linkage, in which cleaned GP registered addresses were matched to old age care home addresses using data from the Care and Quality Commission (CQC); (2) coded events in the EHR; (3) household identifiers, age and household size to identify households with more than 3 individuals aged 65 years or older as potential care home residents. Raw addresses were not available to the investigators. Results: Of 4,437,286 individuals aged 65 years or older, 2.27% were identified as potential care home residents using the complex address linkage, 1.96% using coded events, 3.13% using household size and age and 3.74% using either of these methods. 53,210 individuals (32.0% of all potential care home residents) were classified as care home residents using all three methods. Address linkage had the largest overlap with the other methods; 93.3% of individuals identified as care home residents using the address linkage were also identified as such using either coded events or household age and size. Conclusion: We have described the partial overlap between three methods for identifying care home residents in EHR, and provide detailed instructions for how to implement these in OpenSAFELY-TPP to support research into the impact of the COVID-19 pandemic on care home residents.
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Affiliation(s)
- Anna Schultze
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Chris Bates
- The Phoenix Partnership, Leeds, LS18 5PX, UK
| | | | - Brian MacKenna
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Emily Nightingale
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, Select, WC1E 7HT, UK
| | - Helen J Curtis
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - William J Hulme
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Caroline E Morton
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Richard Croker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Seb Bacon
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Helen I McDonald
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Christopher T Rentsch
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Krishnan Bhaskaran
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Rohini Mathur
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Laurie A Tomlinson
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Elizabeth J Williamson
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Harriet Forbes
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - John Tazare
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Daniel J Grint
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Alex J Walker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Peter Inglesby
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Nicholas J DeVito
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Amir Mehrkar
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - George Hickman
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Simon Davy
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Tom Ward
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Louis Fisher
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - David Evans
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Kevin Wing
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Angel YS Wong
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | | | - John Parry
- The Phoenix Partnership, Leeds, LS18 5PX, UK
| | | | - Sam Harper
- The Phoenix Partnership, Leeds, LS18 5PX, UK
| | - Stephen JW Evans
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Ian J Douglas
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Liam Smeeth
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Rosalind M Eggo
- 1 Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, Select, WC1E 7HT, UK
| | - Ben Goldacre
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
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Shallcross L, Burke D, Abbott O, Donaldson A, Hallatt G, Hayward A, Hopkins S, Krutikov M, Sharp K, Wardman L, Thorne S. Factors associated with SARS-CoV-2 infection and outbreaks in long-term care facilities in England: a national cross-sectional survey. THE LANCET. HEALTHY LONGEVITY 2021; 2:e129-e142. [PMID: 33655236 PMCID: PMC7906733 DOI: 10.1016/s2666-7568(20)30065-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have occurred in long-term care facilities (LTCFs) worldwide, but the reasons why some facilities are particularly vulnerable to outbreaks are poorly understood. We aimed to identify factors associated with SARS-CoV-2 infection and outbreaks among staff and residents in LTCFs. METHODS We did a national cross-sectional survey of all LTCFs providing dementia care or care to adults aged 65 years or older in England between May 26 and June 19, 2020. The survey collected data from managers of eligible LTCFs on LTCF characteristics, staffing factors, the use of disease control measures, and the number of confirmed cases of infection among staff and residents in each LTCF. Survey responses were linked to individual-level SARS-CoV-2 RT-PCR test results obtained through the national testing programme in England between April 30 and June 13, 2020. The primary outcome was the weighted period prevalence of confirmed SARS-CoV-2 infections in residents and staff reported via the survey. Multivariable logistic regression models were fitted to identify factors associated with infection in staff and residents, an outbreak (defined as at least one case of SARS-CoV-2 infection in a resident or staff member), and a large outbreak (defined as LTCFs with more than a third of the total number of residents and staff combined testing positive, or with >20 residents and staff combined testing positive) using data from the survey and from the linked survey-test dataset. FINDINGS 9081 eligible wLTCFs were identified, of which 5126 (56·4%) participated in the survey, providing data on 160 033 residents and 248 594 staff members. The weighted period prevalence of infection was 10·5% (95% CI 9·9-11·1) in residents and 3·8% (3·4-4·2) in staff members. 2724 (53·1%) LTCFs reported outbreaks, and 469 (9·1%) LTCFs reported large outbreaks. The odds of SARS-CoV-2 infection in residents (adjusted odds ratio [aOR] 0·80 [95% CI 0·75-0·86], p<0·0001) and staff (0·70 [0·65-0·77], p<0·0001), and of large outbreaks (0·59 [0·38-0·93], p=0·024) were significantly lower in LTCFs that paid staff statutory sick pay compared with those that did not. Each one unit increase in the staff-to-bed ratio was associated with a reduced odds of infection in residents (0·82 [0·78-0·87], p<0·0001) and staff (0·63 [0·59-0·68], p<0·0001. The odds of infection in residents (1·30 [1·23-1·37], p<0·0001) and staff (1·20 [1·13-1·29], p<0·0001), and of outbreaks (2·56 [1·94-3·49], p<0·0001) were significantly higher in LTCFs in which staff often or always cared for both infected or uninfected residents compared with those that cohorted staff with either infected or uninfected residents. Significantly increased odds of infection in residents (1·01 [1·01-1·01], p<0·0001) and staff (1·00 [1·00-1·01], p=0·0005), and of outbreaks (1·08 [1·05-1·10], p<0·0001) were associated with each one unit increase in the number of new admissions to the LTCF relative to baseline (March 1, 2020). The odds of infection in residents (1·19 [1·12-1·26], p<0·0001) and staff (1·19 [1·10-1·29], p<0·0001), and of large outbreaks (1·65 [1·07-2·54], p=0·024) were significantly higher in LTCFs that were for profit versus those that were not for profit. Frequent employment of agency nurses or carers was associated with a significantly increased odds of infection in residents (aOR 1·65 [1·56-1·74], p<0·0001) and staff (1·85 [1·72-1·98], p<0·0001), and of outbreaks (2·33 [1·72-3·16], p<0·0001) and large outbreaks (2·42 [1·67-3·51], p<0·0001) compared with no employment of agency nurses or carers. Compared with LTCFs that did not report difficulties in isolating residents, those that did had significantly higher odds of infection in residents (1·33 [1·28-1·38], p<0·0001) and staff (1·48 [1·41-1·56], p<0·0001), and of outbreaks (1·84 [1·48-2·30], p<0·0001) and large outbreaks (1·62 [1·24-2·11], p=0·0004). INTERPRETATION Half of LTCFs had no cases of SARS-CoV-2 infection in the first wave of the pandemic. Reduced transmission from staff is associated with adequate sick pay, minimal use of agency staff, an increased staff-to-bed ratio, and staff cohorting with either infected or uninfected residents. Increased transmission from residents is associated with an increased number of new admissions to the facility and poor compliance with isolation procedures. FUNDING UK Government Department of Health and Social Care.
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Affiliation(s)
- Laura Shallcross
- UCL Institute of Health Informatics, University College London, London, UK
| | | | | | | | | | - Andrew Hayward
- UCL Institute of Epidemiology and Healthcare, University College London, London, UK
| | | | - Maria Krutikov
- UCL Institute of Health Informatics, University College London, London, UK
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