Why are some outbreaks worse than others? COVID-19 outbreak management strategies from a PHU perspective

Abstract

Background: From a Public Health Unit (PHU) perspective, this review aimed to examine factors associated with adverse outbreak outcomes, to identify evidence based focal strategies of managing COVID-19 outbreaks in aged care settings. Methods: A retrospective review of PHU documentation identified 55 COVID-19 outbreaks in aged care facilities in Wide Bay during 2022. Results: Thematic analysis using the framework approach identified several themes and subthemes associated with COVID-19 outbreaks in aged care. These were analysed for statistical significance against outbreak outcomes including duration, attack rate and case fatality rate. There was a significant relationship between memory support unit (MSU) involvement and adverse outbreak outcomes. Attack rate was significantly affected by communication efficiency, case detection and staff cohorting. Staff shortages were also significantly associated with adverse outcomes regarding attack rate and duration. Conclusions: This emphasises the importance of frequent communication between PHUs and RACFs during an active outbreak, as well as the need for prompt case detection, to minimise viral transmission, staff shortages and cohorting are also crucial factors to be addressed during outbreak management. Implications for Public Health: This review adds to the evidence basis of COVID-19 outbreak management strategies to improve PHU advice to RACFs during future periods of viral transmission, to ultimately reduce the associated burden of disease.

Predictors of SARS-CoV-2 transmission in congregate living settings: a multicenter prospective study

“…These types of units are recognized to be associated with higher secondary attack rates and longer outbreak duration due to increased number of exposures resulting from the inherent challenges implementing control measures. 27 One way to reconcile this finding is that although memory care units generate increased resident contacts due to the wandering behaviors of the residents, the risk of discrete exposure events is not necessarily higher after adjusting for other factors.…”