Effectiveness of a On-site Medicalization Program for Nursing Homes With COVID-19 Outbreaks

Abstract

Background Nursing homes are highly vulnerable to the occurrence of COVID-19 outbreaks, which result in high lethality rates. Most of them are not prepared to SARS-CoV-2 pandemic. Methods A coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak in four nursing homes was organized, with the objectives of improving survival, offering humanistic palliative care to residents in their natural environment, and reducing hospital referrals. Ten key processes and interventions were established (provision of informatics infrastructure, medical equipment, and human resources, universal testing, separation of 'clean' and 'contaminated' areas, epidemiological surveys, and unified protocols stratifying for active or palliative care approach, among others). Main outcomes were a composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to hospital. Results 272 out of 457 (59.5%) residents and 85 out of 320 (26.5%) staff members were affected. The SOPC, survival, and referrals to hospital, occurred in 77%, 72.5%, and 29% of patients diagnosed before MP start, with respect to 97%, 83.7% and 17% of those diagnosed during the program, respectively. The SOPC was independently associated to MP (OR=15 [3-81]); and survival in patients stratified to active approach, to the use of any antiviral treatment (OR=28 [5-160]). All outbreaks were controlled in 39 [37-42] days. Conclusions A coordinated on-site medicalization program of nursing homes with COVID-19 outbreaks achieved a higher survival or optimal palliative care rate, and a reduction in referrals to hospital, thus ensuring rigorous but also humanistic and gentle care to residents.

Intersection between ageing-related Genes and SARS-CoV-2 Interactome: Is it higher than expected?

“…We observed a significant overlap between the interactors of SARS-CoV-2 and ageing group. Further, we looked at a network-level scenario [35], by considering possible regulatory mechanisms that may be altered [42,43]. These observations support previous reports that SARS-CoV-2 may manifest in the blood leading to multiorgan failure in severe cases of COVID-19.…”

Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis

“…Twelve studies reported hospitalization events for the confirmed COVID-19 residents from care homes. [ 11 , 26 , 39 , 44 , 49 , 52 , 53 , 55 , 58 , 59 , 66 , 68 ] None of the included studies reported information on clinical severity grade, rate of intensive care unit treatment, or invasive/non-invasive intervention following diagnosis. Overall, the rate of hospitalization amongst residents was 37% [95% CI 35–39%] for a total 2829 confirmed cases ( Table 2 ).…”

Early Multidrug Outpatient Treatment of SARS-CoV-2 Infection (COVID-19) and Reduced Mortality Among Nursing Home Residents

“…We found nine reports 3-11 supporting the concept of early multidrug pharmacological intervention can be used to improve clinical outcomes (the most important being reduction in death) in elderly nursing home residents suffering from COVID-19. We were focused on a high-risk group that typically worsens before treatment is administered within an in-patient hospital setting.…”

“…Bernabeu-Wittel et al reported from four nursing homes in Spain 3 that 272 of 457 (59.5%) residents contracted SARS-CoV-2 of whom 189 (69.5%) were given ‘active standard care’ and the rest were given advanced palliative care. For patients assigned to active standard care (i.e.…”