COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence

Abstract

Background: Policy responses to mitigate the impact of the COVID-19 pandemic on long-term care (LTC) require robust and timely evidence on mortality and spread of the disease in these settings. The aim of this living systematic review is to synthesise early international evidence on mortality rates and incidence of COVID-19 among people who use and provide LTC. Methods: We report findings of a living systematic review (CRD42020183557), including studies identified through database searches up to 5 June 2020. We searched seven databases (MEDLINE; Embase; CINAHL Plus; Web of Science; Global Health; WHO COVID-19 Research Database; medRxiv) to identify all studies reporting primary data on COVID-19 related mortality and incidence of disease among LTC users and staff. We excluded studies not focusing on LTC. Included primary studies were critically appraised and results on number of deaths and COVID-19 related mortality rates, case fatality rates, and excess deaths (co-primary outcomes), as well as incidence of disease, hospitalisations, and ICU admissions were synthesised narratively. We further included official figures on number of deaths in LTC. Findings: A total of 33 study reports for 30 unique primary studies or outbreak reports were included. Outbreak investigations in LTC facilities found COVID-19 incidence rates of between 0.0% and 71.7% among residents and between 1.5% and 64.0% among staff. Mortality rates varied from 0.0% to 9.5% of all residents at outbreak facilities, with case fatality rates between 0.0% and 33.7%. In included studies, no LTC staff members had died. LTC residents accounted for between 0% (Hong Kong) and 85% (Canada) of COVID-related deaths, according to official figures. Interpretation: Long-term care users have been particularly vulnerable to the COVID-19 pandemic. However, we found wide variation in spread of disease and mortality rates between outbreaks at individual LTC facilities. Further research into the factors determining successful prevention and containment of COVID-19 outbreaks is needed to protect long-term care users and staff.

Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK

“…In Scottish care homes, a larger proportion of COVID-19 deaths are reported to have occurred than in English care homes (47% vs 28%), 13 , 20 although these proportions are both within the range reported internationally (from 24% in Hungary to 82% in Canada). 1 This difference could reflect differing hospital admission practices in England and Scotland since approximately 12% of COVID-19-related deaths of care home residents in England are in hospital 21 versus only 4% in our study. A London point-prevalence study of four care homes with about 400 residents found 26% mortality, higher than that noted in our study, which probably reflects selection of care homes with large outbreaks.…”

Risk factors for outbreaks of COVID-19 in care homes following hospital discharge: a national cohort analysis

“…Expert commentary on existing data has identified care and non-care staff, visitors and resident discharges from hospital as possible vectors for the introduction of COVID-19 into care homes, particularly where testing is not available, 14 and the discharge back to their care home of untested SARS-CoV-2 positive individuals has been suggested as a risk factor for outbreaks in these settings 15,16 . Studies reporting evidence from testing all staff and residents in specific care homes has suggested high proportions of asymptomatic cases, particularly amongst older residents, than were initially assumed 7,14,17 . This suggests the risk of importing COVID-19 into care homes via hospital discharge of untested asymptomatic residents has been underestimated.…”

Impact of the initial response to COVID‐19 on long‐term care for people with intellectual disability: an interrupted time series analysis of incident reports

“…In response to the spread of SARS-CoV-2, governments, public health agencies and care organisations across the world have taken drastic measures to curb the ensuing COVID-19 pandemic. On top of community interventions for the general public, long-term care facilities for people with disabilities and elderly people limited visits, activities and supportive services (Salcher-Konrad et al 2020). These measures were taken to limit the risk of people acquiring infection in aggregate care settings from other clients, visitors or care staff (nosocomial transmission) and followed on early reports of actual outbreaks in nursing homes (e.g.…”