Outbreak of COVID-19 in a nursing home in Madrid

Bouza, Emilio; Pérez‐Granda, María Jesús; Escribano, Pilar; Fernández-Del-Rey, Rocío; Pastor, I.; Moure, Zaira; Catalán, Pilar; Alonso, Roberto; Muñóz, Patricia; Guinea, Jesús

doi:10.1016/j.jinf.2020.06.055

Cited by 48 publications

(14 citation statements)

References 9 publications

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“…We may therefore have underestimated the attack rates and overestimated the case fatality rate in this cluster. However, our results are consistent with those of similar studies [ 4 – 6 , 8 ].…”

Section: Discussionsupporting

confidence: 94%

“…Comparable but lower attack and case fatality rates were obtained when considering confirmed cases alone (52 and 19%, respectively). These results are consistent with previous studies that showed among nursing home residents a prevalence of COVID-19 of 40–64% in the UK and USA and COVID-19-associated mortality of 17–34% in UK, USA, Spain, and Germany [ 4 – 8 ]. Our study also showed that staff may be widely contaminated and thus contribute to the spread of the virus within the facility [ 9 ].…”

Section: Discussionsupporting

confidence: 93%

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High impact of COVID-19 outbreak in a nursing home in the Nouvelle-Aquitaine region, France, March to April 2020

et al. 2021

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Background Elderly people in nursing homes are particularly vulnerable to COVID-19 due to their age, the presence of comorbidities, and community living. On March 14, 2020, at the beginning of the first epidemic wave of COVID-19 in France, a cluster was reported in a nursing home in the Nouvelle-Aquitaine region. We monitored the outbreak as well as the infection prevention and control (IPC) measures implemented. Methods A confirmed case was defined as laboratory-confirmed COVID-19 in a resident or staff member present in the nursing home between March 7 and May 1, 2020; and a probable case as a person presenting an acute respiratory illness after contact with a confirmed case. Symptomatic inpatient residents and symptomatic staff members were systematically tested for SARS-CoV-2. In addition, two screening sessions were held on site. Results We identified 109 cases (98 confirmed, 11 probable). The attack rate was 66% among residents and 45% among staff. Half of all cases were identified during the screening sessions. One-quarter of cases had minor symptoms or were asymptomatic. The case fatality rate among residents was 29%. IPC measures were rapidly implemented such as the quarantine of residents, the reinforcement of staff personal protective equipment, and home quarantine of staff testing positive, which were supplemented in April by systematic controls at the entrance of the nursing home and the creation of additional staff break rooms. Conclusions This outbreak confirmed the considerable health impact of SARS-CoV-2 transmission in a nursing home. In addition to the implementation of IPC measures, the early detection of cases through the screening of residents and staff is essential to identify asymptomatic and pre-symptomatic cases and limit the spread of the virus.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 93%

High impact of COVID-19 outbreak in a nursing home in the Nouvelle-Aquitaine region, France, March to April 2020

et al. 2021

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“…The clinical characteristics observed in this LTCF cohort are notable in the context of the large cluster of infected and high mortality rate, among the highest reported in current literature to our knowledge [ 14 ]. Incidence, demographic associations [ 20 ], transmission and symptom status [ 9 , 10 , 11 , 12 , 13 , 15 , 16 , 19 ], and atypical presentation [ 17 , 18 , 21 ] in LTCF residents are widely discussed in the literature [ 14 ]. Less attention was paid to the clinical patterns of COVID-19 in LTCF residents, as it relates to mortality outcomes, and those that did were not in exclusively outpatient settings [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the infection control recommendations for LTCFs issued by the Centers for Medicare and Medicaid Services (CMS) in consultation with the Centers for Disease Control and Prevention (CDC) [ 8 ], insight into the clinical presentation of these patients is important for prompt identification of infected cases, subsequent isolation and quarantine measures, and improvement of clinical outcomes. Existing studies on COVID-19 outbreaks in the institutionalized elderly largely focus on epidemiological characteristics [ 9 , 10 , 11 , 12 ] and clinical symptoms related to initial presentation and transmission [ 13 , 14 , 15 , 16 , 17 , 18 ]. Few studies assessed the clinical course and past initial symptom status of residents, as it relates to mortality outcomes [ 19 , 20 , 21 ], especially in a non-hospital setting [ 22 , 23 ], with an infection and mortality rate as high as those documented here.…”

Section: Introductionmentioning

confidence: 99%

Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April–June 2020

et al. 2020

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Long-term care facilities (LTCFs) have had a disproportionally high mortality rate due to COVID-19. We describe a rapidly escalating COVID-19 outbreak among 116 LTCF residents in Rhode Island, USA. Overall, 111 (95.6%) residents tested positive and, of these, 48 (43.2%) died. The most common comorbidities were hypertension (84.7%) and cardiovascular disease (84.7%). A small percentage (9%) of residents were asymptomatic, while 33.3% of residents were pre-symptomatic, with progression to symptoms within a median of three days following the positive test. While typical symptoms of fever (80.2%) and cough (43.2%) were prevalent, shortness of breath (14.4%) was rarely found despite common hypoxemia (95.5%). The majority of patients demonstrated atypical symptoms with the most common being loss of appetite (61.3%), lethargy (42.3%), diarrhea (37.8%), and fatigue (32.4%). Many residents had increased agitation (38.7%) and anxiety (5.4%), potentially due to the restriction measures or the underlying mental illness. The fever curve was characterized by an intermittent low-grade fever, often the first presenting symptom. Mortality was associated with a disease course beginning with a loss of appetite and lethargy, as well as one more often involving fever greater than 38 °C, loss of appetite, altered mental status, diarrhea, and respiratory distress. Interestingly, no differences in age or comorbidities were noted between survivors and non-survivors. Taking demographic factors into account, treatment with anticoagulation was still associated with reduced mortality (adjusted OR 0.16; 95% C.I. 0.06–0.39; p < 0.001). Overall, the clinical features of the disease in this population can be subtle and the symptoms are commonly atypical. However, clinical decline among those who did not survive was often rapid with patients expiring within 10 days from disease detection. Further studies are needed to better explain the variability in clinical course of COVID-19 among LTCF residents, specifically the factors affecting mortality, the differences observed in symptom presentation, and rate of clinical decline.

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“…27 Further research is needed to characterize the mortality in long-term care facilities, which have clusters of vulnerable populations in which the virus may spread very rapidly. 28 As nursing homes had limited access to hospital care during the initial outbreak in Spain, 29 our IFR estimates cannot be transported to the institutionalized elderly. Estimating the IFR for SARS-CoV-2 in long-term care facilities will require its own specific approach.…”

Section: Strengths and Limitationsmentioning

confidence: 98%

Infection fatality risk for SARS-CoV-2: a nationwide seroepidemiological study in the non-institutionalized population of Spain

Pastor-Barriuso

Pérez‐Gómez

Hernán

et al. 2020

Preprint

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The magnitude of the infection fatality risk (IFR) of SARS-CoV-2 remains under debate. Because the IFR is the number of deaths divided by the number of infected, serological studies are needed to identify asymptomatic and mild cases. Also, because ascertainment of deaths attributable to COVID-19 is often incomplete, the calculation of the IFR needs to be complemented with data on excess mortality. We used data from a nation-wide seroepidemiological study and two sources of mortality information -deaths among laboratory-confirmed COVID-19 cases and excess deaths- to estimate the range of IFR, both overall and by age and sex, in Spain. The overall IFR ranged between 1.1% and 1.4% in men and 0.58% to 0.77% in women. The IFR increased sharply after age 50, ranging between 11.6% and 16.4% in men ≥80 years and between 4.6% and 6.5% in women ≥80 years. Our IFR estimates for SARS-CoV-2 are substantially greater than IFR estimators for seasonal influenza, justifying the implementation of special public health measures.

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Outbreak of COVID-19 in a nursing home in Madrid

Abstract: Comparing hospitalised, community and staff COVID-19 infection rates during the early phase of the evolving COVID-19 epidemic Dear Editor, a descriptive and modelling study. Lancet Infect Dis 2020 Apr 2 pii: S1473-3099(20)30230-9[Epub ahead of print].

Cited by 48 publications

References 9 publications

High impact of COVID-19 outbreak in a nursing home in the Nouvelle-Aquitaine region, France, March to April 2020

High impact of COVID-19 outbreak in a nursing home in the Nouvelle-Aquitaine region, France, March to April 2020

Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April–June 2020

Infection fatality risk for SARS-CoV-2: a nationwide seroepidemiological study in the non-institutionalized population of Spain

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