COVID-19: first long-term care facility outbreak in the Netherlands following cross-border introduction from Germany, March 2020

Abstract

Background: The Dutch province of Limburg borders the German district of Heinsberg, which had a large cluster of COVID-19 cases linked to local carnival activities in February, before any cases were reported in the Netherlands. However, Heinsberg was not included as an area reporting local or community transmission per the national case definition at the time. In early March, two residents from a long-term care facility (LTCF) in Sittard, a Dutch town located in close vicinity to the district of Heinsberg, started experiencing respiratory symptoms and were admitted to the regional hospital at which they were tested for COVID-19. Introduction of the virus could have occurred following the carnival activities in the surrounding area by LTCF visitors or health care workers.Methods: Surveys and semi-structured oral interviews were conducted with all present residents by health care workers during regular points of care for information on new or unusual signs and symptoms of disease. Both throat and nasopharyngeal swabs were taken from residents suspect of COVID-19 for the detection of SARS-CoV-2 by Real-time Polymerase Chain Reaction and whole genome sequencing was performed using a SARS-CoV-2 specific amplicon-based Nanopore sequencing approach. Additionally, twelve random residents were sampled for possible asymptomatic infections.Results: Since the start of the outbreak, nineteen (19%) residents tested positive for COVID-19. Eleven samples were sequenced, along with three random samples from COVID-19 patients hospitalized in the regional hospital at the time of the LTCF outbreak. Conclusions: All samples were linked to COVID-19 cases from the cross-border region of Heinsberg, Germany. Symptoms were reported only in about two third of the cases, and tended to be generally mild. We therefore recommend low-level screening of HCWs and residents following a confirmed COVID-19 case, even in the absence of symptoms. Since the LTCF residents who tested positive did not meet the criteria for suspect cases of COVID-19 at the time, this highlights the importance of cooperation among cross-border partners in order to establish a coordinated implementation of infection control measures in the region on top of national guidelines to limit the spread of infectious diseases such as COVID-19.

Spatial patterns of excess mortality in the first year of the COVID-19 pandemic in Germany

“…However, this cannot be proven, as most chains of infection are not traceable. Such cross-border transmission has been confirmed for the first care home outbreak in the Netherlands, which was traced back to mobility from Germany (Mitch van Hensbergen 2021).…”

EU labor policy recommendations drawn from COVID‐driven research attention on cross‐border commuting – A review

“…Furthermore, epidemiological modelling can be observed in Aravindakshan et al (2020) andBrugués Rodríguez et al (2021). However, mixed method approaches are also used in the selected articles, combining both qualitative and quantitative methods, as well as interdisciplinary approaches (O'Connor et al, 2021;Spennemann, 2021).…”

“…On the one hand, the literature targets the effects of a border closure as a 'non-pharmaceutical intervention' (Aravindakshan et al, 2020, p. 2) for the spread of the COVID-19 virus and chains of infection across borders 6 (Brugués Rodríguez et al, 2021;Hamidi et al, 2020;Laroze et al, 2021;Lemey et al, 2021;van Hensbergen et al, 2021;Williams et al, 2021;Wilmes et al, 2021). On the other hand, the literature focuses on the impact of border closures on the mobility and daily life of the population in border regions (Böhm, 2022;Haddawy et al, 2021;Järv et al, 2021;Kajta & Opiłowska, 2021;Leiblfinger et al, 2021;Martin & Bergmann, 2021;Medeiros et al, 2021;Novotný, 2021;O'Connor et al, 2021;Spennemann, 2021;Virkkunen, 2020).…”

“…On the one hand, the literature targets the effects of a border closure as a 'non-pharmaceutical intervention' (Aravindakshan et al, 2020, p. 2) for the spread of the COVID-19 virus and chains of infection across borders 6 (Brugués Rodríguez et al, 2021;Hamidi et al, 2020;Laroze et al, 2021;Lemey et al, 2021;van Hensbergen et al, 2021;Williams et al, 2021;Wilmes et al, 2021). On the other hand, the literature focuses on the impact of border closures on the mobility and daily life of the population in border regions (Böhm, 2022;Haddawy et al, 2021;Järv et al, 2021;Kajta & Opiłowska, 2021;Leiblfinger et al, 2021;Martin & Bergmann, 2021;Medeiros et al, 2021;Novotný, 2021;O'Connor et al, 2021;Spennemann, 2021;Virkkunen, 2020). A smaller share of literature refers to the responsiveness and inclusion of decision-makers on local, regional, and EU levels in reacting to the COVID-19 pandemic and the attempts to contain the spread of the virus or to break the chains of infection by closing national borders (Böhm, 2022;de Vries, 2020;Francetic, 2021;Kajta & Opiłowska, 2021;Medeiros et al, 2021;O'Connor et al, 2021;Opioła & Böhm, 2022).…”

“…The same stock of literature critically evaluates the cooperation and communication of decision-makers of different levels and the impact of decision-making on the border regions. Furthermore, literature aimed at visualizing the effect of lockdowns and home office regulations on public transportation (Zhou et al, 2021) depict 'gendered disease iconography' during the COVID-19 pandemic , analyze the effectiveness of mass screening, and use mass screening data for detecting infection chains (Brugués Rodríguez et al, 2021;van Hensbergen et al, 2021;Williams et al, 2021;Wilmes et al, 2021).…”