Evolution and impact of COVID-19 outbreaks in care homes: population analysis in 189 care homes in one geographic region

Burton, Jennifer K; Bayne, Gwen; Evans, C. Lawrence; Garbe, Frederike; Gorman, Dermot; Honhold, Naomi; McCormick, Duncan; Othieno, Richard; Stevenson, J; Swietlik, Stefanie; Templeton, Kate; Tranter, Mette; Willocks, Lorna; Guthrie, Bruce

doi:10.1101/2020.07.09.20149583

Cited by 23 publications

(38 citation statements)

References 17 publications

(20 reference statements)

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“…A Scientific Pandemic Influenza Group on Modelling (SPI-M) paper predicted that nearly all care homes would become affected if current conditions persisted, and indicated a role for staff in introducing infections, particularly where staff worked across more than one home 5 . Recent studies indicate that Personal Protective Equipment (PPE) and number of staff employed 6,7 have an impact on the number of COVID-19 infections. More recent data from the Care Quality Commission suggest that, to mid-June, 36% of care homes experienced an outbreak (defined as a single laboratory confirmed case) 7 with a study of care homes across a large Scottish Health Board reporting a figure of 37% 7 .…”

Section: Introductionmentioning

confidence: 99%

Risk factors for outbreaks of COVID-19 in care homes following hospital discharge: a national cohort analysis

Emmerson

Adamson

Turner

et al. 2020

Preprint

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Background Adult residential and nursing care homes are settings in which older and often vulnerable people live in close proximity. This population experiences a higher proportion of respiratory and gastrointestinal illnesses than the general population and has been shown to have a high morbidity and mortality in relation to COVID-19. Methods We examined the number of hospital discharges to all Welsh adult care homes and the subsequent outbreaks of COVID-19 occurring over an 18 week period 22 February and 27 June 2020. A Cox proportional hazards regression model was used to assess the impact of time-dependent exposure to hospital discharge on the incidence of the first known outbreak, over a window of 7-21 days after discharge, and adjusted for care home characteristics (including size, type of provision and health board). Results A total of 1068 care homes were monitored; 330 homes experienced an outbreak of COVID-19, and 511 homes received a discharge from hospital over the study period. The exposure to discharge from hospital was not associated with a significant increase in the risk of a new outbreak (hazard ratio 1.15, 95% CI 0.89, 1.49, p = 0.28), after adjusting for care home size, which was by far the most significant predictor. Hazard ratios (95% CI) in comparison to homes of <10 residents were: 3.4 (2.0, 5.8) for 10-24 residents; 8.3 (5.0, 13.8) for 25-49 residents; and 17.3 (9.6, 31.1) for homes of 50+ residents. When stratified for care home size, the outbreak rates were very similar for periods when homes were exposed to a hospital discharge, in comparison to periods when homes were unexposed. Conclusion Our analyses showed that large homes were at considerably greater risk of outbreaks throughout the epidemic, and after adjusting for care home size, a discharge from hospital was not associated with a significant increase in risk. Keywords: COVID-19, care homes, hospital discharge, outbreak, time dependent Cox regression

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Section: Introductionmentioning

confidence: 99%

Risk factors for outbreaks of COVID-19 in care homes following hospital discharge: a national cohort analysis

Emmerson

Adamson

Turner

et al. 2020

Preprint

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“…Geographically we report evidence from eleven countries, the majority (20 studies) are from USA [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and UK. [36][37][38][39][40] We report evidence from Canada, [41][42][43] France, 44,45 Hong Kong, 46,47 Belgium, 48 Germany, 49 Ireland, 50 Japan, 51 Korea, 52 and Spain 53 (Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Twenty studies report the nature of LTCFs related with outbreaks and transmission of COVID-19 infection (Table 2; 16,23,28,29,31,33,[35][36][37][38][39][41][42][43][45][46][47][50][51][52] ). Thirty studies (Table 3a; [17][18][19][20][21][22][23][24][25][26][27][28][29][32][33][34][37][38][39][40][41][42][43][45][46][47][48][49][50]53 ) report evidence of measures to ...…”

Section: Infection Control Measuresmentioning

confidence: 99%

“…positive staff, the proportion of symptomatic cases ranged from 6.4% 26 to 100%, 32 and asymptomatic cases ranged from 23.6% 50 to 100%. 20,22 Mortality results were reported in 22 studies, including information on mortality of residents (22 studies; [17][18][19][22][23][24][27][28][29]33,34,[37][38][39][40][41][42][43]45,47,49,50 ), staff (4 studies; 28,34,45,47 ), and visitors (2 studies; 28,47 ). Mortality rates in COVID-19 positive residents ranged from 5.3% 19 to 55.3%.…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

“…Numerous facility-specific characteristics were linked with risk of COVID-19 cases (Table 2). These include size of LTCF; 16,37,38,51 staffing levels and/or use of agency care staff; 28,31,36,38,39,43,50 part of larger chain of organisations and/or for profit status; 16,31,35,42,43,50 and related staffing, crowding, or availability of single rooms. 23,29,39,41,43,[45][46][47] 25 Facility characteristics 7 staff COVID-19 positive prior to intervention 0 further staff positive after intervention implemented Heung et al (2006) 46 Hand hygiene, contact precautions PPE, personal protective equipment…”

Section: Characteristics Of Ltcfs On Covid-19 Transmissionmentioning

confidence: 99%

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A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

Frazer

Mitchell

Stokes

et al. 2020

Preprint

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The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in long term care facilities to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff, and visitors. Databases (including MedRXiv pre-published repository) were systematically searched to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff, or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities, and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2-85.4% in residents and 0.6-62.6% in staff. Mortality rates ranged from 5.3-55.3% in residents. Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in long term care facilities.

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Impact of visitation and cohorting policies to shield residents from covid-19 spread in care homes: an agent-based model

Nguyen

Howick

McLafferty

et al. 2021

American Journal of Infection Control

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Background: This study examines the impact of visitation and cohorting policies as well as the care home population size upon the spread of COVID-19 and the risk of outbreak occurrence in this setting. Methods: Agent-based modelling Results: The likelihood of the presence of an outbreak in a care home is associated with the care home population size. Cohorting of residents and staff into smaller, self-contained units reduces the spread of COVID-19. Restricting the number of visitors to the care home to shield its residents does not significantly impact the cumulative number of infected residents and risk of outbreak occurrence in most scenarios. Only when the community prevalence where staff live is considerably lower than the prevalence where visitors live (the former prevalence is less than or equal to 30% of the latter), relaxing visitation increases predicted infections much more significantly than it does in other scenarios. Maintaining a low infection probability per resident-visitor contact helps reduce the effect of allowing more visitors into care homes. Conclusions: Our model predictions suggest that cohorting is effective in controlling the spread of COVID-19 in care homes. However, according to predictions shielding residents in care homes is not as effective as predicted in a number of studies that have modelled shielding of vulnerable population in the wider communities.

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Evolution and impact of COVID-19 outbreaks in care homes: population analysis in 189 care homes in one geographic region

Cited by 23 publications

References 17 publications

Risk factors for outbreaks of COVID-19 in care homes following hospital discharge: a national cohort analysis

Risk factors for outbreaks of COVID-19 in care homes following hospital discharge: a national cohort analysis

A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

Impact of visitation and cohorting policies to shield residents from covid-19 spread in care homes: an agent-based model

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