Home-Based Primary Care Led-Outbreak Mitigation in Assisted Living Facilities in the First 100 Days of Coronavirus Disease 2019

Mills, William R.; Buccola, Janet; Sender, Susan; Lichtefeld, Joseph; Romano, Nicholas C.; Reynolds, Karen; Price, Max; Phipps, Jennifer E.; White, Leigh; Howard, Shauen

doi:10.1016/j.jamda.2020.06.014

Cited by 15 publications

(20 citation statements)

References 3 publications

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“…Evidence on the spread of disease within institutional long-term care settings was available from 25 studies, 20,21,22,26,29,30,31,34,36,39,41,45,47,48,51,52,56,58,60,62,63,64,66,67,68 including 17 studies reporting the number of people who contracted COVID-19 in facilities facing potential outbreaks (Table 2) and eight studies reporting relevant figures among regional or national populations of longterm care facilities ( Table 3).…”

Section: Evidence On Disease Incidence In Institutionalised Long-termmentioning

confidence: 99%

“…CFRs for 11 studies of all people at long-term care institutions facing outbreaks (including COVID-19 positive and negative residents and staff) are summarised in Table 5, 10,22,26,29,30,36,39,41,48,51,63 while CFRs for seven studies of COVID-19 positive populations are described further down. 23,25,32,38,60,67,68 For most studies included in Table 5, the source population for the identification of people with COVID-19 were all or close to all (>90%) residents or staff at long-term care institutions where an outbreak occurred. The CFR among long-term care users for these studies ranged from 0% to 33.7%, with differences in follow-up time between one and 12 weeks.…”

Section: Evidence On Disease Incidence In Institutionalised Long-termmentioning

confidence: 99%

“…56 Not included in Table 5 are CFRs reported by seven studies for which the source population consisted exclusively of people who contracted COVID-19. 23,25,32,38,60,67,68 Due to the absence of systematic testing, these studies tended to only include symptomatic people in the denominator, resulting in higher CFRs compared to studies based on systematic testing, as described below.…”

Section: Evidence On Disease Incidence In Institutionalised Long-termmentioning

confidence: 99%

“…68 The CFR was 14.3% for seven people with confirmed COVID-19 among those receiving visiting medical care at assisted living facilities in Ohio (US). 60 Finally, Verbeek et al report that 16 of 29 people with confirmed COVID-19 at 26 nationally representative nursing homes in the Netherlands died, but did not provide a time period for these figures (CFR 55.2%). 67 Evidence on mortality rates in long-term care settings Table 6 presents mortality rates for people who contracted COVID-19 from 11 studies of outbreaks at long-term care institutions.…”

Section: Evidence On Disease Incidence In Institutionalised Long-termmentioning

confidence: 99%

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

Salcher‐Konrad

Jhass

Naci

et al. 2020

Preprint

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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.

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Section: Evidence On Disease Incidence In Institutionalised Long-termmentioning

confidence: 99%

Section: Evidence On Disease Incidence In Institutionalised Long-termmentioning

confidence: 99%

Section: Evidence On Disease Incidence In Institutionalised Long-termmentioning

confidence: 99%

Section: Evidence On Disease Incidence In Institutionalised Long-termmentioning

confidence: 99%

See 2 more Smart Citations

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

Salcher‐Konrad

Jhass

Naci

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…By nature of their design, HC avoid many of these problems, because elderly people stay in their own homes and if demand increases, providers may recruit additional specialized carers [ 16 ]. Indirect savings from homecare come from a decreased number of doctor visits and hospital admissions for people enrolled in homecare systems.…”

Section: Discussionmentioning

confidence: 99%

Assessing the Distribution of Elderly Requiring Care: A Case Study on the Residents in Barcelona and the Impact of COVID-19

Arvelo

Armas

Guillén

2020

IJERPH

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In this work, we establish a methodological framework to analyze the care demand for elderly citizens in any area with a large proportion of elderly population, and to find connections to the cumulative incidence of COVID-19. Thanks to this analysis, it is possible to detect deficiencies in the public elderly care system, identify the most disadvantaged areas in this sense, and reveal convenient information to improve the system. The methods used in each step of the framework belong to data analytics: choropleth maps, clustering analysis, principal component analysis, or linear regression. We applied this methodology to Barcelona to analyze the distribution of the demand for elderly care services. Thus, we obtained a deeper understanding of how the demand for elderly care is dispersed throughout the city. Considering the characteristics that were likely to impact the demand for homecare in the neighborhoods, we clearly identified five groups of neighborhoods with different profiles and needs. Additionally, we found that the number of cases in each neighborhood was more correlated to the number of elderly people in the neighborhood than it was to the number of beds in assisted living or day care facilities in the neighborhood, despite the negative impact of COVID-19 cases on the reputation of this kind of center.

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

Hashan¹,

Smoll²,

King³

et al. 2021

EClinicalMedicine

114

108

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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.

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Home-Based Primary Care Led-Outbreak Mitigation in Assisted Living Facilities in the First 100 Days of Coronavirus Disease 2019

Cited by 15 publications

References 3 publications

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

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

Assessing the Distribution of Elderly Requiring Care: A Case Study on the Residents in Barcelona and the Impact of COVID-19

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

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