COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study

Abstract

IntroductionFrench nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.MethodsA cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.ResultsThe average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.ConclusionDespite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents’ and caregivers’ overall well-being and mental health.

Exploratory study of risk factors related to SARS-CoV-2 prevalence in nursing homes in Flanders (Belgium) during the first wave of the COVID-19 pandemic

“…This suggests that shortages of these PPE could have played a major role in the spreading of the virus in NH during the first wave. This is in line with former research, which found that FFP2 mask shortages or delayed FFP2 mask implementation were associated with higher odds for COVID-19 cases, hospitalization and mortality in NH [28][29][30]. In Belgium, the first case of COVID-19 was reported on February 4 th , 2020, among a passenger who returned from Wuhan, China.…”

National cross-sectional survey on psychological impact on French nursing homes of the first lockdown during the COVID-19 pandemic as observed by psychologists, psychomotor, and occupational therapists

“… * Classification of the location of respondents’ practice based on the DREES map “Proportion of nursing homes affected in wave 1” ( 20 ). ** Chi-2 test.…”

“…The aim had been 2-fold: firstly, to comprehend the crisis-induced needs for refined crisis management strategies ( 17 , 18 ) and secondly, to explore the psychological impact during unprecedented circumstances, shedding light on coping mechanisms ( 18 ). This research, conducted post-lockdown, provides crucial insights into vulnerable populations’ experiences ( 19 , 20 ).…”