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 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, tested positive for COVID-19. In this study we aimed to determine whether cross-border introduction of the virus took place by analysing the LTCF outbreak in Sittard, both epidemiologically and microbiologically. Methods Surveys and semi-structured oral interviews were conducted with all present LTCF 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, based on regional criteria, for the detection of SARS-CoV-2 by Real-time Polymerase Chain Reaction. Additionally, whole genome sequencing was performed using a SARS-CoV-2 specific amplicon-based Nanopore sequencing approach. Moreover, twelve random residents were sampled for possible asymptomatic infections. Results Out of 99 residents, 46 got tested for COVID-19. Out of the 46 tested residents, nineteen (41%) tested positive for COVID-19, including 3 asymptomatic residents. CT-values for asymptomatic residents seemed higher compared to symptomatic residents. 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. All samples were linked to COVID-19 cases from the cross-border region of Heinsberg, Germany. Conclusions Sequencing combined with epidemiological data was able to virtually prove cross-border transmission at the start of the Dutch COVID-19 epidemic. Our results highlight the need for cross-border collaboration and adjustment of national policy to emerging region-specific needs along borders in order to establish coordinated implementation of infection control measures to limit the spread of COVID-19.

Risk Factors Associated with Nursing Home COVID-19 Outbreaks: A Retrospective Cohort Study

“…Understanding clearly the factors that may have contributed to outbreaks as a result of the pandemic have attracted scientific and legal attention for the purposes of devising policies, action plans and standards to safeguard the safety of both residents and employees in such facilities during the COVID-19 pandemic and beyond [6]. Despite a wealth of individual reports of outbreaks and fatalities in aged care facilities related to COVID-19 [7][8][9][10][11][12], as well as review articles quantifying the outsized impact of this pandemic in the frail populations [3], structural, organizational and practice-related protective factors in these setting have been analyzed to a lesser degree. Several studies, mainly conducted in North America, have investigated the relationship between COVID-19 outbreaks and certain features of long-term care facilities (including nursing homes), such as their geography, size, design, staffing levels, compliance with infection prevention and control (IPC) regulations, health inspections and quality ratings [13][14][15].…”

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

“…However, two main aims stand out, which are connected to the same triggering event: the border closure. 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 (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).…”

“…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 (Wu, 2021), 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).…”

Evaluation of symptomatology and viral load among residents and healthcare staff in long-term care facilities: A coronavirus disease 2019 retrospective case-cohort study

“…Contacts of a confirmed COVID-19 case were tested only when they were part of a vulnerable population group; people who had a higher risk of severe COVID-19 outcomes, such as people aged 70 and older, as well as people with underlying disease [ 33 , 34 ]. Within Dutch hospitals, patients were also suspected of COVID-19 when they were diagnosed with pneumonia with unknown cause irrespective of an epidemiological link [ 5 ].…”

“…COVID-19 outbreaks have shown to cause a high burden of disease and deaths within longterm care facilities for the elderly (LTCFs) [1][2][3][4][5]. At the time of the first COVID-19 wave in the Netherlands (early March 2020, wildtype SARS-CoV-2 Wuhan strain), some European countries reported over 60% of all COVID-19 related deaths to occur within LTCFs [6].…”