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Karimi-Dehkordi M, Hanson HM, Silvius J, Wagg A. Drivers of COVID-19 Outcomes in Long-Term Care Facilities Using Multi-Level Analysis: A Systematic Review. Healthcare (Basel) 2024; 12:807. [PMID: 38610229 PMCID: PMC11011537 DOI: 10.3390/healthcare12070807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/30/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed to identify the individual, organizational, and environmental factors which contributed to COVID-19-related outcomes in long-term care facilities (LTCFs). A systematic review was conducted to summarize and synthesize empirical studies using a multi-level analysis approach to address the identified influential factors. Five databases were searched on 23 May 2023. To be included in the review, studies had to be published in peer-reviewed journals or as grey literature containing relevant statistical data. The Joanna Briggs Institute critical appraisal tool was employed to assess the methodological quality of each article included in this study. Of 2137 citations identified after exclusions, 99 records met the inclusion criteria. The predominant individual, organizational, and environmental factors that were most frequently found associated with the COVID-19 outbreak comprised older age, higher dependency level; lower staffing levels and lower star and subset domain ratings for the facility; and occupancy metrics and co-occurrences of outbreaks in counties and communities where the LTCFs were located, respectively. The primary individual, organizational, and environmental factors frequently linked to COVID-19-related deaths comprised age, and male sex; higher percentages of racial and ethnic minorities in LTCFs, as well as ownership types (including private, for-profit, and chain membership); and higher occupancy metrics and LTCF's size and bed capacity, respectively. Unfolding the risk factors collectively may mitigate the risk of outbreaks and pandemic-related mortality in LTCFs during future endemic and pandemics through developing and improving interventions that address those significant factors.
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Affiliation(s)
- Mehri Karimi-Dehkordi
- Faculty of Medicine & Dentistry, Keyano College, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Heather M. Hanson
- Seniors Health Strategic Clinical Network, Alberta Health Services, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (H.M.H.); (J.S.)
| | - James Silvius
- Seniors Health Strategic Clinical Network, Alberta Health Services, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (H.M.H.); (J.S.)
| | - Adrian Wagg
- Seniors Health Strategic Clinical Network, Alberta Health Services, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
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Leis JA, Chan CK, Tan C, Callahan J, Serapion V, Pascual B, Lee W, O'Brien J, Thomas NR, Candon H, Crittenden M, Kiss A, Chan AK, Ofner M, Powis JE. Predictors of SARS-CoV-2 transmission in congregate living settings: a multicenter prospective study. Infect Control Hosp Epidemiol 2024:1-6. [PMID: 38562085 DOI: 10.1017/ice.2024.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Older adults residing in congregate living settings (CLS) such as nursing homes and independent living facilities remain at increased risk of morbidity and mortality from coronavirus disease 2019. We performed a prospective multicenter study of consecutive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) exposures to identify predictors of transmission in this setting. METHODS Consecutive resident SARS-CoV-2 exposures across 17 CLS were prospectively characterized from 1 September 2022 to 1 March 2023, including factors related to environment, source, and exposed resident. Room size, humidity, and ventilation were measured in locations where exposures occurred. Predictors were incorporated in a generalized estimating equation model adjusting for the correlation within CLS. RESULTS Among 670 consecutive exposures to SARS-CoV-2 across 17 CLS, transmission occurred among 328 (49.0%). Increased risk was associated with nursing homes (odds ratio (OR) = 90.8; 95% CI, 7.8-1047.4), Jack and Jill rooms (OR = 2.2; 95% CI, 1.3-3.6), from source who was pre-symptomatic (OR = 11.2; 95% CI, 4.1-30.9), symptomatic (OR = 6.5; 95% CI, 1.4-29.9), or rapid antigen test positive (OR = 35.6; 95% CI, 5.6-225.6), and in the presence of secondary exposure (OR = 6.3; 95% CI, 1.6-24.0). Exposure in dining room was associated with reduced risk (OR = 0.02; 95% CI, 0.005-0.08) as was medium room size (OR = 0.3; 95% CI, 0.2-0.6). Recent vaccination of exposed resident (OR = 0.5; 95% CI, 0.3-1.0) and increased ventilation of room (OR = 0.9; 95% CI, 0.8-1.0) were marginally associated with reduced risk. CONCLUSION Prospective assessment of SARS-CoV-2 exposures in CLS suggests that source characteristics and location of exposure are most predictive of resident transmission. These findings can inform risk assessment and further opportunities to prevent transmission in CLS.
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Affiliation(s)
- Jerome A Leis
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
| | | | - Charlie Tan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | | | - Wayne Lee
- Michael Garron Hospital, Toronto, ON, Canada
| | | | | | | | | | - Alex Kiss
- Sunnybrook Research Institute and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Adrienne K Chan
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Jeff E Powis
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
- Michael Garron Hospital, Toronto, ON, Canada
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Young Y, Hsu WH, Shayya A, Barnes V, Perre T, O'Grady T. Revealing the divide: Contrasting COVID-19 outcomes in Green Houses and traditional nursing homes in the United States. Geriatr Nurs 2024; 55:136-143. [PMID: 37992476 DOI: 10.1016/j.gerinurse.2023.11.001] [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: 08/30/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION This study compares COVID-19 case and mortality rates in Green Houses (GHs) and traditional nursing homes (NHs) during the COVID-19 pandemic. METHODS CMS data from 10 states (June 2020 to September 2022) were analyzed for GHs (n = 19), small NHs (n = 266), and large NHs (n = 2,932). Multivariate Poisson regressions with GEE were used. RESULTS Participants (mean age 73.4) were predominantly female (57.8 %) and White (78.2 %). Small and large NHs had a significantly higher COVID-19 case risk (RR = 1.61; 95 % CI 1.25-2.08 and RR = 1.75; 95 % CI 1.36-2.24, respectively) compared to GHs. Large NHs also had an increased mortality risk (RR = 1.67; 95 % CI 1.01-2.77) compared to GHs, with no difference found between GHs and small NHs. CONCLUSION After adjusting for age, gender, and ADL disability, GHs demonstrated lower COVID-19 case and mortality rates than traditional NHs, likely due to their unique features, including person-centered care, size, and physical structure.
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Affiliation(s)
- Yuchi Young
- Department of Health Policy, Management, & Behavior, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA.
| | - Wan-Hsiang Hsu
- Department of Health Policy, Management, & Behavior, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA; Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY 12237, USA
| | - Ashley Shayya
- Department of Health Policy, Management, & Behavior, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA
| | - Virgile Barnes
- Department of Health Policy, Management, & Behavior, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA
| | - Taylor Perre
- Department of Health Policy, Management, & Behavior, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA; Home Care Association of New York State, Albany, NY 12207, USA
| | - Thomas O'Grady
- Department of Epidemiology & Biostatistics, State University of New York at Albany, School of Public Health, Rensselaer, NY 12144, USA; Bureau of HIV/AIDS Epidemiology, New York State Department of Health, Albany, NY 12237, USA
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Blake MJ, Marka NA, Steer CJ, Ravdin JI. Cause of Death by Race and Ethnicity in Minnesota Before and During the COVID-19 Pandemic, 2019-2020. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01709-z. [PMID: 37548856 DOI: 10.1007/s40615-023-01709-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To measure changes in cause of death dynamics in 2019 and 2020 and the relationship between the concurrent occurrence of the COVID-19 pandemic and mortality outcome by race and ethnicity. PATIENTS AND METHODS We used resident mortality data from the Minnesota Department of Health (MDH) to conduct a retrospective statistical analysis of deaths in Minnesota in 2019 relative to 2020 to assess changes in mortality in a pre-pandemic and pandemic period. RESULTS COVID-19 strongly contributed to ethnicity-related mortality disparities in Minnesota. Not only was there a greater proportion of COVID-19 decedents within Black and Hispanic populations, but their average decedent age was markedly lower relative to the White population. The Black population experienced a disproportionate increase in decedents with a 34% increase during 2020 compared to 2019. CONCLUSIONS This retrospective analysis of death dynamics and mortality outcomes in Minnesota from 2019 to 2020 demonstrated an increase in adverse mortality outcomes relative to the pre-pandemic period that disproportionately impacted Black and Hispanic minority populations.
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Affiliation(s)
- Madelyn J Blake
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, 55347, USA.
| | - Nicholas A Marka
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Clifford J Steer
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Jonathan I Ravdin
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
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Smadi M, Kaburis M, Schnapper Y, Reina G, Molero P, Molendijk ML. SARS-CoV-2 susceptibility and COVID-19 illness course and outcome in people with pre-existing neurodegenerative disorders: systematic review with frequentist and Bayesian meta-analyses. Br J Psychiatry 2023:1-14. [PMID: 37183681 DOI: 10.1192/bjp.2023.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND People with neurodegenerative disease and mild cognitive impairment (MCI) may have an elevated risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and may be disproportionally affected by coronavirus disease 2019 (COVID-19) once infected. AIMS To review all eligible studies and quantify the strength of associations between various pre-existing neurodegenerative disorders and both SARS-CoV-2 susceptibility and COVID-19 illness course and outcome. METHOD Pre-registered systematic review with frequentist and Bayesian meta-analyses. Systematic searches were executed in PubMed, Web of Science and preprint servers. The final search date was 9 January 2023. Odds ratios (ORs) were used as measures of effect. RESULTS In total, 136 primary studies (total sample size n = 97 643 494), reporting on 268 effect-size estimates, met the inclusion criteria. The odds for a positive SARS-CoV-2 test result were increased for people with pre-existing dementia (OR = 1.83, 95% CI 1.16-2.87), Alzheimer's disease (OR = 2.86, 95% CI 1.44-5.66) and Parkinson's disease (OR = 1.65, 95% CI 1.34-2.04). People with pre-existing dementia were more likely to experience a relatively severe COVID-19 course, once infected (OR = 1.43, 95% CI 1.00-2.03). People with pre-existing dementia or Alzheimer's disease were at increased risk for COVID-19-related hospital admission (pooled OR range: 1.60-3.72). Intensive care unit admission rates were relatively low for people with dementia (OR = 0.54, 95% CI 0.40-0.74). All neurodegenerative disorders, including MCI, were at higher risk for COVID-19-related mortality (pooled OR range: 1.56-2.27). CONCLUSIONS Our findings confirm that, in general, people with neurodegenerative disease and MCI are at a disproportionally high risk of contracting COVID-19 and have a poor outcome once infected.
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Affiliation(s)
- Muhannad Smadi
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Melina Kaburis
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Youval Schnapper
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Gabriel Reina
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; and Clínica Universidad de Navarra, Department of Microbiology, Pamplona, Spain
| | - Patricio Molero
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; and Clínica Universidad de Navarra, Department of Psychiatry and Medical Psychology, Pamplona, Spain
| | - Marc L Molendijk
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, The Netherlands; and Leiden Institute for Brain and Cognition, Leiden University Medical Centre, Leiden, The Netherlands
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Blake MJ, Marka NA, Steer CJ, Ravdin JI. Cause of Death by Race and Ethnicity in Minnesota Before and During the COVID-19 Pandemic, 2019-2020. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.09.23287048. [PMID: 36945486 PMCID: PMC10029070 DOI: 10.1101/2023.03.09.23287048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Objectives To measure changes in cause of death dynamics in 2019 and 2020 and the relationship between concurrent occurrence of the COVID-19 pandemic and mortality outcome by race and ethnicity. Patients and Methods We used resident mortality data from the Minnesota Department of Health (MDH) to conduct retrospective statistical analysis of deaths in Minnesota in 2019 relative to 2020 to assess changes in mortality in a pre-pandemic and pandemic period. Results COVID-19 strongly contributed to ethnicity-related mortality disparities in Minnesota. Not only was there a greater proportion of COVID-19 decedents within the Black and Hispanic populations, but their average decedent age was markedly lower relative to the White population. The Black population experienced a disproportionate increase in decedents with a 34% increase during 2020 compared to 2019. Conclusions This retrospective analysis of death dynamics and mortality outcomes in Minnesota from 2019 to 2020 demonstrated an increase in adverse mortality outcomes relative to the pre-pandemic period that disproportionately impacted Black and Hispanic minority populations. Access to non-pharmaceutical interventions combating COVID-19 infection in Black and Hispanic communities should be expanded in Minnesota.
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Affiliation(s)
- Madelyn J Blake
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN
| | - Nicholas A Marka
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Clifford J Steer
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN
| | - Jonathan I Ravdin
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN
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D’Anna T, Argo A, Albano GD, Puntarello M, Rizzo C, Guadagnino D, Zerbo S. Focus on Liability of Residences for Elderly and Sick People: A Case Series and Medico-Legal Issues. Healthcare (Basel) 2023; 11:healthcare11040539. [PMID: 36833073 PMCID: PMC9956670 DOI: 10.3390/healthcare11040539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Residences for elderly and sick people, self-sufficient or dependent, are varied. To date, the liability profiles of these structures are not clearly delineated, and increasingly often, their operating and organization criteria are entrusted to subnational, regional, or local regulations. Among the various deficits, there is the keeping of a complete and detailed documentation/diary of the patient, the lack of which can generate medico-legal problems. In this paper, we present three cases of guests in residences for a dependent person brought to the attention of the Institute of Forensic Medicine of the University Hospital of Palermo due to criminal proceedings, where the lack of existing documentation in the structure and, in some cases, the behavior of the professionals working there, led the evaluator to deduce the organization's culpability.
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Affiliation(s)
- Tommaso D’Anna
- Policlinic Hospital, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
- Correspondence: (T.D.); (A.A.); Tel.: +39-39-3771-4629 (T.D.); +39-09-1238-6301 (A.A.)
| | - Antonina Argo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
- Correspondence: (T.D.); (A.A.); Tel.: +39-39-3771-4629 (T.D.); +39-09-1238-6301 (A.A.)
| | - Giuseppe Davide Albano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
| | - Maria Puntarello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
| | - Chiara Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
| | - Daniela Guadagnino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
| | - Stefania Zerbo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
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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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Kühl A, Hering C, Herrmann WJ, Gangnus A, Kohl R, Steinhagen-Thiessen E, Kuhlmey A, Gellert P. General practitioner care in nursing homes during the first wave of the COVID-19 pandemic in Germany: a retrospective survey among nursing home managers. BMC PRIMARY CARE 2022; 23:334. [PMID: 36550482 PMCID: PMC9773424 DOI: 10.1186/s12875-022-01947-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Though evidence on the detrimental impact of the COVID-19 pandemic in nursing homes is vast, research focusing on general practitioners' (GP) care during the pandemic in nursing homes is still scarce. METHODS A retrospective online survey among 1,010 nursing home managers in Germany was conducted during the first wave of the COVID-19 pandemic between November 2020 and February 2021. Associations between perceived deficits in GP care (routine and acute visits) and both general and COVID-19-related characteristics of nursing homes were analysed using multiple logistic regression analyses. RESULTS The majority of nursing home managers reported no deficits in GP care (routine visits, 84.3%; acute visits, 92.9%). Logistic regression analyses revealed that deficits in GP care (routine visits) were significantly associated with visiting restrictions for GPs and nursing home size. Small nursing homes (1-50 residents) were significantly more likely to report deficits in GP care (routine visits) compared to medium (51-100 residents) and large nursing homes (> 100 residents). Further, deficits in GP care (acute visits) were significantly associated with dementia as a focus of care and the burden of insufficient testing for SARS-CoV-2 among residents. Moreover, visiting restrictions for GPs were significantly associated with dementia as the focus of care and the COVID-19 incidence at the federal state level. Finally, COVID-19 cases in nursing homes were significantly associated with size of nursing homes, COVID-19-incidence on the federal state level and the burden of insufficient testing capacities for SARS-CoV-2 among residents. CONCLUSION We found structural factors associated with GP care deficits during the pandemic. New concepts for GP care should be implemented in pandemic preparedness plans to ensure high quality, consistent, and reliable GP care as well as effective infection prevention measures in nursing homes.
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Affiliation(s)
- Anja Kühl
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Hering
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfram J. Herrmann
- grid.6363.00000 0001 2218 4662Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Annabell Gangnus
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Raphael Kohl
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Steinhagen-Thiessen
- grid.6363.00000 0001 2218 4662Department of Endocrinology, Diabetes and Metabolism, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Adelheid Kuhlmey
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Epidemiological and Genomic Analysis of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Catalonia, Spain. mSphere 2022; 7:e0034622. [PMID: 36448779 PMCID: PMC9769531 DOI: 10.1128/msphere.00346-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Limiting outbreaks in long-term care facilities (LTCFs) is a cornerstone strategy to avoid an excess of COVID-19-related morbidity and mortality and to reduce its burden on the health system. We studied a large outbreak that occurred at an LTCF, combining methods of classical and genomic epidemiology analysis. The outbreak lasted for 31 days among residents, with an attack rate of 98% and 57% among residents and staff, respectively. The case fatality rate among residents was 16% (n = 15). Phylogenetic analysis of 59 SARS-CoV-2 isolates revealed the presence of two closely related viral variants in all cases (B.1.177 lineage), revealing a far more complex outbreak than initially thought and suggesting an initial spread driven by staff members. In turn, our results suggest that resident relocations to mitigate viral spread might have increased the risk of infection for staff members, creating secondary chains of transmission that were responsible for prolonging the outbreak. Our results highlight the importance of considering unnoticed chains of transmission early during an outbreak and making an adequate use and interpretation of diagnostic tests. Outbreak containment measures should be carefully tailored to each LTCF. IMPORTANCE The impact of COVID-19 on long-term care facilities (LTCFs) has been disproportionately large due to the high frailty of the residents. Here, we report epidemiological and genomic findings of a large outbreak that occurred at an LTCF, which ultimately affected almost all residents and nearly half of staff members. We found that the outbreak was initially driven by staff members; however, later resident relocation to limit the outbreak resulted in transmission from residents to staff members, evidencing the complexity and different phases of the outbreak. The phylogenetic analysis of SARS-CoV-2 isolates indicated that two closely related variants were responsible for the large outbreak. Our study highlights the importance of combining methods of classical and genomic epidemiology to take appropriate outbreak containment measures in LTCFs.
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Yang J, Song H, Hao X. Whole-transcriptome sequencing data reveals a disparate cognitive and immune signature in COVID-19 patients with and without dementia. J Med Virol 2022; 95:e28177. [PMID: 36168207 PMCID: PMC9538945 DOI: 10.1002/jmv.28177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/24/2022] [Accepted: 09/24/2022] [Indexed: 01/11/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused more than 6.3 million deaths worldwide. Recent evidence has indicated that elderly people with dementia are particularly vulnerable to COVID-19 and severe disease outcomes. However, its molecular mechanism remains largely unknown. Here, we retrieved frontal cortex samples of COVID-19 patients from the Gene Expression Omnibus database and performed a systematic transcriptomic analysis to compare COVID-19 patients and controls with or without dementia. In nondemented patients, SARS-CoV-2 infection obviously activated T helper type 2 (Th2) cell-mediated humoral immunity and reduced the pathogenesis of dementia-related Alzheimer's disease and Parkinson's disease. In demented patients, conversely, SARS-CoV-2 infection significantly increased T helper type 1 (Th1) cell-mediated cellular immunity and exacerbated the progression of dementia-related diseases. We further analyzed the molecular characteristics of COVID-19 patients with and without dementia. Compared with nondemented COVID-19 patients, demented COVID-19 patients showed decreased enrichment scores of Calcium signaling pathway, Neuroactive ligand-receptor interaction, ABC transporters, and Peroxisome, and increased enrichment scores of Olfactory transduction and Regulation of autophagy. The ratio of Th1/Th2 cells was significantly increased from 1.17 in nondemented COVID-19 patients to 33.32 in demented COVID-19 patients. Taken together, our findings provide transcriptomic evidence that COVID-19 has distinct influences on cognitive function and immune response in patients with and without dementia.
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Affiliation(s)
- Jue Yang
- The State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang & State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of SciencesShanghaiChina,The Key Laboratory of Chemistry for Natural Products of Guizhou Province and Chinese Academic of Sciences, Guiyang, China & Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education & Key Laboratory of Medical Molecular Biology of Guizhou ProvinceGuizhou Medical UniversityGuiyangChina
| | - Hui Song
- The Key Laboratory of Chemistry for Natural Products of Guizhou Province and Chinese Academic of Sciences, Guiyang, China & Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education & Key Laboratory of Medical Molecular Biology of Guizhou ProvinceGuizhou Medical UniversityGuiyangChina
| | - Xiaojiang Hao
- The State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang & State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of SciencesShanghaiChina,The Key Laboratory of Chemistry for Natural Products of Guizhou Province and Chinese Academic of Sciences, Guiyang, China & Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education & Key Laboratory of Medical Molecular Biology of Guizhou ProvinceGuizhou Medical UniversityGuiyangChina
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Risk factors associated with COVID-19 infection and mortality in nursing homes. Aten Primaria 2022; 54:102463. [PMID: 36148713 PMCID: PMC9444496 DOI: 10.1016/j.aprim.2022.102463] [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: 04/20/2022] [Revised: 07/29/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this paper was to analyse the association of demographic, clinical and pharmacological risk factors with the presence of SARS-COV-2 virus infection, as well as to know the variables related to mortality from COVID-19 in nursing home (NH) residents. DESIGN Retrospective case-control study. The study variables of those residents who acquired the infection (case) were compared with those of the residents who did not acquire it (control). A subgroup analysis was carried out to study those variables related to mortality. SITE: Nursing homes in the region of Guipúzcoa (Spain). PARTICIPANTS AND INTERVENTIONS 4 NHs with outbreaks of SARS-CoV-2 between March and December 2020 participated in the study. The infectivity and, secondary, mortality was studied, as well as demographic, clinical and pharmacological variables associated with them. Data were collected from the computerised clinical records. MAIN MEASUREMENTS Infection and mortality rate. Risk factors associated with infection and mortality. RESULTS 436 residents were studied (median age 87 years (IQR 11)), 173 acquired SARS-CoV-2 (39.7%). People with dementia and Global Deterioration Scale ≥6 were less likely to be infected by SARS-CoV-2 virus [OR=0.65 (95% CI 0.43-0.97; p<.05)]. Overall case fatality rate was 10.3% (a mortality of 26% among those who acquired the infection). COVID-19 mortality was significantly associated with a Global Deterioration Scale ≥6 (OR=4.9 (95% CI 1.5-16.1)), COPD diagnosis (OR=7.8 (95% CI 1.9-31.3)) and antipsychotic use (OR=3.1 (95% CI 1.0-9.0)). CONCLUSIONS Advanced dementia has been associated with less risk of SARS-CoV-2 infection but higher risk of COVID-19 mortality. COPD and chronic use of antipsychotics have also been associated with mortality. These results highlight the importance of determining the stage of diseases such as dementia as well as maintaining some caution in the use of some drugs such as antipsychotics.
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Zunzunegui MV, Béland F, Rico M, López FJG. Long-Term Care Home Size Association with COVID-19 Infection and Mortality in Catalonia in March and April 2020. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:369-390. [PMID: 36417245 PMCID: PMC9620903 DOI: 10.3390/epidemiologia3030029] [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: 06/28/2022] [Revised: 07/26/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
We aim to assess how COVID-19 infection and mortality varied according to facility size in 965 long-term care homes (LTCHs) in Catalonia during March and April 2020. We measured LTCH size by the number of authorised beds. Outcomes were COVID-19 infection (at least one COVID-19 case in an LTCH) and COVID-19 mortality. Risks of these were estimated with logistic regression and hurdle models. Models were adjusted for county COVID-19 incidence and population, and LTCH types. Sixty-five per cent of the LTCHs were infected by COVID-19. We found a strong association between COVID-19 infection and LTCH size in the adjusted analysis (from 45% in 10-bed homes to 97.5% in those with over 150 places). The average COVID-19 mortality in all LTCHs was 6.8% (3887 deaths) and 9.2% among the COVID-19-infected LTCHs. Very small and large homes had higher COVID-19 mortality, whereas LTCHs with 30 to 70 places had the lowest level. COVID-19 mortality sharply increased with LTCH size in counties with a cumulative incidence of COVID-19 which was higher than 250/100,000, except for very small homes, but slightly decreased with LTCH size when the cumulative incidence of COVID-19 was lower. To prevent infection and preserve life, the optimal size of an LTCH should be between 30 and 70 places.
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Affiliation(s)
- Maria Victoria Zunzunegui
- École de Santé Publique, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Correspondence: ; Tel.: +34-692-064-134
| | - François Béland
- École de Santé Publique, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Institut Lady Davis, Montreal Jewish Hospital, McGill University, Montreal, QC H3C 3J7, Canada
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Booij JA, van de Haterd JC, Huttjes SN, van Deijck RH, Koopmans RT. Short- and Long-Term Mortality and Mortality Risk Factors among Nursing Home Patients after COVID-19 Infection. J Am Med Dir Assoc 2022; 23:1274-1278. [PMID: 35809633 PMCID: PMC9212799 DOI: 10.1016/j.jamda.2022.06.005] [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: 02/08/2022] [Revised: 05/15/2022] [Accepted: 06/11/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess short- and long-term mortality and risk factors in nursing home patients with COVID-19 infection. DESIGN Retrospective 2-center cohort study. SETTING AND PARTICIPANTS Dutch nursing home patients with clinically suspected COVID-19 infection confirmed by reverse transcription-polymerase chain reaction testing. METHODS Data were gathered between March 2020 and November 2020 using electronic medical records, including demographic characteristics, comorbidities, medical management, and symptoms on the first day of suspected COVID-19 infection. Mortality at 30 days and 6 months was assessed using multivariate logistic regression models and Kaplan-Meier analysis. At 6 months, a subgroup analysis was performed to estimate the mortality risk between COVID-negative patients and patients who survived COVID-19. Risk factors for mortality were assessed through multivariate logistic regression models. RESULTS A total of 321 patients with suspected COVID-19 infection were included, of whom 134 tested positive. Sixty-two patients in the positive group died at 30 days, with a short-term mortality rate of 2.9 (95% CI 1.7-5.3). Risk factors were fatigue (OR 2.6, 95% CI 1.3-6.2) and deoxygenation (OR 2.9, 95% CI 1.3-7.6). At 6 months, the mortality risk was 2.1 (95% CI 1.3-3.7). Risk factors for 6-month mortality were shortness of breath (OR 2.7, 95% CI 1.3-7.0), deoxygenation (OR 2.5, 95% CI 1.1-6.5) and medical management (OR 4.5, 95% CI 1.7-25.8). However, among patients who survived COVID-19 infection, the long-term mortality risk was not sustained (OR 1.0, 95% CI 0.4-2.7). CONCLUSIONS AND IMPLICATIONS Overall, COVID-19 infection increases short- and long-term mortality risk among nursing home patients. However, this study shows that surviving COVID-19 infection does not lead to increased mortality in the long term within this population. Therefore, advanced care planning should focus on quality of life among nursing home patients after COVID-19 infection.
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Affiliation(s)
- Johannes A. Booij
- De Zorggroep, Region Venlo (EBC), Venlo, the Netherlands,Address correspondence to Johannes A. Booij, MD, De Zorggroep, region Venlo (EBC), 5900 AR Venlo, the Netherlands
| | - Julie C.H.Q. van de Haterd
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Raymond T.C.M. Koopmans
- Department of Primary and Community Care: Center for Family Medicine, Geriatric Care, and Public Health, Radboud University Medical Center, Nijmegen, the Netherlands,De Waalboog, Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, the Netherlands
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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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