Nursing home staff networks and COVID-19

Abstract

Nursing homes and other long-term care facilities account for a disproportionate share of COVID-19 cases and fatalities worldwide. Outbreaks in US nursing homes have persisted despite nationwide visitor restrictions beginning in mid-March. An early report issued by the Centers for Disease Control and Prevention identified staff members working in multiple nursing homes as a likely source of spread from the Life Care Center in Kirkland, WA, to other skilled nursing facilities. The full extent of staff connections between nursing homes—and the role these connections serve in spreading a highly contagious respiratory infection—is currently unknown given the lack of centralized data on cross-facility employment. We perform a large-scale analysis of nursing home connections via shared staff and contractors using device-level geolocation data from 50 million smartphones, and find that 5.1% of smartphone users who visited a nursing home for at least 1 h also visited another facility during our 11-wk study period—even after visitor restrictions were imposed. We construct network measures of connectedness and estimate that nursing homes, on average, share connections with 7.1 other facilities. Traditional federal regulatory metrics of nursing home quality are unimportant in predicting outbreaks, consistent with recent research. Controlling for demographic and other factors, a home’s staff network connections and its centrality within the greater network strongly predict COVID-19 cases.

High coverage COVID-19 mRNA vaccination rapidly controls SARS-CoV-2 transmission in Long-Term Care Facilities

“…In this study we show that high vaccination coverage (over 70%) prevented around 3 out of 4 expected COVID-19 deaths in subsequent weeks, which is consistent with the vaccine effect estimated in clinical trials [2] and observational studies [4,8]. Furthermore, LTCFs represent enclosed populations, where transmission is caused both by external introduction of the virus, mostly by the staff [10], and internal transmission. Observational findings from facilities with high infection-ascertainment, such as those studied here, may provide valuable information of what may be expected to happen in more general settings and populations.…”

The BNT162b2 vaccine is associated with lower new COVID‐19 cases in nursing home residents and staff

“…Thus, facilities may have benefitted from staff being vaccinated earlier in a different facility, so that staff in facilities in cohorts 2 and 3 may have been vaccinated before their facility's initial vaccine clinic. 36 However, because individual-level staff vaccination information was not available, we were not able to further disentangle this relationship.…”

“Somebody Like Me”: Understanding COVID-19 Vaccine Hesitancy among Staff in Skilled Nursing Facilities

“…13 The key point is that SNF workers provide care to society's most vulnerable citizens for low wages, under hazardous conditions, and at the same time, are among the most vulnerable groups at risk of contracting COVID-19 through their work and residence in at-risk communities. 14,15 In December 2020, 2 candidate vaccines were approved by the FDA for Emergency Use Authorization in the United States. 16 Because of the tremendous disease burden and risk of COVID-19 in long-term care, initial recommendations by the CDC for vaccine distribution specified SNF residents and staff in the first priority group to receive the vaccine in a phased allocation process.…”