Mass Screening for SARS-CoV-2 Infection among Residents and Staff in Twenty-eight Long-term Care Facilities in Fulton County, Georgia

Telford, Carson; Onwubiko, Udodirim; Holland, David; Turner, Kim; Prieto, Juliana; Smith, Sasha; Yoon, Jane; Brown, W. L.; Chamberlain, Allison T.; Gandhi, Neel R.; Khan, Shamimul; Williams, Steve; Khan, Fazle; Shah, Sarita

doi:10.1101/2020.07.01.20144162

Cited by 5 publications

(20 citation statements)

References 5 publications

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“…Geographically we report evidence from eleven countries, the majority (20 studies) are from USA [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and UK. [36][37][38][39][40] We report evidence from Canada, [41][42][43] France, 44,45 Hong Kong, 46,47 Belgium, 48 Germany, 49 Ireland, 50 Japan, 51 Korea, 52 and Spain 53 (Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Twenty studies report the nature of LTCFs related with outbreaks and transmission of COVID-19 infection (Table 2; 16,23,28,29,31,33,[35][36][37][38][39][41][42][43][45][46][47][50][51][52] ). Thirty studies (Table 3a; [17][18][19][20][21][22][23][24][25][26][27][28][29][32][33][34][37][38][39][40][41][42][43][45][46][47][48][49][50]53 ) report evidence of measures to ...…”

Section: Infection Control Measuresmentioning

confidence: 99%

“…A variety of infection control measures are described (Tables 1 and 3a-c) including: mass testing/point-prevalence testing (22 studies; 17,[19][20][21][22][25][26][27][28][29][30][32][33][34]38,39,44,45,[48][49][50]53 ), use of personal protective equipment (10 studies; 17,18,20,25,28,29,32,45,47,49 ), screening of residents, staff, or visitors for symptoms (8 studies; [18][19][20]23,25,27,29,32 ), restrictions on visitor entry (10 studies; [18][19][20]25,27,29,32,45,49,…”

Section: Infection Control Measuresmentioning

confidence: 99%

“…Morbidity and mortality results from included studies are presented for residents (Table 3a), staff (Table 3b), and visitors (Table 3c). Prevalence of COVID-19 infection was reported in 29 studies, including prevalence in residents (27 studies; [17][18][19][20][21][22][23][24][25][26][27][28][29][32][33][34]38,39,41,43,[45][46][47][48][49][50]53 ) and staff (22 studies; 17,[19][20][21][22]24,[26][27][28][29][30]32,34,38,39,[44][45][46][47][48]…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

“…positive staff, the proportion of symptomatic cases ranged from 6.4% 26 to 100%, 32 and asymptomatic cases ranged from 23.6% 50 to 100%. 20,22 Mortality results were reported in 22 studies, including information on mortality of residents (22 studies; [17][18][19][22][23][24][27][28][29]33,34,[37][38][39][40][41][42][43]45,47,49,50 ), staff (4 studies; 28,34,45,47 ), and visitors (2 studies; 28,47 ). Mortality rates in COVID-19 positive residents ranged from 5.3% 19 to 55.3%.…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

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A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

Frazer

Mitchell

Stokes

et al. 2020

Preprint

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The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in long term care facilities to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff, and visitors. Databases (including MedRXiv pre-published repository) were systematically searched to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff, or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities, and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2-85.4% in residents and 0.6-62.6% in staff. Mortality rates ranged from 5.3-55.3% in residents. Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in long term care facilities.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Infection Control Measuresmentioning

confidence: 99%

Section: Infection Control Measuresmentioning

confidence: 99%

Section: Morbidity and Mortalitymentioning

confidence: 99%

Section: Morbidity and Mortalitymentioning

confidence: 99%

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A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

Frazer

Mitchell

Stokes

et al. 2020

Preprint

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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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Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence

Dykgraaf

Matenge

Desborough

et al. 2021

Journal of the American Medical Directors Association

116

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Objectives The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision-making. Design Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long term care. Setting and Participants Residents and staff in care settings such as nursing homes and long term care facilities. Methods PubMed/Medline, Cochrane Library and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (for example commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesised narratively using tabulated data extracts and summary tables. Results Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control (IPC) measures. Symptom or temperature based screening, and single point-prevalence testing, were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, inter-sectoral collaboration and policy that facilitated access to critical resources were all significant enablers of success. Conclusions and Implications High quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long term care residents from COVID-19 and other infectious diseases. This rapid review summarises current evidence regarding strategies which may be effective.

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Mass Screening for SARS-CoV-2 Infection among Residents and Staff in Twenty-eight Long-term Care Facilities in Fulton County, Georgia

Cited by 5 publications

References 5 publications

A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

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

Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence

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