Outbreaks of COVID-19 in Nursing Homes: A Cross-Sectional Survey of 74 Nursing Homes in a French Area

Piet, Emilie; Maillard, Alexis; Mallaval, F.; Dusseau, Jean Yves; Galas-Haddad, Murielle; Ducki, Sébastien; Creton, Hélène; Lallemant, Marc; Forestier, E.; Gavazzi, G.; Delory, Tristan

doi:10.3390/jcm10184280

Cited by 10 publications

(6 citation statements)

References 29 publications

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“…This is in line with limited introduction, but suggests that transmission occurred and remained possible in these closed environments irrespective of the general epidemic (R was slightly above 1) [21]. R was however much lower than initially reported, providing evidence that contact tracing and screening among staff members [22] and design of facilities helped limit the spread of infection [21]. The heterogeneity in transmission indicates that superspreading was possible, even though less than generally reported for COVID-19 [23].…”

Section: Discussionsupporting

confidence: 57%

SARS-CoV-2 in Nursing Homes: Analysis of Routine Surveillance Data in Four European Countries

Delory¹,

Arino²,

Haÿ³

et al. 2022

Aging and disease

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Transmission of SARS-CoV-2 in nursing homes is poorly documented. Using surveillance data of 228 European private nursing homes, we estimated weekly SARS-CoV-2 incidences among 21,467 residents and 14,371 staff members, compared to that in the general population, between August 3, 2020, and February 20, 2021. We studied the outcomes of "episodes of introduction" where one case was first detected and computed attack rates, reproduction ratio (R), and dispersion parameter (k). Out of 502 episodes of SARS-CoV-2 introduction, 77.1% (95%CI, 73.2%-80.6%) led to additional cases. Attack rates were highly variable, ranging from 0.4% to 86.5%. The R was 1.16 (95%CI, 1.11-1.22) with k at 2.5 (95%CI, 0.5-4.5). The timing of viral circulation in nursing homes did not mirror that in the general population (p-values<0.001). We estimated the impact of vaccination in preventing SARS-CoV-2 transmission. Before vaccination's roll-out, a cumulated 5,579 SARS-CoV-2 infections were documented among residents and 2,321 among staff. Higher staffing ratio and previous natural immunization reduced the probability of an outbreak following introduction. Despite strong preventive measures, transmission likely occurred, regardless of building characteristics. Vaccination started on January 15, 2021, and coverage reached 65.0% among residents, and 42.0% among staff by February 20, 2021. Vaccination yielded a 92% reduction (95%CI, 71%-98%) of outbreak probability, and lowered R to 0.87 (95%CI, 0.69-1.10). In the post-pandemic era, much attention will have to be paid to multi-lateral collaboration, policy making, and prevention plans.

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Section: Discussionsupporting

confidence: 57%

SARS-CoV-2 in Nursing Homes: Analysis of Routine Surveillance Data in Four European Countries

Delory¹,

Arino²,

Haÿ³

et al. 2022

Aging and disease

Self Cite

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“…22,25,51e55 The relationship between staffing levels and likelihood of SARS-CoV-2 outbreaks is less certain, with both lower and higher staff numbers associated with likelihood of SARS-CoV-2 outbreaks in early reports. 16,23,57,58,66 However, there are issues apart from absolute staffing numbers that may influence this relationship. In a nationwide study in England, the likelihood of SARS-CoV-2 outbreak was significantly lower per unit increase in the staff-to-bed ratio and significantly lower in facilities that paid staff statutory sick pay.…”

Section: Risk Factors For Sars-cov-2 Infection In Nursing Homesmentioning

confidence: 99%

Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update

Dyer

Fallon

Noonan

et al. 2022

Journal of the American Medical Directors Association

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“…The European Medicines Agency authorized the use of the mRNA vaccines according to their vaccine efficacy information [ 11 ]. Since the staff and visitors are the primary transmission sources [ 12 , 13 ], outbreaks continue to emerge in LFTC even when most of the residents (97.3%) and staff are fully vaccinated [ 14 , 15 , 16 , 17 ]. For all these reasons, the last guidelines enforce the need to maintain and maximize all preventive and control measures in LTFC to reduce the risk of infection after starting the vaccination process and the danger that may arise from the false sense of security after the administration of the first dose.…”

Section: Introductionmentioning

confidence: 99%

“…For all these reasons, the last guidelines enforce the need to maintain and maximize all preventive and control measures in LTFC to reduce the risk of infection after starting the vaccination process and the danger that may arise from the false sense of security after the administration of the first dose. For instance, to interrupt transmission and prevent dissemination, the European Geriatric Medicine Society and CDC recommend weekly screening programs until they reached a 70% vaccination rate [ 18 ] and 3–7 days of testing when a case of COVID-19 is detected [ 7 , 12 ]. Accordingly, new preventive strategies focus on the long-term effects of vaccination in LTFC residents and other subgroups at higher risk of COVID-19 [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of a COVID-19 Outbreak in an Elderly Care Home after Primary Vaccination

Mauriz,

Fernández-Vázquez,

Díez-Flecha

et al. 2023

Vaccines

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Elderly care home residents are particularly vulnerable to COVID-19 due to immune-senescence, pre-existing medical conditions, and the risk of transmission from staff and visitors. This study aimed to describe the outcomes of a COVID-19 outbreak in a long-term care facility for elderly persons following the initial vaccination. A single-center, retrospective, observational design was used to analyze the variables associated with hospitalization and death rate by logistic regression. Adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were calculated. Sixty-eight residents received the first dose of the COVID-19 vaccine. Despite being negative six days after vaccination, the performance of a second test 4 days later revealed 51 positives (75.0%) among residents and 18 among workers (56.3%). A total of 65 of the 68 residents (95.58%) had positive results with symptoms, whereas 34.9% required hospitalization, and 25.8% died. The best-fitting model to explain the distribution of cases reflects three points at the time of infection.. The time from vaccination to symptom onset explains the hospitalization and mortality rates since a day elapsed halves the risk of hospitalization (aOR = 0.57; CI = 0.38−0.75) and the risk of death by a quarter (aOR = 0.74; CI = 0.63−0.88). Nursing homes present an elevated risk of transmission and severity of SARS-CoV-2 infection. Although vaccination reduces the risk of hospitalization and death, extreme prevention and control measures are essential in these institutions despite the high vaccination coverage.

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Outbreaks of COVID-19 in Nursing Homes: A Cross-Sectional Survey of 74 Nursing Homes in a French Area

Cited by 10 publications

References 29 publications

SARS-CoV-2 in Nursing Homes: Analysis of Routine Surveillance Data in Four European Countries

SARS-CoV-2 in Nursing Homes: Analysis of Routine Surveillance Data in Four European Countries

Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update

Impact of a COVID-19 Outbreak in an Elderly Care Home after Primary Vaccination

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