COVID-19 burden and influencing factors in Swiss long-term-care facilities: a cross-sectional analysis of a multicentre observational cohort

Abstract

OBJECTIVES: To describe the burden of COVID-19 in Swiss long-term care facilities in 2020, to identify its influencing factors, and to assess vaccination rates among residents and healthcare workers at the end of the vaccine campaign in Switzerland in May 2021.
 DESIGN: Cross-sectional survey.
 SETTING AND PARTICIPANTS: Long-term care facilities from two Swiss cantons (St. Gallen / Eastern Switzerland and Vaud / Western Switzerland).
 METHODS: We collected numbers of COVID-19 cases and related deaths and all-cause mortality for 2020, potential risk factors at the institutional level (e.g. size, infection prevention and control measures, and resident characteristics), and vaccination rates among residents and healthcare workers. Univariate and multivariate analyses were used to identify factors associated with resident mortality in 2020.
 RESULTS: We enrolled 59 long-term care facilities with a median of 46 (interquartile range [IQR]: 33–69) occupied beds. In 2020, the median COVID-19 incidence was 40.2 (IQR: 0–108.6) per 100 occupied beds, with higher rates in VD (49.9%) than in SG (32.5%; p = 0.037). Overall, 22.7% of COVID-19 cases died, of which 24.8% were COVID-19-related deaths. In the univariate analysis, higher resident mortality was associated with COVID-19 rates among residents (p < 0.001) and healthcare workers (p = 0.002) and age (p = 0.013). Lower resident mortality was associated with the proportion of single rooms (p = 0.012), isolation of residents with COVID-19 in single rooms (p = 0.003), symptom screening of healthcare workers (p = 0.031), limiting the number of visits per day (p = 0.004), and pre-scheduling visits (p = 0.037). In the multivariate analysis, higher resident mortality was only associated with age (p = 0.03) and the COVID-19 rate among residents (p = 0.013). Among 2936 residents, 2042 (69.9%) received ≥1 dose of the COVID-19 vaccine before 31 May 2021. Vaccine uptake among healthcare workers was 33.8%.
 CONCLUSION AND IMPLICATIONS: COVID-19 burden was high but also highly variable in Swiss long-term care facilities. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers was a modifiable factor associated with increased resident mortality. Symptom screening of healthcare workers appeared to be an effective preventive strategy and should be included in routine infection prevention and control measures. Promoting COVID-19 vaccine uptake among healthcare workers should be a priority in Swiss long-term care facilities.

Drivers of COVID-19 Outcomes in Long-Term Care Facilities Using Multi-Level Analysis: A Systematic Review

“…Similarly, for mortality rates it remains uncertain whether deaths among residents with positive COVID-19 status died because of, or with, COVID-19. This was evident in a study where 22.7% of COVID-19 cases resulted in death, of which only 24.8% were classified as COVID-19-related deaths [66].…”

“…The organizational factors that consistently emerged and were supported by a substantial body of evidence with relation to mortality include LTCF's racial and ethnic composition [2,63,67,70,75,81,83,85,89,95,96,103,109,110], for-profit and/or private ownership [2,24,30,56,63,83,87,98,102,104,113], nursing staffing levels [2,48,56,75,80,81,92,94,98,110], star rating and subdomains (inverse association) [63,74,81,87,88,98,111,113], infected staff [27,56,66,89,113], chain membership…”

“…Several factors frequently linked to mortality include male sex [20,24,29,32,46,51,52,54,55,[58][59][60]62,68,98,101,103], age [24,29,32,33,46,51,53,55,[58][59][60]66,68,75,98,[101][102][103]115], dependency and level of care needed, [2,20,32,44,46,54,56,63,101,103,110,113,116], cognitive deterioration [20,29,…”

“…The environmental factors frequently associated with mortality include occupancy, levels of crowding [2,25,56,64,83,94,98,104], the larger size of the facility or the number of beds in the LTCF [2,32,33,62,63,65], the location of the LTCF [2,21,24,62,87], higher community or county incidences [60,77,80,104,113], and structural design of the rooms or number of beds in a room [21,25,66,113].…”