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Kogoj R, Grašek M, Suljič A, Zakotnik S, Vlaj D, Kotnik Koman K, Fafangel M, Petrovec M, Avšič-Županc T, Korva M. Sequencing analysis of SARS-CoV-2 cases in Slovenian long-term care facilities to support outbreak control. Front Public Health 2024; 12:1406777. [PMID: 38813418 PMCID: PMC11133669 DOI: 10.3389/fpubh.2024.1406777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Residents of long-term care facilities (LTCFs) are at high risk of morbidity and mortality due to COVID-19, especially when new variants of concern (VOC) emerge. To provide intradisciplinary data in order to tailor public health interventions during future epidemics, available epidemiologic and genomic data from Slovenian LTCFs during the initial phases of the COVID-19 pandemic was analyzed. Methods The first part of the study included SARS-CoV-2 reverse-transcription Real-Time PCR (rtRT-PCR) positive LTCF residents, from 21 facilities with COVID-19 outbreaks occurring in October 2020. The second part of the study included SARS-CoV-2 rtRT-PCR positive LTCF residents and staff between January and April 2021, when VOC Alpha emerged in Slovenia. Next-generation sequencing (NGS) was used to acquire SARS-CoV-2 genomes, and lineage determination. In-depth phylogenetic and mutational profile analysis were performed and coupled with available field epidemiological data to assess the dynamics of SARS-CoV-2 introduction and transmission. Results 370/498 SARS-CoV-2 positive residents as well as 558/699 SARS-CoV-2 positive residents and 301/358 staff were successfully sequenced in the first and second part of the study, respectively. In October 2020, COVID-19 outbreaks in the 21 LTCFs were caused by intra-facility transmission as well as multiple independent SARS-CoV-2 introductions. The Alpha variant was confirmed in the first LTCF resident approximately 1.5 months after the first Alpha case was identified in Slovenia. The data also showed a slower replacement of existing variants by Alpha in residents compared to staff and the general population. Discussion Multiple SARS CoV-2 introductions as well as intra-facility spreading impacted disease transmission in Slovenian LTCFs. Timely implementation of control measures aimed at limiting new introductions while controlling in-facility transmission are of paramount importance, especially as new VOCs emerge. Sequencing, in conjunction with epidemiological data, can facilitate the determination of the need for future improvements in control measures to protect LTCF residents from COVID-19 or other respiratory infections.
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Affiliation(s)
- Rok Kogoj
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Manja Grašek
- Communicable Diseases Center, National Institute of Public Health, Ljubljana, Slovenia
| | - Alen Suljič
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Samo Zakotnik
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Doroteja Vlaj
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kaja Kotnik Koman
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mario Fafangel
- Communicable Diseases Center, National Institute of Public Health, Ljubljana, Slovenia
| | - Miroslav Petrovec
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tatjana Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Misa Korva
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Chen R, Kezhekkekara SG, Kunasekaran MP, MacIntyre CR. Universal masking during COVID-19 outbreaks in aged care settings: A systematic review and meta-analysis. Ageing Res Rev 2024; 93:102138. [PMID: 38007047 DOI: 10.1016/j.arr.2023.102138] [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: 02/21/2023] [Revised: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
Aged care facilities (ACF) are a high-risk COVID-19 transmission setting, and older residents are at greater risk of severe outcomes. This systematic review and meta-analysis assessed whether universal masking and COVID-19 vaccination reduce SARS-CoV-2 attack rates (ARs) in ACF. Articles published between 1 December 2019 and 28 February 2022 were screened across five databases (Medline, Embase, PubMed, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL)). Risk of bias was assessed using relevant Joanna Briggs Institute critical appraisal tools. Meta-analysis of single proportions, subgroup analysis, and meta-regression were performed to compare the effects of universal masking and vaccine doses on pooled SARS-CoV-2 ARs. Of 99 included articles, SARS-CoV-2 ARs for residents were available in 86 studies (representing 139 outbreaks), and for staff in 49 studies (78 outbreaks). Universal masking was associated with lower SARS-CoV-2 ARs in ACF outbreaks (AR = 34.9% [95% CI: 27.2-42.6%]) compared to facilities without universal masking (67.3% [54.2-80.4%], p < .0001). In ACF with universal masking prior to outbreak onset, facility-wide testing, and documentation of asymptomatic infection, the asymptomatic AR at time of testing was 11.4% (6.5-17.4%) in residents. Receipt of zero, one and two vaccination doses were associated with ARs of 64.9% (49.6-80.2%), 54.9% (33.7-76.1%) and 45.2% (29.2-61.3%), respectively. To protect residents from COVID-19, ACF should provide vaccination of residents and staff, universal masking for staff, and facility-wide testing during times of heightened community transmission.
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Affiliation(s)
- Rosalie Chen
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; School of Population Health, The University of New South Wales, Sydney, NSW, Australia.
| | - Shwetha G Kezhekkekara
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; School of Population Health, The University of New South Wales, Sydney, NSW, Australia; Australian Centre for Integration of Oral Health (ACIOH), Western Sydney University, Sydney, Australia
| | | | - C Raina MacIntyre
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, United States
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Nair SP, Quigley AL, Moa A, Chughtai AA, Macintyre CR. Monitoring the burden of COVID-19 and impact of hospital transfer policies on Australian aged-care residents in residential aged-care facilities in 2020. BMC Geriatr 2023; 23:507. [PMID: 37608356 PMCID: PMC10463348 DOI: 10.1186/s12877-023-04154-z] [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: 04/01/2023] [Accepted: 07/05/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Residential aged-care facilities in Australia emerged as the high-risk setting the COVID-19 outbreaks due to community transmission. The vulnerable aged-care residents of these facilities suffered due to low hospital transfers and high mortality and morbidity rates. This study aimed to monitor and report the burden of COVID-19 in residential aged-care facilities across Australia and the impact of hospital transfer policies on resident hospitalisation during the first year of the pandemic. METHODS We conducted a retrospective cohort study by collecting data from weekly aged-care outbreak reports published by open sources and official government sources between 1st March and 20th November 2020. A comprehensive line list of outbreaks was created using open-source data. The line list included the name of the facility, location, COVID-19 cases among residents, & staff, resident hospitalisations, mode of transmission, number of resident deaths, and state policies involving resident hospitalisation. We also searched the websites of these facilities to collect data on their COVID-19 policies for the residents, staff, and visitors. Statistical analyses were performed on the data obtained. RESULTS 126 aged-care COVID-19 outbreaks were identified in Australia during the study period. The incidence rate of COVID-19 infections among aged-care residents in Australia was (1118.5 per 100,000 resident population) which is 10 times higher than the general population (107.6 per 100,000 population). The hospitalisation rate for aged-care residents in Australia was 0.93 per 100,000 population. The hospitalisation rate of aged-care residents in Victoria was 3.14 per 100,000 population despite having the highest COVID-19 cases. Excluding South Australia, all states followed ad-hoc case-by-case hospital transfer policies for aged-care residents. CONCLUSION This study documented a higher risk of COVID-19 infection for aged-care residents and workers but found low hospitalisation rates among residents across Australia. The hospitalisation rates in Victoria were higher than the national average but low when considering the COVID-19 infection rates in the state. The hospitalisation rates could have been impacted due to the state hospital transfer policies at that time. Immediate transfer of infected residents to hospitals may improve their survival and reduce the risk of infection to the other residents, as healthcare settings have more advanced infection control measures and are well-equipped with trained staff and resources.
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Affiliation(s)
- Shruti Premshankar Nair
- Ingham Institute, SWSLHD, Liverpool, Sydney, NSW 2170 Australia
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, High St, Kensington Campus, Kensington, NSW 2052 Australia
| | - Ashley L Quigley
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, High St, Kensington Campus, Kensington, NSW 2052 Australia
| | - Aye Moa
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, High St, Kensington Campus, Kensington, NSW 2052 Australia
| | - Abrar Ahmad Chughtai
- School of Population Health, UNSW Medicine, Samuel’s building, Kensington, Sydney, NSW 2052 Australia
| | - Chandini Raina Macintyre
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, High St, Kensington Campus, Kensington, NSW 2052 Australia
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Dix S, Rawson H, Russo P, Team V, Griffiths D, Morphet J. Practical infection control training for Victoria's aged care workforce at the time of COVID-19 pandemic: a community case study. Front Public Health 2023; 11:1155980. [PMID: 37304118 PMCID: PMC10248151 DOI: 10.3389/fpubh.2023.1155980] [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: 02/01/2023] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Abstract
The need to improve career development and training for residential aged care workers in Australia to achieve required essential competencies, including infection prevention and control competencies, has been repeatedly highlighted. In Australia long-term care settings for older adults are known as residential aged care facilities (RACFs). The COVID-19 pandemic has brought to light the lack of preparedness of the aged care sector to respond to emergencies, and the urgent need to improve the infection prevention and control training in residential aged care facilities. The government in the Australian State of Victoria allocated funds to support older Australians in RACFs, including funds toward infection prevention and control training of RACF staff. The School of Nursing and Midwifery at Monash University addressed some of these challenges in delivering an education program on effective infection prevention and control practices to the RACF workforce in Victoria, Australia. This was the largest state-funded program delivered to RACF workers to date in the State of Victoria. The aim of this paper is to provide a community case study, where we share our experience of program planning and implementation during early stages of the COVID-19 pandemic and lessons learned.
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Abu-Fraiha Y, Robinson SG, Maimon M, Hassan L, Grotto I, Uzan LG, Goldin S, Novack V, Maimon N. National Weekly SARS-CoV-2 RT-PCR Screening of All Workers in Long-Term Care Facilities Associated with Decrease in Resident Mortality Rate. Gerontology 2023; 69:541-548. [PMID: 36630938 PMCID: PMC9981777 DOI: 10.1159/000529029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 11/30/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Outbreaks of COVID-19 in long-term care facilities (LTCFs) have resulted mainly from disease transmission by asymptomatic health care workers. This study examines whether routine screening tests carried out on health care workers can help in reducing COVID-19 outbreaks, morbidity, and mortality of LTCF residents. Methods The study followed a weekly, nationwide, government-funded screening program of LTCF personnel for SARS-CoV-2, by using reverse transcription polymerase chain reaction as the main testing technology. It included all residents and employees in Israeli LTCFs who were screened weekly during the second wave of COVID-19, during the time period between July 13, 2020, and November 21, 2020. Results During the study period, 1,107 LTCFs were screened on a weekly basis, including 62,159 HCWs and 100,046 residents. The program screened a median of 55,282 (Range 16,249, min 45,910, max 62,159) employees per week, 0.05-1.5% of which were positive for SARS-CoV-2. LTCF mortality in the first wave accounted for 45.3% of all COVID-19 deaths recorded nationally (252 of 556), and in the second wave this ratio was reduced to 30.3% (709 of 2,337) representing a reduction of 33.8% in expected mortality (P<0.001). A significant reduction was detected also in hospitalization rate (13.59% vs. 11.41%, p<0.001) and elder (≥75 years-old) mortality rate (52.89% vs. 41.42%, p<0.001). 214 outbreaks in the second wave were avoided by early identification of SARS-CoV-2 positive HCWs and successful prevention of subsequent infections in the facility. Conclusions and relevance Routine weekly SARS-CoV-2 RT-PCR testing of LTCF employees was associated with reduced national LTCF residents' hospitalizations and mortality rate.
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Affiliation(s)
- Yasmeen Abu-Fraiha
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Israel,Department of Internal Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel,Israel Ministry of Health and School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shahar Geva Robinson
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Israel,Department of Internal Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michal Maimon
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Israel
| | - Lior Hassan
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel,Division of Medicine, Soroka University Medical Center, Beer Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Itamar Grotto
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Limor Gortzak Uzan
- Israel Ministry of Health, “Senior Shield” Project, Airport City, Israel
| | - Sivan Goldin
- Israel Ministry of Health, “Senior Shield” Project, Airport City, Israel
| | - Victor Novack
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Israel,Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Nimrod Maimon
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Israel,Department of Internal Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel,Israel Ministry of Health, “Senior Shield” Project, Airport City, Israel,*Nimrod Maimon,
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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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Beogo I, Bationo NJC, Sia D, Collin S, Kinkumba Ramazani B, Létourneau AA, Ramdé J, Gagnon MP, Tchouaket EN. COVID-19 pandemic or chaos time management: first-line worker shortage - a qualitative study in three Canadian Provinces. BMC Geriatr 2022; 22:727. [PMID: 36057549 PMCID: PMC9440325 DOI: 10.1186/s12877-022-03419-3] [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: 04/03/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Over the successive waves of the COVID-19 pandemic, front-line care workers (FLCWs) —in this case, at long-term care facilities (LTCFs)— have been the backbone of the fight. The COVID-19 pandemic has disproportionately affected LTCFs in terms of the number of cases, deaths, and other morbidities, requiring managers to make rapid and profound shifts. The purpose of this study is to describe the effects of the pandemic on LTCF services offered and LTCFs staff dedicated to linguistic minorities in three Canadian provinces. Methods This qualitative descriptive study involved eleven managers and fourteen FLCWs, from six LTCFs of three Canadian provinces (New-Brunswick, Manitoba and Quebec). A qualitative content analysis was performed to identify key themes describing the effects of the COVID-19 pandemic on the services offered and the management of LTCFs staff. Results Based on participants’ experiences, we identified three main categories of themes. These macro-themes are as follows: (i) organization and management of staff, (ii) communication and decision-making method, and (iii) staff support. Conclusion The study highlighted the tremendous impact of COVID-19 on direct care staff in terms of the high risks associated with caring for LTCFs residents, which are exacerbated by absences and resignations (sometimes up to 50% of staff), resulting in higher resident to FLCWs ratios. Team members had to support each other, they also received accolades and appreciation from the residents.. Finally, the pandemic led to the rethinking of management procedures centred on a coordinated, inclusive and more hands-on management approach.
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Affiliation(s)
- Idrissa Beogo
- École des sciences infirmières, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada. .,College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | | | - Drissa Sia
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Gatineau, Québec, Canada.,Département de médecine sociale et préventive, École de santé publique Université de Montréal, Montréal, Québec, Canada
| | - Stephanie Collin
- École des hautes études publiques (HEP), Université de Moncton, New Brunswick, Moncton, Canada
| | | | - Aurée-Anne Létourneau
- English Language and Cultural Communities Planning, Programming and Research Officer, Jeffery Hale - Saint Brigid's, CIUSSSCN, Québec, Canada
| | - Jean Ramdé
- Faculté des sciences de l'éducation, Université Laval, Québec, Québec, Canada
| | | | - Eric Nguemeleu Tchouaket
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Gatineau, Québec, Canada.,Département de Gestion, d'évaluation Et de Politique de Santé, École de santé publique, Université de Montréal, Montréal, Québec, Canada
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Radcliffe NJ, Lau L, Hack E, Huynh A, Puri A, Yao H, Wong A, Kohler S, Chua M, Amadoru S, Haywood C, Yates P. Site of care and factors associated with mortality in unvaccinated Australian aged care residents during COVID-19 outbreaks. Intern Med J 2022; 53:690-699. [PMID: 36008359 PMCID: PMC9539151 DOI: 10.1111/imj.15914] [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: 02/13/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Residential InReach presents an alternative to hospital admission for aged care residents swabbed for COVID-19, though relative outcomes remain unknown. AIMS To compare rates and predictors of 28-day mortality for aged care residents seen by InReach with COVID-19, or 'suspected COVID-19' ('sCOVID'), including hospital vs InReach-based care. METHODS Prospective observational study of consecutive patients referred to a Victorian InReach service meeting COVID-19 testing criteria between April-October 2020 (pre-vaccine availability). COVID-19 was determined by positive polymerase chain reaction testing on nasopharyngeal swab. sCOVID-19 was defined as meeting symptomatic Victorian Government testing criteria but persistently swab negative. RESULTS There were no significant differences in age, gender, Clinical Frailty Score (CFS) or Charlson Comorbidity Index (CCI) between 152 patients with COVID-19 and 118 patients with sCOVID. 28-day mortality was similar between patients with COVID-19 (35/152, 23%) and sCOVID (32/118, 27%) (p=0.4). For the combined cohort, 28-day mortality was associated with initial oxygen saturation (p<0.001), delirium (p<0.001), hospital transfer for acuity (p=0.02; but not public health/facility reasons), CFS (p=0.04), prior ischaemic heart disease (p=0.01) and dementia (p=0.02). For COVID-19 patients, 28-day mortality was associated with initial oxygen saturation (p=0.02), delirium (p<0.001), and hospital transfer for acuity (p=0.01), but not public health/facility reasons. CONCLUSION Unvaccinated aged care residents meeting COVID-19 testing criteria seen by InReach during a pandemic experience high mortality rates, including with negative swab result. Residents remaining within-facility (with InReach) experienced similar adjusted mortality odds to residents transferred to hospital for public health/facility-based reasons, and lower than those transferred for clinical acuity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nicholas J Radcliffe
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Liza Lau
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Emma Hack
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Huynh
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,Florey Neuroscience Institute, Melbourne, Victoria, Australia
| | - Arvind Puri
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Henry Yao
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Aaron Wong
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,Melbourne Health, Parkville, Melbourne, Australia
| | - Sabrina Kohler
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Maggie Chua
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Aged Care, Northern Health, Melbourne, Victoria, Australia
| | - Sanka Amadoru
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Cilla Haywood
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Department of Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Aged Care, Northern Health, Melbourne, Victoria, Australia
| | - Paul Yates
- Medical Practitioner, Department of Geriatric Medicine, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Department of Medicine, Austin Health, Melbourne, Victoria, Australia.,Florey Neuroscience Institute, Melbourne, Victoria, Australia
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Duckett S. Public Health Management of the COVID-19 Pandemic in Australia: The Role of the Morrison Government. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10400. [PMID: 36012035 PMCID: PMC9407931 DOI: 10.3390/ijerph191610400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 05/24/2023]
Abstract
The Australian Commonwealth government has four health-related responsibilities during the SARS-CoV-2 pandemic: to provide national leadership; to manage external borders; to protect residents of residential aged care facilities; and to approve, procure and roll-out tests and vaccines. State governments are responsible for determining what public health measures are appropriate and implementing them-including managing the border quarantine arrangements and the testing, tracing, and isolation regime-and managing the hospital response. This paper analyses the national government's response to the pandemic and discusses why it has attracted a thesaurus of negative adjectives.
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Affiliation(s)
- Stephen Duckett
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia
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10
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Thomas S, Bolsewicz K, Latta R, Hewitt J, Byles J, Durrheim D. The Impact of Public Health Restrictions in Residential Aged Care on Residents, Families, and Staff During COVID-19: Getting the Balance Right. J Aging Soc Policy 2022:1-20. [PMID: 35946918 DOI: 10.1080/08959420.2022.2110802] [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: 06/15/2021] [Accepted: 03/15/2022] [Indexed: 10/15/2022]
Abstract
Outbreaks of COVID-19 in a small number of aged care facilities in Australia had devastating mortality ratios. Strict infection control measures were implemented with little time to adapt. This study explored the views and experiences of residents, families, and care providers about the preparation for COVID-19 and identified areas for improvement. Twenty-one individual interviews were conducted. Using interpretative phenomenological analysis, we found rapid changes to visiting and activities, with physical and emotional impact. Some participants coped using personal resources. Family and residents valued the empathy and quality care provided, despite the overburdened workforce. Good leadership supported implementation of public health advice, but the severity of measures should be proportionate to local risk. Better pandemic planning that includes clear responsibilities, training, and evaluation is important. Consultation with residents, family, and health workers throughout a pandemic will help identify those most at risk of social isolation and physical decline and develop strategies to minimize their impact. The rights and welfare of residents must be respected at all times.
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Affiliation(s)
- Susan Thomas
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Health Protection, Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia
| | - Katarzyna Bolsewicz
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Social Science Research Fellow, National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Health Protection, c/o Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Rachel Latta
- Health Protection, Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia
| | - Jacquie Hewitt
- Hunter New England and Central Coast Primary Health Network, Newcastle, New South Wales, Australia
| | - Julie Byles
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - David Durrheim
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Health Protection, Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia
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11
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Chan HY, Zhao YY, Liu L, Chong YY, Cheng HY, Chien WT. Ethical challenges experienced by care home staff during COVID-19 pandemic. Nurs Ethics 2022; 29:1750-1760. [PMID: 35798543 DOI: 10.1177/09697330221111446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Care homes have been disproportionately affected during the COVID-19 pandemic. Practical challenges of enacting infection control measures in care home settings have been widely reported, but little is known about the ethical concerns of care home staff during the implementation of such measures. . OBJECTIVES To understand the ethical challenges perceived by care home staff during the early months of the COVID-19 pandemic. RESEARCH DESIGN An exploratory qualitative study. PARTICIPANTS AND RESEARCH CONTEXT A purposive sample of 15 care home staff in different roles and ranks in Hong Kong was recruited to take part in semi-structured interviews between June and August 2020. ETHICAL CONSIDERATIONS Ethical approval for this study was obtained. Participation was voluntary and anonymous. Participants had the right to withdraw from the study at any time without reprisal. FINDINGS Three themes were identified: unclear legitimacy regarding infection control measures, limited autonomy in choices over infection control measures and inevitable harms to residents' well-being. While the participants expected that they would have legitimated power to implement infection control measures, they were resistant when their right to self-determination of testing and vaccination was infringed. They also felt trapped between ethical duties to protect care home residents from infection risk and the anticipated detrimental effects of infection control measures. CONCLUSIONS The findings of this study reveal tensions among the ethical obligations of care home staff in response to a public health emergency. They highlight the importance of strengthening ethical sensitivity and ethical leadership in identifying and resolving the challenges of pandemic responses.
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Affiliation(s)
- Helen Yl Chan
- Faculty of Medicine, 71024The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ya-Yi Zhao
- School of Nursing, 71024Nanjing University of Chinese Medicine, Nanjing, China
| | - Li Liu
- Xiangya Nursing School, 71024Central South University, Hunan, China
| | - Yuen-Yu Chong
- Faculty of Medicine, 71024The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho-Yu Cheng
- Faculty of Medicine, 71024The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wai-Tong Chien
- Faculty of Medicine, 71024The Chinese University of Hong Kong, Hong Kong SAR, China
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12
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Dai Z, Sezgin G, Li J, Franco GS, McGuire P, Datta S, Pearce C, McLeod A, Georgiou A. Telehealth utilisation in residential aged care facilities during the COVID-19 pandemic: A retrospective cohort study in Australian general practice. J Telemed Telecare 2022:1357633X221094406. [PMID: 35544365 PMCID: PMC9096176 DOI: 10.1177/1357633x221094406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Our earlier analysis during the COVID-19 surges in 2020 showed a reduction in general practitioner (GP) in-person visits to residential aged care facilities (RACFs) and increased use of telehealth. This study assessed how sociodemographic characteristics affected telehealth utilisation. METHODS This retrospective cohort consists of 27,980 RACF residents aged 65 years and over, identified from general practice electronic health records in Victoria and New South Wales during March 2020-August 2021. Residents' demographic characteristics, including age, sex, region, and pension status, were analysed to estimate the odds ratio (OR) and 95% confidence interval (CI) for the associations with telehealth utilisation (telephone/video vs. in-person consultations) and with video versus telephone consultations, in mixed-effects multiple level regression models. RESULTS Of 32,330 median monthly GP consultations among 21,987 residents identified in 2020, telehealth visits accounted for 17% of GP consultations, of which 93% were telephone consults. In 2021, of 32,229 median monthly GP consultations among 22,712 residents, telehealth visits accounted for 11% of GP consultations (97% by telephone). Pension holders (OR: 1.14; 95% CI: 1.10, 1.17) and those residing in rural areas (OR: 1.72; 95% CI: 1.57, 1.90) were more likely to use telehealth. However, residents in rural areas were less likely to use video than telephone in GP consultations (OR: 0.41; 95% CI: 0.29, 0.57). Results were similar in separate analyses for each COVID surge. DISCUSSION Telephone was primarily used in telehealth consultations among pension holders and rural residents in RACFs. Along with the limited use of video in virtual care in rural RACFs, the digital divide may imply potential healthcare disparities in socially disadvantaged patients.
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Affiliation(s)
- Zhaoli Dai
- Centre for Health Systems and Safety
Research, Australian Institute of Health Innovation Faculty of Medicine, Health and
Human Sciences, Macquarie
University, Sydney, Australia
- College of Medicine & Public
Health, Flinders University
| | - Gorkem Sezgin
- Centre for Health Systems and Safety
Research, Australian Institute of Health Innovation Faculty of Medicine, Health and
Human Sciences, Macquarie
University, Sydney, Australia
| | - Julie Li
- Centre for Health Systems and Safety
Research, Australian Institute of Health Innovation Faculty of Medicine, Health and
Human Sciences, Macquarie
University, Sydney, Australia
| | - Guilherme S. Franco
- Centre for Health Systems and Safety
Research, Australian Institute of Health Innovation Faculty of Medicine, Health and
Human Sciences, Macquarie
University, Sydney, Australia
| | | | - Shirmilla Datta
- Eastern Melbourne Primary Health
Network, Victoria, Australia
| | | | | | - Andrew Georgiou
- Centre for Health Systems and Safety
Research, Australian Institute of Health Innovation Faculty of Medicine, Health and
Human Sciences, Macquarie
University, Sydney, Australia
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13
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Brydon A, Bhar S, Doyle C, Batchelor F, Lovelock H, Almond H, Mitchell L, Nedeljkovic M, Savvas S, Wuthrich V. National Survey on the Impact of COVID-19 on the Mental Health of Australian Residential Aged Care Residents and Staff. Clin Gerontol 2022; 45:58-70. [PMID: 34634217 DOI: 10.1080/07317115.2021.1985671] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study is the first to obtain data on the prevalence of, contributors to, and supports required for, pandemic-related distress within the residential aged care sector in Australia. A nested mixed-methods approach was used to examine aged care leaders' opinions about the impact of COVID-19 on the mental health of aged care residents and staff. METHODS A total of 288 senior staff of Australian residential aged care facilities (care managers, clinical care coordinators, and lifestyle team leaders; mean age = 52.7 years, SD = 10.3) completed an online survey between 10th September and 31st October 2020. RESULTS On average, nearly half of their residents experienced loneliness (41%) and a third experienced anxiety in response to COVID-19 (33%). The most frequently noted contributors to poor mental health among residents were restrictions to recreational outings and watching news coverage relating to COVID-19. Participants emphasized the need for increased access to counseling services and improved mental health training amongst staff. Residential care staff were similarly impacted by the pandemic. More than a third of staff were reported as anxious (36%) and 20% depressed, in response to COVID-19. Staff were worried about introducing COVID-19 into their facility and were impacted by news coverage of COVID-19. Staff would feel supported by financial assistance and by increased staff-resident ratios. CONCLUSIONS Senior staff perceive that the mental health of Australian aged care residents and staff was negatively impacted by the COVID-19 pandemic. The most noted contributors were identified, as was the mental health support for aged care communities. CLINICAL IMPLICATIONS This study provides government and policymakers with clear intervention targets for supporting the sector. Clinicians can support residential aged care communities by providing on-site or telehealth counseling, and upskill and train residential aged care staff on how to respond to the emotional needs of residents in response to COVID-19.
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Affiliation(s)
- Aida Brydon
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Colleen Doyle
- National Ageing Research Institute, Melbourne, Australia
| | | | | | - Helen Almond
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Leander Mitchell
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Maja Nedeljkovic
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Steven Savvas
- National Ageing Research Institute, Melbourne, Australia
| | - Viviana Wuthrich
- Department of Psychology, Macquarie University, Sydney, Australia
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14
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Beogo I, Ramdé J, Nguemeleu Tchouaket E, Sia D, Bationo NJC, Collin S, Anne A, Gagnon MP. Co-Development of a Web-Based Hub (eSocial-hub) to Combat Social Isolation and Loneliness in Francophone and Anglophone Older People in the Linguistic Minority Context (Quebec, Manitoba, and New Brunswick): Protocol for a Mixed Methods Interventional Study. JMIR Res Protoc 2021; 10:e30802. [PMID: 34464326 PMCID: PMC8767988 DOI: 10.2196/30802] [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] [Received: 05/29/2021] [Revised: 07/15/2021] [Accepted: 08/02/2021] [Indexed: 12/01/2022] Open
Abstract
Background The first wave of the COVID-19 pandemic has severely hit Canadian nursing facilities (81% of deaths). To this toll, public health measures (eg, visitation restriction) have subsequently deepened the social isolation and loneliness of residents in nursing facilities (NFs), especially those in linguistic minority settings: Anglophone institutions in Quebec and Francophone institutions outside Quebec. However, very few COVID-19 initiatives targeting these populations specifically have been documented. Given the limited number of NFs serving linguistic minorities in Canadian populations, families and loved ones often live far from these facilities, sometimes even in other provinces. This context places the digital solutions as particularly relevant for the present COVID-19 pandemic as well as in the post–COVID-19 era. Objective This project aims to co-develop a virtual community of practice through a web-based platform (eSocial-hub) to combat social isolation and loneliness among the older people in linguistic minority settings in Canada. Methods An interventional study using a sequential mixed methods design will be conducted. Four purposely selected NFs will be included, 2 among facilities in Manitoba and 2 in New Brunswick; and 2 Anglophone NFs in Quebec will serve as knowledge users. The development of eSocial-hub will include an experimental 4-month phase involving the following end users: (1) older people (n=3 per NF), (2) families of the participating older people (n=3 per NF), and (3) frontline staff (nurse and health care aid; n=2 per NF). Results Activities and solutions aiming at reducing social isolation and loneliness will be implemented and then evaluated with the project stakeholders, and the best practices generated. The assessment will be conducted using indicators derived from the 5 domains of the Consolidated Framework for Implementation Research. The project will be led by an interdisciplinary team and will involve a multisectoral partnership. Conclusions The project will develop a promising and generalizable solution that uses virtual technology to help reduce social isolation and loneliness among the older people. International Registered Report Identifier (IRRID) PRR1-10.2196/30802
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Affiliation(s)
- Idrissa Beogo
- École des sciences infirmières, Faculté des sciences de la santé, Université d'Ottawa, Ottawa, ON, Canada.,College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jean Ramdé
- Département des fondements et pratiques en éducation, Faculté des sciences de l'éducation, Université Laval, Québec, QC, Canada
| | - Eric Nguemeleu Tchouaket
- Département des sciences infirmières, Université du Québec en Outaouais, Campus de Saint-Jérôme, Campus de Saint-Jérôme, QC, Canada
| | - Drissa Sia
- Département des sciences infirmières, Université du Québec en Outaouais, Campus de Saint-Jérôme, Campus de Saint-Jérôme, QC, Canada
| | - Nebila Jean-Claude Bationo
- Département des fondements et pratiques en éducation, Faculté des sciences de l'éducation, Université Laval, Québec, QC, Canada
| | - Stephanie Collin
- École des hautes études publiques, Université de Moncton, Campus de Moncton, Moncton, NB, Canada
| | - Abdoulaye Anne
- Département des fondements et pratiques en éducation, Faculté des sciences de l'éducation, Université Laval, Québec, QC, Canada
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15
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Everitt R, Robinson N, Marco D, Weil J, Bryan T. Increased number of deaths within 24 h of admission during a period of social restriction related to the COVID-19 pandemic: A retrospective service evaluation in a metropolitan palliative care unit. Palliat Med 2021; 35:1508-1513. [PMID: 34159860 DOI: 10.1177/02692163211026518] [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: 11/15/2022]
Abstract
BACKGROUND COVID-19 has led to implementation of wide-ranging social restriction measures with consequent impact on health care utilisation in many domains. There is little published data on the experience of palliative care services catering to a population with low case numbers of COVID-19. AIM This study aimed to consider the impact of COVID-19 on utilisation of inpatient palliative care in the context of low community transmission, and low numbers of cases in hospital. DESIGN A retrospective service evaluation examining differences in number of admissions, diagnoses, number of deaths and time from admission to death, across three discrete 8-week time periods spanning the early COVID-19 pandemic. SETTING/PARTICIPANTS All admissions (n = 194) to a metropolitan tertiary hospital inpatient palliative care unit in Melbourne during the study period. RESULTS An initial 16.9% fall in admissions was followed by a return to baseline admission numbers, with a 46.7% increase in number of deaths compared to baseline. The number of deaths within 24 h rose from 10.8% to 37.3% (p < 0.01). The number of patients with non-malignant diagnoses increased from 32.4% to 52%, and those with non-malignant diagnoses were more likely to die rapidly (p < 0.01). There were no patients with COVID-19 infection. CONCLUSION Increased numbers of deaths within 24 h of admission occurred on the palliative care unit despite low COVID-19 case numbers in the wider community, and in the setting of widespread social restriction measures. More research is needed examining the health-related consequences of such restrictions for individuals not infected with COVID-19.
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Affiliation(s)
- Rachel Everitt
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Neil Robinson
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - David Marco
- Centre for Palliative Care, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Weil
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Tamsin Bryan
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
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16
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Dykgraaf SH, Matenge S, Desborough J, Sturgiss E, Dut G, Roberts L, McMillan A, Kidd M. Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence. J Am Med Dir Assoc 2021; 22:1969-1988. [PMID: 34428466 PMCID: PMC8328566 DOI: 10.1016/j.jamda.2021.07.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long-term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision making. DESIGN Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long-term care. SETTING AND PARTICIPANTS Residents and staff in care settings such as nursing homes and long-term care facilities. METHODS PubMed/Medline, Cochrane Library, and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (eg, commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesized narratively using tabulated data extracts and summary tables. RESULTS Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational, with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control measures. Symptom- or temperature-based screening and single point-prevalence testing were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications, and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher-performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, intersectoral collaboration, and policy that facilitated access to critical resources were all significant enablers of success. CONCLUSIONS AND IMPLICATIONS High-quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though it continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long-term care residents from COVID-19 and other infectious diseases. This rapid review summarizes current evidence regarding strategies that may be effective.
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Affiliation(s)
- Sally Hall Dykgraaf
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia.
| | - Sethunya Matenge
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Jane Desborough
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Elizabeth Sturgiss
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Garang Dut
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Leslee Roberts
- Medical Advisory Unit, Primary Care Division, Australian Government Department of Health, Canberra ACT, Australia
| | - Alison McMillan
- Australian Government Department of Health, Canberra ACT, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra ACT, Australia
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17
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Hashan MR, Smoll N, King C, Ockenden-Muldoon H, Walker J, Wattiaux A, Graham J, Booy R, Khandaker G. Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis. EClinicalMedicine 2021; 33:100771. [PMID: 33681730 PMCID: PMC7917447 DOI: 10.1016/j.eclinm.2021.100771] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 outbreaks in aged care facilities (ACFs) often have devastating consequences. However, epidemiologically these outbreaks are not well defined. We aimed to define such outbreaks in ACFs by systematically reviewing literature published during the current COVID-19 pandemic. METHODS We searched 11 bibliographic databases for literature published on COVID-19 in ACFs between December 2019 and September 2020. Original studies reporting extractable epidemiological data as part of outbreak investigations or non-outbreak surveillance of ACFs were included in this systematic review and meta-analysis. PROSPERO registration: CRD42020211424. FINDINGS We identified 5,148 publications and selected 49 studies from four continents reporting data on 214,380 residents in 8,502 ACFs with 25,567 confirmed cases of COVID-19. Aged care residents form a distinct vulnerable population with single-facility attack rates of 45% [95% CI 32-58%] and case fatality rates of 23% [95% CI 18-28%]. Of the cases, 31% [95% CI 28-34%] were asymptomatic. The rate of hospitalization amongst residents was 37% [95% CI 35-39%]. Data from 21 outbreaks identified a resident as the index case in 58% of outbreaks and a staff member in 42%. Findings from the included studies were heterogeneous and of low to moderate quality in risk of bias assessment. INTERPRETATION The clinical presentation of COVID-19 varies widely in ACFs residents, from asymptomatic to highly serious cases. Preventing the introduction of COVID-19 into ACFs is key, and both residents and staff are a priority group for COVID-19 vaccination. Rapid diagnosis, identification of primary and secondary cases and close contacts plus their isolation and quarantine are of paramount importance. FUNDING Queensland Advancing Clinical Research Fellowship awarded to Prof. Gulam Khandaker by Queensland Health's Health Innovation, Investment and Research Office (HIRO), Office of the Director-General.
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Affiliation(s)
- Mohammad Rashidul Hashan
- Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Nicolas Smoll
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Catherine King
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Hannah Ockenden-Muldoon
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Jacina Walker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Andre Wattiaux
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Julieanne Graham
- Medical Services Team, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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18
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Zheng A, Govindasamy LS, Thomas J, Branley J, Craig AT, Douglas M. Lessons from a successful public health response to COVID-19 in a New South Wales residential aged care facility, 2020. Aust N Z J Public Health 2021; 45:13-16. [PMID: 33522665 PMCID: PMC8013354 DOI: 10.1111/1753-6405.13077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anthony Zheng
- New South Wales Ministry of Health,Correspondence to: Dr Anthony Zheng, New South Wales Ministry of Health, 1 Reserve Rd, St Leonards NSW 2065
| | | | - Jane Thomas
- Nepean Blue Mountains Local Health District Public Health Unit, New South Wales
| | - James Branley
- Department of Microbiology and Infectious Diseases, New South Wales Health Pathology
| | - Adam T. Craig
- School of Population Health, Faculty of Medicine and Health, University of New South Wales
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19
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Talley NJ. Health and medicine in a pandemic year: moving from the “winter of despair” to the “spring of hope”. Med J Aust 2020; 213:484-488. [DOI: 10.5694/mja2.50861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 01/06/2023]
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20
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Aitken GE, Holmes AL, Ibrahim JE. COVID-19 and residential aged care: priorities for optimising preparation and management of outbreaks. Med J Aust 2020; 214:6-8.e1. [PMID: 33296510 DOI: 10.5694/mja2.50892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Alice L Holmes
- Victorian Institute of Forensic Medicine, Melbourne, VIC
| | - Joseph E Ibrahim
- Victorian Institute of Forensic Medicine, Melbourne, VIC.,Queen Elizabeth Centre, Ballarat Health Services, Ballarat, VIC
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