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Welk B, Richard L. Does COVID-19 infection change the need for future surgical interventions? An exploratory analysis. F1000Res 2021; 10:1167. [PMID: 35136581 PMCID: PMC8787588 DOI: 10.12688/f1000research.74861.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background: It is unknown whether recovery from coronavirus disease 2019 (COVID-19) infection leads to an increased need for common surgical procedures. Our objective was to conduct an exploratory analysis of surgical procedures performed after a documented COVID-19 infection. Methods: We conducted a retrospective cohort study using routinely collected data from the province of Ontario, Canada. We identified individuals with a positive COVID-19 test between February 1 2020 and May 31 2020, and matched them 1:2 with individuals who had a negative COVID-19 test during the same period. We used physician billing codes to identify the ten most frequent surgical procedures in the COVID-19 cohort. An at-risk period 30 days after the first positive COVID-19 swab (or matched index date in the control group) until November 30 2020 was used. Cox proportional hazard models (adjusted for important baseline differences) are reported with hazard ratios (HR) and 95% confidence intervals. Results: After exclusions and matching, we had 19,143 people in the COVID-19 cohort, and 38,286 people in the control cohort. The top ten surgical procedures were hand/wrist fracture fixation, cesarean-section, ureteral stent placement, cholecystectomy, treatment of an upper tract urinary stone, hysterectomy, femur fracture repair, hip replacement, transurethral prostatectomy, and appendectomy. There was a significantly reduced hazard of requiring upper tract renal stone surgery (adjusted hazard ratio [aHR] 0.50, 95% confidence interval [CI] 0.29-0.87) or ureteral stent placement (aHR 0.54, 95%CI 0.36-0.82), or undergoing a cholecystectomy (aHR 0.43, 95%CI 0.26-0.71) among those with a prior positive COVID-19 test. Conclusions: After a COVID-19 infection there is not an increased risk of needing several common surgical procedures. There appears to be a reduced risk of renal stone disease treatment and ureteral stent placement, and a reduced risk of cholecystectomy, however understanding the reasons for this will require further study.
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Affiliation(s)
- Blayne Welk
- Surgery, Western University, London, ON, Canada
- ICES, London, Canada
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Impact of COVID-19 on Relationship-Centred Residential Dining Practices. Can J Aging 2021. [DOI: 10.1017/s0714980821000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractThis study describes changes in dining practices and provider perspectives on meal-related challenges due to the coronavirus disease (COVID-19) pandemic. An online survey was disseminated between July and September 2020 through stakeholder networks and social media with 1,036 respondents. Altered dining practices included residents eating in rooms (54.3%), spacing residents in common areas for meals (69.3%), and disposable dish use (44.9%). The most common mealtime challenges were reduced socializing opportunities at meals (29.3%), inadequate staffing (22.8%), reduced family/volunteer help (16.7%), and assisting residents to eat (10.5%). Many participants (72.2%) felt conflict balancing safety and relationship-centred care. Geographic region, home size, building age, respondent’s job title, pre-pandemic relationship-centred practices, and mealtime satisfaction, and some pandemic-initiated practices were associated with mealtime challenges and feeling conflicted in binary logistic regression analyses. Considering trade-offs between safety and relational aspects of mealtimes during the pandemic is crucial.
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Dickson GS, Taylor D, Hartney E, Tholl B, Grimes K, Chan MK, Van Aerde J, Horsley T, Melis E. The relevance of the LEADS framework during the COVID-19 pandemic. Healthc Manage Forum 2021; 34:326-331. [PMID: 34496640 PMCID: PMC8547233 DOI: 10.1177/08404704211033002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
COVID-19 has created a unique context for the practice of leadership in healthcare. Given the significant use of the LEADS in a Caring Environment capabilities framework (LEADS) in Canada's health system, it is important to document the relevancy of LEADS. The authors reviewed literature, conducted research, and reflected on their own experience to identify leadership practices during the pandemic and related them to LEADS. Findings are presented in three sections: Hindsight (before), Insight (during), and Foresight (post). We profile the issue of improving long-term Care to provide an example of how LEADS can be applied in crisis times. Our analysis suggests that while LEADS appears to specify the leadership capabilities needed, it requires adaptation to context. The vision Canada has for healthcare will dictate how LEADS will be used as a guide to leadership practice in the current context or to shape a bolder vision of healthcare's future.
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Affiliation(s)
- Graham Stewart Dickson
- Royal Roads University, Canadian Health Leadership Network, Vancouver, British Columbia, Canada
| | - Deanne Taylor
- Interior Health Authority, Kelowna, British Columbia, Canada
| | | | - Bill Tholl
- Canadian Health Leadership Network, Ottawa, Ontario, Canada
| | - Kelly Grimes
- Canadian Health Leadership Network, Ottawa, Ontario, Canada
| | - Ming-Ka Chan
- University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - John Van Aerde
- Canadian Society of Physician Leaders, Ottawa, Ontario, Canada
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | - Ellen Melis
- Unlimited Potentialities, Canadian Health Leadership Network, Mumbai, Maharashtra, India
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The impact of COVID-19 on community antibiotic use in Canada: an ecological study. Clin Microbiol Infect 2021; 28:426-432. [PMID: 34757115 PMCID: PMC8556063 DOI: 10.1016/j.cmi.2021.10.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 12/01/2022]
Abstract
Objectives The COVID-19 pandemic has had an effect on the incidence of infectious diseases and medical care. This study aimed to describe the impact of the COVID-19 pandemic on community-level antibiotic use. Methods Using national antibiotic dispensing data from IQVIA's CompuScript database, this ecological study investigated antibiotic dispensing through community retail pharmacies in Canada from November 2014 to October 2020. Analyses were stratified by age, sex, prescription origin and approximate indication. Results Adjusting for seasonality, the national rate of antibiotic dispensing in Canada decreased by 26.5% (50.4 to 37.0 average prescriptions per 1000 inhabitants) during the first 8 months of the Canadian COVID-19 period (March to October 2020), compared with the pre-COVID-19 period. Prescribing rates in children ≤18 years decreased from 43.7 to 12.2 prescriptions per 1000 inhabitants in males (–72%) and from 46.8 to 14.9 prescriptions per 1000 inhabitants in females (–68%) in April 2020. Rates in adults ≥65 decreased from 74.9 to 48.8 prescriptions per 1000 inhabitants in males (–35%) and from 91.7 to 61.3 prescriptions per 1000 inhabitants in females (–33%) in May 2020. Antibiotic prescriptions from family physicians experienced a greater decrease than from surgeons and infectious disease physicians. Prescribing rates for antibiotics for respiratory indications decreased by 56% in May 2020 (29.2 to 12.8 prescriptions per 1000 inhabitants), compared with prescribing rates for urinary tract infections (9.4 to 7.8 prescriptions per 1000 inhabitants; –17%) and skin and soft tissue infections (6.4 to 5.2 prescriptions per 1000 inhabitants; –19%). Discussion The first 8 months of the COVID-19 pandemic reduced community antibiotic dispensing by 26.5% in Canada, compared with the marginal decrease of 3% in antibiotic consumption between 2015 and 2019. Further research is needed to understand the implications and long-term effects of the observed reductions on antibiotic use on antibiotic resistance in Canada.
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Cyr A, Mondal P, Hansen G. An Inconsistent Canadian Provincial and Territorial Response During the Early COVID-19 Pandemic. Front Public Health 2021; 9:708903. [PMID: 34646800 PMCID: PMC8502853 DOI: 10.3389/fpubh.2021.708903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: According to the World Health Organization (WHO), an early and consistent international and national response is needed to control a pandemic's spread. In this analysis, we evaluate the coordination of Canada's early response to the coronavirus (COVID-19) pandemic in terms of public health interventions and policies implemented in each province and territory. Methods: Retrospective data was obtained from publicly accessible websites maintained by federal, provincial and territorial governmental agencies. Consistent with WHO's spreading of the disease pandemic action, individual and community-based public health interventions and policies were the focus. Time of intervention or policy, and COVID-19 cases per million at time of intervention was recorded for each province and territory. Results: Most public health interventions and policies demonstrated wide time ranges of implementation across individual provinces and territories. At time of implementation, there were also wide variations in the number of positive COVID-19 cases in these jurisdictions. Cases per million per implemented day were also not similar across interventions or policy, suggesting that other factors may have been preferentially considered. Conclusions: Whether an earlier and more structured national approach would have lessened the pandemic's burden is uncertain, calls for greater federal coordination and leadership should to examined.
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Affiliation(s)
- Amelie Cyr
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Prosanta Mondal
- Clinical Research Support Unit, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Gregory Hansen
- Division of Pediatric Critical Care, Jim Pattison Children's Hospital, Saskatoon, SK, Canada
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Levitt D. Transforming the hospital-style nursing home to a centre for living. Healthc Manage Forum 2021; 35:35-38. [PMID: 34643121 DOI: 10.1177/08404704211045053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
COVID-19 has put a spotlight on the senior living sector. Transformational change is needed to address the challenges of an institutional model of long-term care. This article makes recommendations applying the Systems Transformation domain of the LEADS leadership capabilities framework to change the way older persons experience the ageing journey by creating a small home model of living. A literature review reinforces the spotlight on the capital investment needed to reinvent the nursing home into a centre for living.
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Affiliation(s)
- Dan Levitt
- Simon Fraser 1763University, Burnaby, British Columbia, Canada
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Benvenuti E, Rivasi G, Bulgaresi M, Barucci R, Lorini C, Balzi D, Faraone A, Fortini G, Vaccaro G, Del Lungo I, Gangemi S, Giardini S, Piga C, Barghini E, Boni S, Bulli G, Carrai P, Crociani A, Lo Forte A, Martella L, Pupo S, Marozzi I, Bandini G, Buscemi P, Cosma C, Stacchini L, Baggiani L, Ungar A, Mossello E, Bonaccorsi G, Landini G. Caring for nursing home residents with COVID-19: a "hospital-at-nursing home" intermediate care intervention. Aging Clin Exp Res 2021; 33:2917-2924. [PMID: 34417733 PMCID: PMC8378521 DOI: 10.1007/s40520-021-01959-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/09/2021] [Indexed: 01/30/2023]
Abstract
Background Nursing home (NH) residents have been dramatically affected by COVID-19, with extremely high rates of hospitalization and mortality. Aims To describe the features and impact of an assistance model involving an intermediate care mobile medical specialist team (GIROT, Gruppo Intervento Rapido Ospedale Territorio) aimed at delivering “hospital-at-nursing home” care to NH residents with COVID-19 in Florence, Italy. Methods The GIROT activity was set-up during the first wave of the pandemic (W1, March–April 2020) and became a structured healthcare model during the second (W2, October 2020–January 2021). The activity involved (1) infection transmission control among NHs residents and staff, (2) comprehensive geriatric assessment including prognostication and geriatric syndromes management, (3) on-site diagnostic assessment and protocol-based treatment of COVID-19, (4) supply of nursing personnel to understaffed NHs. To estimate the impact of the GIROT intervention, we reported hospitalization and infection lethality rates recorded in SARS-CoV-2-positive NH residents during W1 and W2. Results The GIROT activity involved 21 NHs (1159 residents) and 43 NHs (2448 residents) during W1 and W2, respectively. The percentage of infected residents was higher in W2 than in W1 (64.5% vs. 38.8%), while both hospitalization and lethality rates significantly decreased in W2 compared to W1 (10.1% vs 58.2% and 23.4% vs 31.1%, respectively). Discussion Potentiating on-site care in the NHs paralleled a decrease of hospital admissions with no increase of lethality. Conclusions An innovative “hospital-at-nursing home” patient-centred care model based on comprehensive geriatric assessment may provide a valuable contribution in fighting COVID-19 in NH residents. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01959-z.
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Affiliation(s)
- Enrico Benvenuti
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
| | - Matteo Bulgaresi
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Riccardo Barucci
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Chiara Lorini
- Department of Health Science, University of Florence, Florence, Italy
| | - Daniela Balzi
- Epidemiology Unit, Local Health Unit "Toscana Centro", Florence, Italy
| | - Antonio Faraone
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Giacomo Fortini
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Gabriele Vaccaro
- Department of Health Science, University of Florence, Florence, Italy
| | - Ilaria Del Lungo
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Salvatore Gangemi
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Sante Giardini
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Cecilia Piga
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Eleonora Barghini
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Serena Boni
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Giulia Bulli
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Paolo Carrai
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Andrea Crociani
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Aldo Lo Forte
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Letizia Martella
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Simone Pupo
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Irene Marozzi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Giulia Bandini
- Division of Internal Medicine, Careggi Hospital, Florence, Italy
| | - Primo Buscemi
- Department of Health Science, University of Florence, Florence, Italy
| | - Claudia Cosma
- Department of Health Science, University of Florence, Florence, Italy
| | - Lorenzo Stacchini
- Department of Health Science, University of Florence, Florence, Italy
| | | | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Enrico Mossello
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | | | - Giancarlo Landini
- Department of Internal Medicine, Santa Maria Nuova Hospital, Local Health Unit "Toscana Centro", Florence, Italy
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Tong N, To S, Wyatt CCL. Impact of the COVID-19 pandemic on the University of British Columbia Geriatric Dentistry Program: Clinical education and service. Gerodontology 2021; 39:348-353. [PMID: 34580910 PMCID: PMC8652979 DOI: 10.1111/ger.12591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
Background and Objective In Canada, the COVID‐19 pandemic was associated with significant morbidity and mortality in older adults, particularly those in long‐term care (LTC). Access to oral health services was limited during the pandemic due to public health restrictions. The aim of this paper was to describe the impact of the pandemic on the clinical education and service of the University of British Columbia (UBC) Geriatric Dentistry Program (GDP), which provides care to LTC residents. Methods Data were collected from UBC GDP AxiUm dental software records, including number of dental appointments in 2019 and 2020. Data on revenue in 2019 and 2020 based on clinical production were collected through financial summary reports. Data on the number of educational rotations were collected from summary reports from scheduling software. Results In 2020, significant reductions in clinical service, revenue, and productivity were observed in the UBC GDP relative to 2019. The number of GDP appointments for June‐December 2020 was lower by 68%. The clinical productivity reduced by 67% for the same period. Expenses were slightly reduced. The overall number of LTC clinical rotations for students were only slightly lower for undergraduate students in 2020 than in 2019, and it increased for graduate students. Conclusion The COVID‐19 pandemic and associated public health restrictions had a negative impact on the clinical service and productivity of the UBC GDP in 2020 relative to 2019. However, clinical educational rotations to LTC were slightly increased in 2020 relative to 2019. Dental care for LTC residents can be provided if rigorous administrative controls, engineering controls and personal protective equipment are employed.
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Affiliation(s)
- Nicholas Tong
- Program Director- General Practice Residency Program, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Shunhau To
- University of British Columbia Geriatric Dentistry Program, Vancouver, BC, Canada
| | - Chris C L Wyatt
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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Décarie Y, Michaud PC. Counting the Dead: COVID-19 and Mortality in Quebec and British Columbia During the First Wave. CANADIAN STUDIES IN POPULATION 2021; 48:139-164. [PMID: 34548750 PMCID: PMC8446740 DOI: 10.1007/s42650-021-00053-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/09/2021] [Indexed: 01/18/2023]
Abstract
The first wave of the COVID-19 pandemic has led to excess mortality across the globe, and Canada has been no exception. Nonetheless, the pandemic experience has been very different across provinces, and the objective of this paper is to investigate these differences focusing on two extreme cases. We contrast the mortality experience of British Columbia with that of Québec to understand how large differences in mortality during the first wave of the pandemic emerged across these two provinces. We find that most of the differences can be found in excess mortality in institutions (nursing homes) and that travel restrictions, differences in how deaths are recorded, differences in the seasonality of the flu, or differences in how the pandemic spread across different economic segments of the population are unlikely explain these large differences. We document that the reported death toll from COVID-19 is about 30% larger than excess mortality in Quebec due to lower mortality from other causes of death, in particular malignant tumors, heart disease, and respiratory problems. We do not find evidence of an income gradient (measured by postal code level income) in relative excess death for the first wave.
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Affiliation(s)
- Yann Décarie
- HEC Montreal, 3000 chemin Cote-Ste-Catherine, Montreal, H3T 2A7 Canada
| | - Pierre-Carl Michaud
- HEC Montreal, 3000 chemin Cote-Ste-Catherine, Montreal, H3T 2A7 Canada
- CIRANO, Montreal, Canada
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Dykgraaf SH, Matenge S, Desborough J, Sturgiss E, Dut G, Roberts L, McMillan A, Kidd M. Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence. J Am Med Dir Assoc 2021; 22:1969-1988. [PMID: 34428466 PMCID: PMC8328566 DOI: 10.1016/j.jamda.2021.07.027] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long-term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision making. DESIGN Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long-term care. SETTING AND PARTICIPANTS Residents and staff in care settings such as nursing homes and long-term care facilities. METHODS PubMed/Medline, Cochrane Library, and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (eg, commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesized narratively using tabulated data extracts and summary tables. RESULTS Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational, with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control measures. Symptom- or temperature-based screening and single point-prevalence testing were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications, and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher-performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, intersectoral collaboration, and policy that facilitated access to critical resources were all significant enablers of success. CONCLUSIONS AND IMPLICATIONS High-quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though it continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long-term care residents from COVID-19 and other infectious diseases. This rapid review summarizes current evidence regarding strategies that may be effective.
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Affiliation(s)
- Sally Hall Dykgraaf
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia.
| | - Sethunya Matenge
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Jane Desborough
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Elizabeth Sturgiss
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Garang Dut
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Leslee Roberts
- Medical Advisory Unit, Primary Care Division, Australian Government Department of Health, Canberra ACT, Australia
| | - Alison McMillan
- Australian Government Department of Health, Canberra ACT, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra ACT, Australia
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Bej T, Kothadia S, Wilson BM, Song S, Briggs JM, Banks RE, Donskey CJ, Perez F, Jump RLP. Impact of fever thresholds in detection of COVID-19 in Department of Veterans Affairs Community Living Center residents. J Am Geriatr Soc 2021; 69:3044-3050. [PMID: 34375443 PMCID: PMC8447344 DOI: 10.1111/jgs.17415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 11/29/2022]
Abstract
Background Among nursing home residents, for whom age and frailty can blunt febrile responses to illness, the temperature used to define fever can influence the clinical recognition of COVID‐19 symptoms. To assess the potential for differences in the definition of fever to characterize nursing home residents with COVID‐19 infections as symptomatic, pre‐symptomatic, or asymptomatic, we conducted a retrospective study on a national cohort of Department of Veterans Affairs (VA) Community Living Center (CLC) residents tested for SARS‐CoV‐2. Methods Residents with positive SARS‐CoV‐2 tests were classified as asymptomatic if they did not experience any symptoms, and as symptomatic or pre‐symptomatic if the experienced a fever (>100.4°F) before or following a positive SARS‐CoV‐2 test, respectively. All‐cause 30‐day mortality was assessed as was the influence of a lower temperature threshold (>99.0°F) on classification of residents with positive SARS‐CoV‐2 tests. Results From March 2020 through November 2020, VA CLCs tested 11,908 residents for SARS‐CoV‐2 using RT‐PCR, with a positivity of rate of 13% (1557). Among residents with positive tests and using >100.4°F, 321 (21%) were symptomatic, 425 (27%) were pre‐symptomatic, and 811 (52%) were asymptomatic. All‐cause 30‐day mortality among residents with symptomatic and pre‐symptomatic COVID‐19 infections was 24% and 26%, respectively, while those with an asymptomatic infection had mortality rates similar to residents with negative SAR‐CoV‐2 tests (10% and 5%, respectively). Using >99.0°F would have increased the number of residents categorized as symptomatic at the time of testing from 321 to 773. Conclusions All‐cause 30‐day mortality was similar among VA CLC residents with symptomatic or pre‐symptomatic COVID‐19 infection, and lower than rates reported in non‐VA nursing homes. A lower temperature threshold would increase the number of residents recognized as having symptomatic infection, potentially leading to earlier detection and more rapid implementation of therapeutic interventions and infection prevention and control measures.
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Affiliation(s)
- Taissa Bej
- Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Sonya Kothadia
- Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Brigid M Wilson
- Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA.,Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sunah Song
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Janet M Briggs
- Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Richard E Banks
- Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Curtis J Donskey
- Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA.,Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Federico Perez
- Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA.,Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Robin L P Jump
- Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA.,Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Yau B, Vijh R, Prairie J, McKee G, Schwandt M. Lived experiences of frontline workers and leaders during COVID-19 outbreaks in long-term care: A qualitative study. Am J Infect Control 2021; 49:978-984. [PMID: 33762181 PMCID: PMC7981788 DOI: 10.1016/j.ajic.2021.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 12/22/2022]
Abstract
Background Long-term care facilities across Canada have been disproportionately affected by the COVID-19 pandemic. This study aims to describe the experiences of frontline workers and leaders involved in COVID-19 outbreak management in these facilities, identify best practices, and provide recommendations for improvement. Methods This is a qualitative study using key informant, semi-structured interviews. Key informants were defined as individuals with direct experience managing COVID-19 outbreaks in long-term care. Thematic content analysis of interview transcripts identified key themes important for outbreak management. Results Twenty-three interviews were conducted with key informants from the following categories: public health, health authority leadership for long-term care, infection prevention and control, long-term care operators, and frontline staff. Eight themes were identified as critical factors for outbreak management on thematic analysis, which included: (1) early identification of cases, (2) the suite of public health interventions implemented, (3) external support and assistance, (4) staff training and education, (5) personal protective equipment use and supply, (6) workplace culture, organizational leadership and management, (7) coordination and communication, and (8) staffing. Conclusions Best practices and areas for improvement in outbreak response identified in this study can help to inform policy and practice to reduce the impact of COVID-19 in these settings.
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63
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[COVID-19 in care homes: equity will be needed to avoid new catastrophes]. GACETA SANITARIA 2021; 36:3-5. [PMID: 34400008 PMCID: PMC8292036 DOI: 10.1016/j.gaceta.2021.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 11/21/2022]
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Murti M, Goetz M, Saunders A, Sunil V, Guthrie JL, Eshaghi A, Zittermann S, Teatero S, Fittipaldi N, Rilkoff H, Gubbay JB, Garber G, Callery S, Holt AM, Noseworthy AL. Enquête sur une éclosion importante de SRAS-CoV-2 dans un établissement de soins de longue durée au début de la pandémie. CMAJ 2021; 193:E1098-E1106. [PMID: 34281972 PMCID: PMC8315195 DOI: 10.1503/cmaj.202485-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michelle Murti
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont.
| | - Monika Goetz
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Andrea Saunders
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Vidya Sunil
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Jennifer L Guthrie
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - AliReza Eshaghi
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Sandra Zittermann
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Sarah Teatero
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Nahuel Fittipaldi
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Heather Rilkoff
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Jonathan B Gubbay
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Gary Garber
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Sandra Callery
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Anne Marie Holt
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - A Lynn Noseworthy
- Santé publique Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); Université de Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Bureau de santé du district d'Haliburton, Kawartha et Pine Ridge (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
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Vilches TN, Nourbakhsh S, Zhang K, Juden-Kelly L, Cipriano LE, Langley JM, Sah P, Galvani AP, Moghadas SM. Multifaceted strategies for the control of COVID-19 outbreaks in long-term care facilities in Ontario, Canada. Prev Med 2021; 148:106564. [PMID: 33878351 PMCID: PMC8053216 DOI: 10.1016/j.ypmed.2021.106564] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/31/2021] [Accepted: 04/15/2021] [Indexed: 12/19/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) has caused severe outbreaks in Canadian long-term care facilities (LTCFs). In Canada, over 80% of COVID-19 deaths during the first pandemic wave occurred in LTCFs. We sought to evaluate the effect of mitigation measures in LTCFs including frequent testing of staff, and vaccination of staff and residents. We developed an agent-based transmission model and parameterized it with disease-specific estimates, temporal sensitivity of nasopharyngeal and saliva testing, results of vaccine efficacy trials, and data from initial COVID-19 outbreaks in LTCFs in Ontario, Canada. Characteristics of staff and residents, including contact patterns, were integrated into the model with age-dependent risk of hospitalization and death. Estimates of infection and outcomes were obtained and 95% credible intervals were generated using a bias-corrected and accelerated bootstrap method. Weekly routine testing of staff with 2-day turnaround time reduced infections among residents by at least 25.9% (95% CrI: 23.3%-28.3%), compared to baseline measures of mask-wearing, symptom screening, and staff cohorting alone. A similar reduction of hospitalizations and deaths was achieved in residents. Vaccination averted 2-4 times more infections in both staff and residents as compared to routine testing, and markedly reduced hospitalizations and deaths among residents by 95.9% (95% CrI: 95.4%-96.3%) and 95.8% (95% CrI: 95.5%-96.1%), respectively, over 200 days from the start of vaccination. Vaccination could have a substantial impact on mitigating disease burden among residents, but may not eliminate the need for other measures before population-level control of COVID-19 is achieved.
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Affiliation(s)
- Thomas N Vilches
- Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Campinas, SP, Brazil.
| | - Shokoofeh Nourbakhsh
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada.
| | - Kevin Zhang
- Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada.
| | - Lyndon Juden-Kelly
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada.
| | - Lauren E Cipriano
- Ivey Business School, Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario N6G 0N1, Canada.
| | - Joanne M Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax, Nova Scotia B3K 6R8, Canada.
| | - Pratha Sah
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, USA.
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, USA.
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada.
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Verma AA, Hora T, Jung HY, Fralick M, Malecki SL, Lapointe-Shaw L, Weinerman A, Tang T, Kwan JL, Liu JJ, Rawal S, Chan TCY, Cheung AM, Rosella LC, Ghassemi M, Herridge M, Mamdani M, Razak F. Caractéristiques et issues des hospitalisations pour les cas de COVID-19 et d’influenza dans la région de Toronto. CMAJ 2021; 193:E859-E869. [PMID: 34099474 PMCID: PMC8203257 DOI: 10.1503/cmaj.202795-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 12/15/2022] Open
Abstract
CONTEXTE: Les caractéristiques des patients, les soins cliniques, l’utilisation des ressources et les issues cliniques des personnes atteintes de la maladie à coronavirus 2019 (COVID-19) hospitalisées au Canada ne sont pas bien connus. MÉTHODES: Nous avons recueilli des données sur tous les adultes hospitalisés atteints de la COVID-19 ou de l’influenza ayant obtenu leur congé d’unités médicales ou d’unités de soins intensifs médicaux et chirurgicaux entre le 1er novembre 2019 et le 30 juin 2020 dans 7 centres hospitaliers de Toronto et de Mississauga (Ontario). Nous avons comparé les issues cliniques des patients à l’aide de modèles de régression multivariée, en tenant compte des facteurs sociodémographiques et de l’intensité des comorbidités. Nous avons validé le degré d’exactitude de 7 scores de risque mis au point à l’externe pour déterminer leur capacité à prédire le risque de décès chez les patients atteints de la COVID-19. RÉSULTATS: Parmi les hospitalisations retenues, 1027 patients étaient atteints de la COVID-19 (âge médian de 65 ans, 59,1 % d’hommes) et 783 étaient atteints de l’influenza (âge médian de 68 ans, 50,8 % d’hommes). Les patients âgés de moins de 50 ans comptaient pour 21,2 % de toutes les hospitalisations dues à la COVID-19 et 24,0 % des séjours aux soins intensifs. Comparativement aux patients atteints de l’influenza, les patients atteints de la COVID-19 présentaient un taux de mortalité perhospitalière (mortalité non ajustée 19,9 % c. 6,1 %; risque relatif [RR] ajusté 3,46 %, intervalle de confiance [IC] à 95 % 2,56–4,68) et un taux d’utilisation des ressources des unités de soins intensifs (taux non ajusté 26,4 % c. 18,0 %; RR ajusté 1,50, IC à 95 % 1,25–1,80) significativement plus élevés, ainsi qu’une durée d’hospitalisation (durée médiane non ajustée 8,7 jours c. 4,8 jours; rapport des taux d’incidence ajusté 1,45; IC à 95 % 1,25–1,69) significativement plus longue. Le taux de réhospitalisation dans les 30 jours n’était pas significativement différent (taux non ajusté 9,3 % c. 9,6 %; RR ajusté 0,98 %, IC à 95 % 0,70–1,39). Trois scores de risque utilisant un pointage pour prédire la mortalité perhospitalière ont montré une bonne discrimination (aire sous la courbe [ASC] de la fonction d’efficacité du récepteur [ROC] 0,72–0,81) et une bonne calibration. INTERPRÉTATION: Durant la première vague de la pandémie, l’hospitalisation des patients atteints de la COVID-19 était associée à des taux de mortalité et d’utilisation des ressources des unités de soins intensifs et à une durée d’hospitalisation significativement plus importants que les hospitalisations des patients atteints de l’influenza. De simples scores de risque peuvent prédire avec une bonne exactitude le risque de mortalité perhospitalière des patients atteints de la COVID-19.
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Affiliation(s)
- Amol A Verma
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont.
| | - Tejasvi Hora
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Hae Young Jung
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Michael Fralick
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Sarah L Malecki
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Lauren Lapointe-Shaw
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Adina Weinerman
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Terence Tang
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Janice L Kwan
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Jessica J Liu
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Shail Rawal
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Timothy C Y Chan
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Angela M Cheung
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Laura C Rosella
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Marzyeh Ghassemi
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Margaret Herridge
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Muhammad Mamdani
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Fahad Razak
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
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Murti M, Goetz M, Saunders A, Sunil V, Guthrie JL, Eshaghi A, Zittermann S, Teatero S, Fittipaldi N, Rilkoff H, Gubbay JB, Garber G, Callery S, Holt AM, Noseworthy AL. Investigation of a severe SARS-CoV-2 outbreak in a long-term care home early in the pandemic. CMAJ 2021; 193:E681-E688. [PMID: 33972221 PMCID: PMC8158000 DOI: 10.1503/cmaj.202485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: The implementation of outbreak management measures has decreased the frequency and severity of SARS-CoV-2 outbreaks in Ontario long-term care homes. We describe the epidemiological and laboratory data from one of the first such outbreaks in Ontario to assess factors associated with its severity, and the impact of progressive interventions for infection control over the course of the outbreak. METHODS: We obtained line list and outbreak data from the public health unit to describe resident and staff cases, severity and distribution of cases over time and within the outbreak facility. Where available, we obtained data on laboratory specimens from the Public Health Ontario Laboratory and performed whole genome sequencing and phylogenetic analysis of viral specimens from the outbreak. RESULTS: Among 65 residents of the long-term care home, 61 (94%) contracted SARS-CoV-2, with a case fatality rate of 45% (28/61). Among 67 initial staff, 34 (51%) contracted the virus and none died. When the outbreak was declared, 12 staff, 2 visitors and 9 residents had symptoms. Resident cases were located in 3 of 4 areas of the home. Phylogenetic analysis showed tight clustering of cases, with only 1 additional strain of genetically distinct SARS-CoV-2 identified from a staff case in the third week of the outbreak. No cases were identified among 26 new staff brought into the home after full outbreak measures were implemented. INTERPRETATION: Rapid and undetected viral spread in a long-term care home led to high rates of infection among residents and staff. Progressive implementation of outbreak measures after the peak of cases prevented subsequent staff cases and are now part of long-term care outbreak policy in Ontario.
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Affiliation(s)
- Michelle Murti
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont.
| | - Monika Goetz
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Andrea Saunders
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Vidya Sunil
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Jennifer L Guthrie
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - AliReza Eshaghi
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Sandra Zittermann
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Sarah Teatero
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Nahuel Fittipaldi
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Heather Rilkoff
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Jonathan B Gubbay
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Gary Garber
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Sandra Callery
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - Anne Marie Holt
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
| | - A Lynn Noseworthy
- Public Health Ontario (Murti, Saunders, Guthrie, Eshaghi, Zittermann, Teatero, Fittipaldi, Rilkoff, Gubbay, Garber, Callery); University of Toronto (Murti, Fittipaldi, Gubbay, Garber), Toronto, Ont.; Haliburton, Kawartha, Pine Ridge District Health Unit (Goetz, Sunil, Holt, Noseworthy), Port Hope, Ont
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68
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Verma AA, Razak F. Lessons for hospital care from the first wave of COVID-19 in Ontario, Canada. Hosp Pract (1995) 2021; 49:229-231. [PMID: 33832401 DOI: 10.1080/21548331.2021.1915657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Amol A Verma
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Fahad Razak
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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69
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Ioannidis JPA, Axfors C, Contopoulos-Ioannidis DG. Second versus first wave of COVID-19 deaths: Shifts in age distribution and in nursing home fatalities. ENVIRONMENTAL RESEARCH 2021; 195:110856. [PMID: 33581086 PMCID: PMC7875012 DOI: 10.1016/j.envres.2021.110856] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To examine whether the age distribution of COVID-19 deaths and the share of deaths in nursing homes changed in the second versus the first pandemic wave. ELIGIBLE DATA We considered all countries that had at least 4000 COVID-19 deaths occurring as of January 14, 2021, at least 200 COVID-19 deaths occurring in each of the two epidemic wave periods; and which had sufficiently detailed information available on the age distribution of these deaths. We also considered countries with data available on COVID-19 deaths of nursing home residents for the two waves. MAIN OUTCOME MEASURES Change in the second wave versus the first wave in the proportion of COVID-19 deaths occurring in people <50 years ("young deaths") among all COVID-19 deaths and among COVID-19 deaths in people <70 years old; and change in the proportion of COVID-19 deaths in nursing home residents among all COVID-19 deaths. RESULTS Data on age distribution were available for 14 eligible countries. Individuals <50 years old had small absolute difference in their share of the total COVID-19 deaths in the two waves across 13 high-income countries (absolute differences 0.0-0.4%). Their proportion was higher in Ukraine, but it decreased markedly in the second wave. The proportion of young deaths was lower in the second versus the first wave (summary prevalence ratio 0.81, 95% CI 0.71-0.92) with large between-country heterogeneity. The proportion of young deaths among deaths <70 years did not differ significantly across the two waves (summary prevalence ratio 0.96, 95% CI 0.86-1.06). Eligible data on nursing home COVID-19 deaths were available for 11 countries. The share of COVID-19 deaths that were accounted by nursing home residents decreased in the second wave significantly and substantially in 8 countries (prevalence ratio estimates: 0.36 to 0.78), remained the same in Denmark and Norway and markedly increased in Australia. CONCLUSIONS In the examined countries, age distribution of COVID-19 deaths has been fairly similar in the second versus the first wave, but the contribution of COVID-19 deaths in nursing home residents to total fatalities has decreased in most countries in the second wave.
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Affiliation(s)
- John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, and Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA.
| | - Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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70
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Vilches TN, Nourbakhsh S, Zhang K, Juden-Kelly L, Cipriano LE, Langley JM, Sah P, Galvani AP, Moghadas SM. Multifaceted strategies for the control of COVID-19 outbreaks in long-term care facilities in Ontario, Canada. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2020.12.04.20244194. [PMID: 33330884 PMCID: PMC7743093 DOI: 10.1101/2020.12.04.20244194] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) has caused severe outbreaks in Canadian long-term care facilities (LTCFs). In Canada, over 80% of COVID-19 deaths during the first pandemic wave occurred in LTCFs. We sought to evaluate the effect of mitigation measures in LTCFs including frequent testing of staff, and vaccination of staff and residents. We developed an agent-based transmission model and parameterized it with disease-specific estimates, temporal sensitivity of nasopharyngeal and saliva testing, results of vaccine efficacy trials, and data from initial COVID-19 outbreaks in LTCFs in Ontario, Canada. Characteristics of staff and residents, including contact patterns, were integrated into the model with age-dependent risk of hospitalization and death. Estimates of infection and outcomes were obtained and 95% credible intervals were generated using a bias-corrected and accelerated bootstrap method. Weekly routine testing of staff with 2-day turnaround time reduced infections among residents by at least 25.9% (95% CrI: 23.3% - 28.3%), compared to baseline measures of mask-wearing, symptom screening, and staff cohorting alone. A similar reduction of hospitalizations and deaths was achieved in residents. Vaccination averted 2-4 times more infections in both staff and residents as compared to routine testing, and markedly reduced hospitalizations and deaths among residents by 95.9% (95% CrI: 95.4% - 96.3%) and 95.8% (95% CrI: 95.5% - 96.1%), respectively, over 200 days from the start of vaccination. Vaccination could have a substantial impact on mitigating disease burden among residents, but may not eliminate the need for other measures before population-level control of COVID-19 is achieved.
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Affiliation(s)
- Thomas N. Vilches
- Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Campinas SP, Brazil
| | - Shokoofeh Nourbakhsh
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, M3J 1P3 Canada
| | - Kevin Zhang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8 Canada
| | - Lyndon Juden-Kelly
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, M3J 1P3 Canada
| | - Lauren E. Cipriano
- Ivey Business School and Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario N6G 0N1 Canada
| | - Joanne M. Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax, Nova Scotia, B3K 6R8 Canada
| | - Pratha Sah
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| | - Seyed M. Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, M3J 1P3 Canada
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71
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Shim E. Regional Variability in COVID-19 Case Fatality Rate in Canada, February-December 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041839. [PMID: 33672804 PMCID: PMC7918493 DOI: 10.3390/ijerph18041839] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 12/13/2022]
Abstract
A total of 475,214 COVID-19 cases, including 13,659 deaths, had been recorded in Canada as of 15 December 2020. The daily reports of confirmed cases and deaths in Canada prior to 15 December 2020 were obtained from publicly available sources and used to examine regional variations in case fatality rate (CFR). Based on a factor of underestimation and the duration of time from symptom onset to death, the time-delay adjusted CFR for COVID-19 was estimated in the four most affected provinces (Quebec, Ontario, Alberta, and British Columbia) and nationwide. The model-based adjusted CFR was higher than the crude CFR throughout the pandemic, primarily owing to the incorporation in our estimation of the delay between case reports and deaths. The adjusted CFR in Canada was estimated to be 3.36% nationwide. At the provincial level, the adjusted CFR was the highest in Quebec (5.13%)—where the proportion of deaths among older individuals was also the highest among the four provinces—followed by Ontario (3.17%), British Columbia (1.97%), and Alberta (1.13%). Provincial-level variations in CFR were considerable, suggesting that public health interventions focused on densely populated areas and elderly individuals can ameliorate the mortality burden of the COVID-19 pandemic.
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Affiliation(s)
- Eunha Shim
- Department of Mathematics, Soongsil University, Seoul 06978, Korea
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72
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Wong EKC, Thorne T, Estabrooks C, Straus SE. Recommendations from long-term care reports, commissions, and inquiries in Canada. F1000Res 2021; 10:87. [PMID: 34631013 PMCID: PMC8474099 DOI: 10.12688/f1000research.43282.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 04/04/2024] Open
Abstract
Background: Multiple long-term care (LTC) reports have issued similar recommendations for improvement across Canadian LTC homes. Our primary objective was to identify the most common recommendations made over the past 10 years. Our secondary objective was to estimate the total cost of studying LTC issues repeatedly from 1998 to 2020. Methods: The qualitative and cost analyses were conducted in Canada from July to October 2020. Using a list of reports, inquiries and commissions from The Royal Society of Canada Working Group on Long-Term Care, we coded recurrent recommendations in LTC reports. We contacted the sponsoring organizations for a cost estimate, including direct and indirect costs. All costs were adjusted to 2020 Canadian dollar values. Results: Of the 80 Canadian LTC reports spanning the years of 1998 to 2020, 24 (30%) were based on a national level and 56 (70%) were focused on provinces or municipalities. Report length ranged from 4 to 1491 pages and the median number of contributors was 14 (interquartile range, IQR, 5-26) per report. The most common recommendation was to increase funding to LTC to improve staffing, direct care and capacity (67% of reports). A median of 8 (IQR 3.25-18) recommendations were made per report. The total cost for all 80 reports was estimated to be $23,626,442.78. Conclusions: Problems in Canadian LTC homes and their solutions have been known for decades. Despite this, governments and non-governmental agencies continue to produce more reports at a monetary and societal cost to Canadians.
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Affiliation(s)
- Eric K C Wong
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trina Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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73
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Wong EKC, Thorne T, Estabrooks C, Straus SE. Recommendations from long-term care reports, commissions, and inquiries in Canada. F1000Res 2021; 10:87. [PMID: 34631013 PMCID: PMC8474099 DOI: 10.12688/f1000research.43282.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 04/04/2024] Open
Abstract
Background: Multiple long-term care (LTC) reports have issued similar recommendations for improvement across Canadian LTC homes. Our primary objective was to identify the most common recommendations made over the past 10 years. Our secondary objective was to estimate the total cost of studying LTC issues repeatedly from 1998 to 2020. Methods: The qualitative and cost analyses were conducted in Canada from July to October 2020. Using a list of reports, inquiries and commissions from The Royal Society of Canada Working Group on Long-Term Care, we coded recurrent recommendations in LTC reports. We contacted the sponsoring organizations for a cost estimate, including direct and indirect costs. All costs were adjusted to 2020 Canadian dollar values. Results: Of the 80 Canadian LTC reports spanning the years of 1998 to 2020, 24 (30%) were based on a national level and 56 (70%) were focused on provinces or municipalities. Report length ranged from 4 to 1491 pages and the median number of contributors was 14 (interquartile range, IQR, 5-26) per report. The most common recommendation was to increase funding to LTC to improve staffing, direct care and capacity (67% of reports). A median of 8 (IQR 3.25-18) recommendations were made per report. The total cost for all 80 reports was estimated to be $23,626,442.78. Conclusions: Problems in Canadian LTC homes and their solutions have been known for decades. Despite this, governments and non-governmental agencies continue to produce more reports at a monetary and societal cost to Canadians.
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Affiliation(s)
- Eric K. C. Wong
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1W8, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trina Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1W8, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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74
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Wong EKC, Thorne T, Estabrooks C, Straus SE. Recommendations from long-term care reports, commissions, and inquiries in Canada. F1000Res 2021; 10:87. [PMID: 34631013 PMCID: PMC8474099 DOI: 10.12688/f1000research.43282.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Multiple long-term care (LTC) reports have issued similar recommendations for improvement across Canadian LTC homes. Our primary objective was to identify the most common recommendations made over the past 10 years. Our secondary objective was to estimate the total cost of studying LTC issues repeatedly from 1998 to 2020. Methods: The qualitative and cost analyses were conducted in Canada from July to October 2020. Using a list of reports, inquiries and commissions from The Royal Society of Canada Working Group on Long-Term Care, we coded recurrent recommendations in LTC reports. We contacted the sponsoring organizations for a cost estimate, including direct and indirect costs. All costs were adjusted to 2020 Canadian dollar values. Results: Of the 80 Canadian LTC reports spanning the years of 1998 to 2020, 24 (30%) were based on a national level and 56 (70%) were focused on provinces or municipalities. Report length ranged from 4 to 1491 pages and the median number of contributors was 14 (interquartile range, IQR, 5-26) per report. The most common recommendation was to increase funding to LTC to improve staffing, direct care and capacity (67% of reports). A median of 8 (IQR 3.25-18) recommendations were made per report. The total cost for all 80 reports was estimated to be $23,626,442.78. Conclusions: Problems in Canadian LTC homes and their solutions have been known for decades. Despite this, governments and non-governmental agencies continue to produce more reports at a monetary and societal cost to Canadians.
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Affiliation(s)
- Eric K. C. Wong
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1W8, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trina Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1W8, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Verma AA, Hora T, Jung HY, Fralick M, Malecki SL, Lapointe-Shaw L, Weinerman A, Tang T, Kwan JL, Liu JJ, Rawal S, Chan TCY, Cheung AM, Rosella LC, Ghassemi M, Herridge M, Mamdani M, Razak F. Characteristics and outcomes of hospital admissions for COVID-19 and influenza in the Toronto area. CMAJ 2021; 193:E410-E418. [PMID: 33568436 PMCID: PMC8096386 DOI: 10.1503/cmaj.202795] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND: Patient characteristics, clinical care, resource use and outcomes associated with admission to hospital for coronavirus disease 2019 (COVID-19) in Canada are not well described. METHODS: We described all adults with COVID-19 or influenza discharged from inpatient medical services and medical–surgical intensive care units (ICUs) between Nov. 1, 2019, and June 30, 2020, at 7 hospitals in Toronto and Mississauga, Ontario. We compared patient outcomes using multivariable regression models, controlling for patient sociodemographic factors and comorbidity level. We validated the accuracy of 7 externally developed risk scores to predict mortality among patients with COVID-19. RESULTS: There were 1027 hospital admissions with COVID-19 (median age 65 yr, 59.1% male) and 783 with influenza (median age 68 yr, 50.8% male). Patients younger than 50 years accounted for 21.2% of all admissions for COVID-19 and 24.0% of ICU admissions. Compared with influenza, patients with COVID-19 had significantly greater in-hospital mortality (unadjusted 19.9% v. 6.1%, adjusted relative risk [RR] 3.46, 95% confidence interval [CI] 2.56–4.68), ICU use (unadjusted 26.4% v. 18.0%, adjusted RR 1.50, 95% CI 1.25–1.80) and hospital length of stay (unadjusted median 8.7 d v. 4.8 d, adjusted rate ratio 1.45, 95% CI 1.25–1.69). Thirty-day readmission was not significantly different (unadjusted 9.3% v. 9.6%, adjusted RR 0.98, 95% CI 0.70–1.39). Three points-based risk scores for predicting in-hospital mortality showed good discrimination (area under the receiver operating characteristic curve [AUC] ranging from 0.72 to 0.81) and calibration. INTERPRETATION: During the first wave of the pandemic, admission to hospital for COVID-19 was associated with significantly greater mortality, ICU use and hospital length of stay than influenza. Simple risk scores can predict in-hospital mortality in patients with COVID-19 with good accuracy.
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Affiliation(s)
- Amol A Verma
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont.
| | - Tejasvi Hora
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Hae Young Jung
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Michael Fralick
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Sarah L Malecki
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Lauren Lapointe-Shaw
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Adina Weinerman
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Terence Tang
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Janice L Kwan
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Jessica J Liu
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Shail Rawal
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Timothy C Y Chan
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Angela M Cheung
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Laura C Rosella
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Marzyeh Ghassemi
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Margaret Herridge
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Fahad Razak
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
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Jones A, Watts AG, Khan SU, Forsyth J, Brown KA, Costa AP, Bogoch II, Stall NM. Impact of a Public Policy Restricting Staff Mobility Between Nursing Homes in Ontario, Canada During the COVID-19 Pandemic. J Am Med Dir Assoc 2021; 22:494-497. [PMID: 33516671 DOI: 10.1016/j.jamda.2021.01.068] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess changes in the mobility of staff between nursing homes in Ontario, Canada, before and after enactment of public policy restricting staff from working at multiple homes. DESIGN Pre-post observational study. SETTING AND PARTICIPANTS 623 nursing homes in Ontario, Canada, between March 2020 and June 2020. METHODS We used GPS location data from mobile devices to approximate connectivity between all 623 nursing homes in Ontario during the 7 weeks before (March 1-April 21) and after (April 22-June 13) the policy restricting staff movement was implemented. We constructed a network diagram visualizing connectivity between nursing homes in Ontario and calculated the number of homes that had a connection with another nursing home and the average number of connections per home in each period. We calculated the relative difference in these mobility metrics between the 2 time periods and compared within-home changes using McNemar test and the Wilcoxon rank-sum test. RESULTS In the period preceding restrictions, 266 (42.7%) nursing homes had a connection with at least 1 other home, compared with 79 (12.7%) homes during the period after restrictions, a drop of 70.3% (P < .001). Including all homes, the average number of connections in the before period was 3.90 compared to 0.77 in the after period, a drop of 80.3% (P < .001). In both periods, mobility between nursing homes was higher in homes located in larger communities, those with higher bed counts, and those part of a large chain. CONCLUSIONS AND IMPLICATIONS Mobility between nursing homes in Ontario fell sharply after an emergency order by the Ontario government limiting long-term care staff to a single home, though some mobility persisted. Reducing this residual mobility should be a focus of efforts to reduce risk within the long-term care sector during the COVID-19 pandemic.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | | | | | | | - Kevin A Brown
- Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, Canada
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Divisions of General Internal Medicine and Infectious Diseases, University Health Network, Toronto, Canada
| | - Nathan M Stall
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Divisions of General Internal Medicine and Geriatrics, Sinai Health System and the University Health Network, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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