COVID ‐19 in a Sydney nursing home: a case study and lessons learnt

Abstract

Perspectives COVID-19 in a Sydney nursing home: a case study and lessons learnt Lessons learnt from COVID-19 outbreaks in residential aged care facilities could limit future impacts I nfectious disease outbreaks are a hazard of communal living in places such as military barracks, boarding schools, prisons and residential care homes. The risks are exacerbated when residents are vulnerable because of advanced age, comorbidities and frailty, or there are too few or inadequately trained staff. The home-like setting of modern residential aged care facilities (RACFs), and the overcrowding and limited staffing that are features of many, are not conducive to prevention or control of infectious diseases. 1-3 Early in the coronavirus disease 2019 (COVID-19) pandemic it was clear that age would be a risk factor. 4,5 Internationally, age-stratified case fatality rates (CFRs) have been an estimated three times higher in people aged over 60 years (4.5%) than in those aged under 60 years (1.4%). 6 In Australia, the overall CFR from COVID-19 is about 3%. 7 The majority of deaths have occurred in people over 70 years of age. At 14 September 2020, there were 1995 COVID-19 cases among residents of government-subsidised RACFs, of whom 604 (30%) died. This is in contrast to a CFR of 8.5% (7/82) among recipients of government-subsidised domiciliary aged care services. Residents of RACFs represent 74% (602/816) of all COVID-19 deaths in Australia to date. 7 Comorbidities associated with an increased risk of severe COVID-19, including diabetes, chronic kidney and cardiovascular disease, are more common among RACF residents. 8 Transmission of COVID-19 can spread silently within an RACF from someone with asymptomatic or presymptomatic infection, or atypical symptoms. 9-11 Outbreaks in RACFs, with high attack rates and CFRs, have been reported in many countries. 9,10,12-14

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

“…The studies were all observational in nature. [ [11] , [12] , [13] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] ] All of the studies reported RT-PCR-confirmed COVID-19 cases amongst the residents.

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COVID‐19 and residential aged care: priorities for optimising preparation and management of outbreaks

“…However, empirical evidence of whether learning and practice change occurs is scarce, especially in times of crisis. Lessons learned from a RACF outbreak in Sydney were that additional training by infection prevention and control professionals improved compliance with infection control and contributed to controlling the outbreak 11 . As of early August 2020, the Victorian government is offering free face‐to‐face infection control for all Victorian RACFs without outbreaks.…”

Health and medicine in a pandemic year: moving from the “winter of despair” to the “spring of hope”

“…The MJA has engaged in the debate about how to protect health care workers from infection, 10 a devastating outcome of the pandemic that was largely preventable. MJA authors have jumped into the often heated debates about schools and virus transmission, 11 the value of face masks, 12 the positive and negative effects of various public health measures, 10,13 lessons learned in an early nursing home outbreak, 14 the urgency of ensuring sufficient numbers of intensive care beds, 15 professional guidelines, 16,17 and protecting Indigenous Australians, 18 to name a few of the areas touched upon in our Journal. As, despite evidence and expert agreement, aberrant beliefs continued to circulate widely on social media, often causing alarm, the MJA has provided a source of reputable peer‐reviewed evidence, with expert syntheses of what is known and what has changed, published as rapidly as is responsible 19…”