Reply to Comment on <scp>COVID</scp>‐19 Deaths in Long Term Care Facilities ‐ A Critical Piece of the Puzzle

Lau‐Ng, Rossana; Caruso, Lisa B.; Perls, Thomas T.

doi:10.1111/jgs.16804

J American Geriatrics Society

2020

DOI: 10.1111/jgs.16804

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Reply to Comment on COVID‐19 Deaths in Long Term Care Facilities ‐ A Critical Piece of the Puzzle

Rossana Lau‐Ng

Lisa B. Caruso

Thomas T. Perls

Abstract: This letter comments on the letter by https://doi.org/10.1111/jgs.16806.

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“…Other local LTCFs have employed technological innovations, such as a robotic healthcare assistant equipped with high-resolution cameras and autofocus, to enable families to make virtual visits to their older relatives in LTCFs through videoconferencing. 10 Tak-kwan Kong, MBBS(HK) Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China…”

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Comment on: COVID‐19 Deaths in Long‐Term Care Facilities: A Critical Piece of the Pandemic Puzzle

Kong

2020

J American Geriatrics Society

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, nine staff and 34 of its 37 residents were infected, four of whom died. The improvements in and implementations of infection control measures in LTCFs in Hong Kong were built on lessons learned from severe acute respiratory syndrome (SARS) epidemics in 2003, which affected 6.72% (51/759) of the LTCFs and 0.13% (72/54,754) of the LTCF residents, with a mortality rate of 78.1%. 2-4 Collaboration among medical, social welfare, and private sectors is the key to the early detection of cases and the prevention of spread during infectious outbreaks in LTCFs. Effective measures include training on proper infection control practices, the correct use of personal protective equipment, cohort formation and surveillance of LTCF residents recently discharged from hospitals during the epidemics, and hospitalbased community geriatric teams led by geriatric specialist to render support to LTCFs. The last is particularly important to reduce avoidable hospitalization by attending to the medical needs of frail older people. 4 The outreach role of geriatricians was found to be especially important during the 2003 SARS epidemic when scrutiny of cases among LTCF residents revealed that 81% had been hospital acquired and only 14% were acquired in LTCFs. 4 Among the reasons why LTCFs are so vulnerable to COVID-19, Lau-Ng et al 1 listed asymptomatic transmission as the "Achilles heel." 1 To this, I would add the longer incubation period of COVD-19 in older adults, 5 which predisposes to presymptomatic transmission. Transmission toward the end of the incubation period and before the onset of symptoms is more likely to occur during a long incubation period. 6 Arons et al 7 reported presymptomatic SARS coronavirus 2 (SARS-CoV-2) infections in half (24/48) of the residents tested positive for COVID-19 during an LTCF outbreak. Symptoms developed subsequently within a median of 4 days, and viable virus isolated up to 6 days before symptom onset. 7 A longer incubation period in older adults was suspected clinically during the 2003 SARS epidemic 2-4 and has been documented recently for SARS-CoV-2 during COVID-19 pandemic. 5 Knowledge of a longer COVID-19 incubation period (median = 11.2 days; 90th percentile = 17 days) in older adults 5 supports extending the duration of transmission-based precautions, isolation, and observation strategies for LTCF residents to minimize spread. [Correction added on October 14, 2020 after first online publication: In the preceding sentence, the reference citation was

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Comment on: COVID‐19 Deaths in Long‐Term Care Facilities: A Critical Piece of the Pandemic Puzzle

Kong

2020

J American Geriatrics Society

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Reply to Comment on COVID‐19 Deaths in Long Term Care Facilities ‐ A Critical Piece of the Puzzle

Abstract: This letter comments on the letter by https://doi.org/10.1111/jgs.16806.

Cited by 1 publication

References 4 publications

Comment on: COVID‐19 Deaths in Long‐Term Care Facilities: A Critical Piece of the Pandemic Puzzle

Comment on: COVID‐19 Deaths in Long‐Term Care Facilities: A Critical Piece of the Pandemic Puzzle

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