Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis

Abstract

Background COVID-19 outbreaks in aged care facilities (ACFs) often have devastating consequences. However, epidemiologically these outbreaks are not well defined. We aimed to define such outbreaks in ACFs by systematically reviewing literature published during the current COVID-19 pandemic. Methods We searched 11 bibliographic databases for literature published on COVID-19 in ACFs between December 2019 and September 2020. Original studies reporting extractable epidemiological data as part of outbreak investigations or non-outbreak surveillance of ACFs were included in this systematic review and meta-analysis. PROSPERO registration: CRD42020211424. Findings We identified 5,148 publications and selected 49 studies from four continents reporting data on 214,380 residents in 8,502 ACFs with 25,567 confirmed cases of COVID-19. Aged care residents form a distinct vulnerable population with single-facility attack rates of 45% [95% CI 32–58%] and case fatality rates of 23% [95% CI 18–28%]. Of the cases, 31% [95% CI 28–34%] were asymptomatic. The rate of hospitalization amongst residents was 37% [95% CI 35–39%]. Data from 21 outbreaks identified a resident as the index case in 58% of outbreaks and a staff member in 42%. Findings from the included studies were heterogeneous and of low to moderate quality in risk of bias assessment. Interpretation The clinical presentation of COVID-19 varies widely in ACFs residents, from asymptomatic to highly serious cases. Preventing the introduction of COVID-19 into ACFs is key, and both residents and staff are a priority group for COVID-19 vaccination. Rapid diagnosis, identification of primary and secondary cases and close contacts plus their isolation and quarantine are of paramount importance. Funding Queensland Advancing Clinical Research Fellowship awarded to Prof. Gulam Khandaker by Queensland Health's Health Innovation, Investment and Research Office (HIRO), Office of the Director-General.

Long-Term Care Facilities and Nursing Homes during the First Wave of the COVID-19 Pandemic: A Scoping Review of the Perspectives of Professionals, Families and Residents

“…Elderly people in nursing homes have been one of the worst affected groups in terms of numbers of infections and deaths [ 7 ]. In 2020, around half of all COVID-19 deaths occurred in nursing homes [ 8 ].…”

“…In 2020, around half of all COVID-19 deaths occurred in nursing homes [ 8 ]. During the pandemic, residents of these facilities experienced a higher risk of infection and a greater impact of the virus due to their fragility, advanced age, and comorbidity, as well as the absence of personal protective equipment, staff shortages, and a lack of rapid diagnostic tests [ 7 ]. The conditions in nursing homes and long-term care facilities affected residents, their relatives, and health and social care workers [ 9 ].…”

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People

“…There are very few high-quality studies on the involvement and the real impact of COVID-19 in nursing homes [ 26 ]. Scientific societies have elaborated multiple recommendations regarding the management of the pandemic in nursing homes [ 27 , 28 , 29 , 30 , 31 ].…”

Hospital-level work organization drives the spread of SARS-CoV-2 within hospitals: insights from a multi-ward model

“…Hospitals and Long Term Care Facilities (LTCFs) have been hit hard, with the former being on the front line to deal with the epidemic and the latter having to deal with repercussions on often vulnerable patients while not always being sufficiently prepared (4), (5), (6). Despite most countries doing their best to ramp up vaccination efforts in these healthcare institutions and among the healthcare worker (HCW) population, the spread of variants of concern which could evade vaccination is an ongoing issue (7), (8).…”