Risk Factors Associated With Mortality Among Residents With Coronavirus Disease 2019 (COVID-19) in Long-term Care Facilities in Ontario, Canada

Fisman, David N.; Bogoch, Isaac I.; Lapointe‐Shaw, Lauren; McCready, Janine; Tuite, Ashleigh R.

doi:10.1001/jamanetworkopen.2020.15957

Cited by 241 publications

(246 citation statements)

References 6 publications

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“…In a study of COVID-19 in Canadian long-term care facilities, mortality among residents was associated with viral infection among staff with a 6-day lag period. 27 This study highlights the fact that asymptomatic staff, including clinicians and contractors who come in and out of the facility, are likely to be the source of infection that could perpetuate outbreaks in nursing homes for many months to come. In addition, federal guidance now allows states to open nursing homes to visitors.…”

Section: The Storm Will Continuementioning

confidence: 85%

COVID‐19 in Nursing Homes: Calming the Perfect Storm

Ouslander

Grabowski

2020

J American Geriatrics Society

292

269

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The pandemic of viral infection with the severe acute respiratory syndrome coronavirus-2 that causes COVID-19 disease has put the nursing home industry in crisis. The combination of a vulnerable population that manifests nonspecific and atypical presentations of COVID-19, staffing shortages due to viral infection, inadequate resources for and availability of rapid, accurate testing and personal protective equipment, and lack of effective treatments for COVID-19 among nursing home residents have created a "perfect storm" in our countryʼs nursing homes. This perfect storm will continue as society begins to reopen, resulting in more infections among nursing home staff and clinicians who acquire the virus outside of work, remain asymptomatic, and unknowingly perpetuate the spread of the virus in their workplaces. Because of the elements of the perfect storm, nursing homes are like a tinderbox, and it only takes one person to start a fire that could cause many deaths in a single facility. Several public health interventions and health policy strategies, adequate resources, and focused clinical quality improvement initiatives can help calm the storm. The saddest part of this perfect storm is that many years of inaction on the part of policy makers contributed to its impact. We now have an opportunity to improve nursing homes to protect residents and their caregivers ahead of the next storm. It is time to reimagine how we pay for and regulate nursing home care to achieve this goal.

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Section: The Storm Will Continuementioning

confidence: 85%

COVID‐19 in Nursing Homes: Calming the Perfect Storm

Ouslander

Grabowski

2020

J American Geriatrics Society

292

269

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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%

“…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%

“…Numerous facility-specific characteristics were linked with risk of COVID-19 cases (Table 2). These include size of LTCF; 16,37,38,51 staffing levels and/or use of agency care staff; 28,31,36,38,39,43,50 part of larger chain of organisations and/or for profit status; 16,31,35,42,43,50 and related staffing, crowding, or availability of single rooms. 23,29,39,41,43,[45][46][47] 25 Facility characteristics 7 staff COVID-19 positive prior to intervention 0 further staff positive after intervention implemented Heung et al (2006) 46 Hand hygiene, contact precautions PPE, personal protective equipment…”

Section: Characteristics Of Ltcfs On Covid-19 Transmissionmentioning

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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Effect of Bamlanivimab vs Placebo on Incidence of COVID-19 Among Residents and Staff of Skilled Nursing and Assisted Living Facilities

Cohen

Nirula²,

Mulligan

et al. 2021

JAMA

183

151

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IMPORTANCE Preventive interventions are needed to protect residents and staff of skilled nursing and assisted living facilities from COVID-19 during outbreaks in their facilities. Bamlanivimab, a neutralizing monoclonal antibody against SARS-CoV-2, may confer rapid protection from SARS-CoV-2 infection and COVID-19.OBJECTIVE To determine the effect of bamlanivimab on the incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, single-dose, phase 3 trial that enrolled residents and staff of 74 skilled nursing and assisted living facilities in the United States with at least 1 confirmed SARS-CoV-2 index case. A total of 1175 participants enrolled in the study from August 2 to November 20, 2020. Database lock was triggered on January 13, 2021, when all participants reached study day 57.INTERVENTIONS Participants were randomized to receive a single intravenous infusion of bamlanivimab, 4200 mg (n = 588), or placebo (n = 587). MAIN OUTCOMES AND MEASURESThe primary outcome was incidence of COVID-19, defined as the detection of SARS-CoV-2 by reverse transcriptase-polymerase chain reaction and mild or worse disease severity within 21 days of detection, within 8 weeks of randomization. Key secondary outcomes included incidence of moderate or worse COVID-19 severity and incidence of SARS-CoV-2 infection. RESULTSThe prevention population comprised a total of 966 participants (666 staff and 300 residents) who were negative at baseline for SARS-CoV-2 infection and serology (mean age, 53.0 [range, 18-104] years; 722 [74.7%] women). Bamlanivimab significantly reduced the incidence of COVID-19 in the prevention population compared with placebo (8.5% vs 15.2%; odds ratio, 0.43 [95% CI, 0.28-0.68]; P < .001; absolute risk difference, −6.6 [95% CI, −10.7 to −2.6] percentage points). Five deaths attributed to COVID-19 were reported by day 57; all occurred in the placebo group. Among 1175 participants who received study product (safety population), the rate of participants with adverse events was 20.1% in the bamlanivimab group and 18.9% in the placebo group. The most common adverse events were urinary tract infection (reported by 12 participants [2%] who received bamlanivimab and 14 [2.4%] who received placebo) and hypertension (reported by 7 participants [1.2%] who received bamlanivimab and 10 [1.7%] who received placebo).CONCLUSIONS AND RELEVANCE Among residents and staff in skilled nursing and assisted living facilities, treatment during August-November 2020 with bamlanivimab monotherapy reduced the incidence of COVID-19 infection. Further research is needed to assess preventive efficacy with current patterns of viral strains with combination monoclonal antibody therapy.

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Risk Factors Associated With Mortality Among Residents With Coronavirus Disease 2019 (COVID-19) in Long-term Care Facilities in Ontario, Canada

Cited by 241 publications

References 6 publications

COVID‐19 in Nursing Homes: Calming the Perfect Storm

COVID‐19 in Nursing Homes: Calming the Perfect Storm

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

Effect of Bamlanivimab vs Placebo on Incidence of COVID-19 Among Residents and Staff of Skilled Nursing and Assisted Living Facilities

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