Analysis of COVID-19 outbreaks in 3 long-term care facilities in Graz, Austria

Abstract

Background: Nursing homes and long-term care facilities (LTCF) caring for elderly and chronically ill residents are at high risk to experience SARS-CoV-2 outbreaks. We report an outbreak of COVID-19 in three LTCFs of the Geriatric Health Centres of Graz, Austria lasting from 22nd March to 14th April, 2020. Aim: The objectives of our study were: (1) to elucidate contributing factors and transmission pathways of SARS-CoV-2, (2) to analyse symptoms of COVID-19 in the residents and health care workers. Methods: We carried out a retrospective outbreak analysis. Findings: 36/277 residents of 3 LTCFs were infected with SARS-CoV-2. Only a quarter of COVID-19 cases among residents had fever ≥ 38.1°C and 19% suffered from cough. 6/36 residents remained asymptomatic. Hospitalization rate was 58% in residents. Overall, 33% (12/36) residents infected with SARS-CoV-2 died. 19/214 health care workers were tested positive for SARS-CoV-2. Universal rt-PCR testing for SARS-CoV-2 of all residents and health care workers as well as infection control measures contributed to ending the outbreaks. Conclusion: Delayed recognition of possible COVID-19 cases due to either mild symptoms or symptoms that were perceived as atypical early in the pandemic contributed to the transmission of SARS-CoV-2 in LTCFs. This emphasizes the importance of low-threshold testing in LTCF residents.

Low-Threshold Testing for SARS-CoV-2 (COVID-19) in Long-Term Care Facilities Early in the First Pandemic Wave, the Twente Region, the Netherlands: A Possible Factor in Reducing Morbidity and Mortality

“…In a LTC facility in West Virginia, the most helpful strategies managing outbreaks, and limiting virus spread and deaths, included early testing and isolation ( Shrader et al, 2021 ). In an Austrian study, it was concluded that delayed recognition of COVID-19-positive cases due to mild or non-specific symptoms contributed to virus transmission in multiple facilities, emphasizing the importance of low-threshold testing ( Zollner-Schwetz et al, 2021 ). Low-threshold testing of HCWs in a hospital early in the pandemic enabled the identification of asymptomatic and mildly symptomatic SARS-CoV-2-positive HCWs, when easily accessible public facilities were absent, preventing further spread of the infection ( Menting et al, 2021 ).…”

SARS-CoV-2 Alpha-Variant Outbreak Amongst a Partially Vaccinated Long-Term Care Facility Population in The Netherlands—Phylogenetic Analysis and Infection Control Observations

“…SARS-CoV-2 is known to be transmitted by pre- and asymptomatic individuals, diagnosis and isolation of these cases are an essential part of outbreak control [ 7 ]. Furthermore, SARS-CoV-2 is known to present atypically in the elderly leading to potential delayed recognition and spread [ 8 ]. Noteworthy, five (63%) of the fully vaccinated cases were detected through one of these screenings.…”

Residential Environment Assessment by Older Adults in Nursing Homes during COVID-19 Outbreak

“…Although it responds to very specific objectives, it should be noted that not all the elements involved in the care of the institutionalized older adult population during the COVID-19 period have been considered. As highlighted in other publications from the pandemic period, both nursing-home workers and family members have been involved in caring for older adults, as well as in the possible transmission of infection [ 15 , 17 , 21 , 26 , 83 , 120 , 121 ]. Workers have reported COVID-19 effects related to emotional health and workload due to staff shortages, as well as concerns about severe isolation measures, death of residents, and fear of transmitting the virus to family members [ 122 ].…”