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Burton JK, McMinn M, Vaughan JE, Fleuriot J, Guthrie B. Care-home outbreaks of COVID-19 in Scotland March to May 2020: National linked data cohort analysis. Age Ageing 2021; 50:1482-1492. [PMID: 33963849 PMCID: PMC8136021 DOI: 10.1093/ageing/afab099] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND understanding care-home outbreaks of COVID-19 is a key public health priority in the ongoing pandemic to help protect vulnerable residents. OBJECTIVE to describe all outbreaks of COVID-19 infection in Scottish care-homes for older people between 01/03/2020 and 31/03/2020, with follow-up to 30/06/2020. DESIGN AND SETTING National linked data cohort analysis of Scottish care-homes for older people. METHODS data linkage was used to identify outbreaks of COVID-19 in care-homes. Care-home characteristics associated with the presence of an outbreak were examined using logistic regression. Size of outbreaks was modelled using negative binomial regression. RESULTS 334 (41%) Scottish care-homes for older people experienced an outbreak, with heterogeneity in outbreak size (1-63 cases; median = 6) and duration (1-94 days, median = 31.5 days). Four distinct patterns of outbreak were identified: 'typical' (38% of outbreaks, mean 11.2 cases and 48 days duration), severe (11%, mean 29.7 cases and 60 days), contained (37%, mean 3.5 cases and 13 days) and late-onset (14%, mean 5.4 cases and 17 days). Risk of a COVID-19 outbreak increased with increasing care-home size (for ≥90 beds vs <20, adjusted OR = 55.4, 95% CI 15.0-251.7) and rising community prevalence (OR = 1.2 [1.0-1.4] per 100 cases/100,000 population increase). No routinely available care-home characteristic was associated with outbreak size. CONCLUSIONS reducing community prevalence of COVID-19 infection is essential to protect those living in care-homes. More systematic national data collection to understand care-home residents and the homes in which they live is a priority in ensuring we can respond more effectively in future.
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Affiliation(s)
- Jennifer Kirsty Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G31 2ER, UK
| | - Megan McMinn
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - James E Vaughan
- School of Informatics, University of Edinburgh, Edinburgh EH8 9AB, UK
| | - Jacques Fleuriot
- School of Informatics, University of Edinburgh, Edinburgh EH8 9AB, UK
| | - Bruce Guthrie
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
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102
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Jamrozik E, Heriot GS. Pandemic public health policy: with great power comes great responsibility. Intern Med J 2021; 50:1169-1173. [PMID: 33111413 DOI: 10.1111/imj.15038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Euzebiusz Jamrozik
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Monash Bioethics Centre, Monash University, Melbourne, Victoria, Australia.,Nuffield Department of Population Health, Wellcome Centre for Ethics and the Humanities and The Ethox Centre, University of Oxford, Oxford, UK
| | - George S Heriot
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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103
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Proceedings from an International Virtual Townhall: Reflecting on the COVID-19 Pandemic: Themes from Long-Term Care. J Am Med Dir Assoc 2021; 22:1128-1132. [PMID: 33932351 PMCID: PMC8030741 DOI: 10.1016/j.jamda.2021.03.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
Residents of long-term care (LTC) homes have suffered disproportionately during the COVID-19 pandemic, from the virus itself and often from the imposition of lockdown measures. Provincial Geriatrics Leadership Ontario, in collaboration with interRAI and the International Federation on Aging, hosted a virtual Town Hall on September 25, 2020. The purpose of this event was to bring together international perspectives from researchers, clinicians, and policy experts to address important themes potentially amenable to timely policy interventions. This article summarizes these themes and the ensuing discussions among 130 attendees from 5 continents. The disproportionate impact of the COVID-19 pandemic on frail residents of LTC homes reflects a systematic lack of equitable prioritization by health system decision makers around the world. The primary risk factors for an outbreak in an LTC home were outbreaks in the surrounding community, high staff and visitor traffic in large facilities, and crowding of residents in ageing buildings. Infection control measures must be prioritized in LTC homes, though care must be taken to protect frail and vulnerable residents from their overly blunt application that deprives residents from appropriate physical and psychosocial support. Staffing, in terms of overall numbers, training, and leadership skills, was inadequate. The built environment of LTC homes can be configured for both optimal resident well-being and infection control. Infection control and resident wellness need not be mutually exclusive. Improving outcomes for LTC residents requires more staffing with proper training and interprofessional leadership. All these initiatives must be underpinned by an effective quality assurance system based on standardized, comprehensive, accessible, and clinically relevant data, and which can support broad communities of practice capable of effecting real and meaningful change for frail older persons, wherever they chose to reside.
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104
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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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105
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Morciano M, Stokes J, Kontopantelis E, Hall I, Turner AJ. Excess mortality for care home residents during the first 23 weeks of the COVID-19 pandemic in England: a national cohort study. BMC Med 2021; 19:71. [PMID: 33663498 PMCID: PMC7932761 DOI: 10.1186/s12916-021-01945-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics. METHODS Daily number of deaths in all residential and nursing homes in England notified to the Care Quality Commission (CQC) from 1 January 2017 to 7 August 2020. Care home-level data linked with CQC care home register to identify home characteristics: client type (over 65s/children and adults), ownership status (for-profit/not-for-profit; branded/independent) and size (small/medium/large). Excess deaths computed as the difference between observed and predicted deaths using local authority fixed-effect Poisson regressions on pre-pandemic data. Fixed-effect logistic regressions were used to model odds of experiencing COVID-19 suspected/confirmed deaths. RESULTS Up to 7 August 2020, there were 29,542 (95% CI 25,176 to 33,908) excess deaths in all care homes. Excess deaths represented 6.5% (95% CI 5.5 to 7.4%) of all care home beds, higher in nursing (8.4%) than residential (4.6%) homes. 64.7% (95% CI 56.4 to 76.0%) of the excess deaths were confirmed/suspected COVID-19. Almost all excess deaths were recorded in the quarter (27.4%) of homes with any COVID-19 fatalities. The odds of experiencing COVID-19 attributable deaths were higher in homes providing nursing services (OR 1.8, 95% CI 1.6 to 2.0), to older people and/or with dementia (OR 5.5, 95% CI 4.4 to 6.8), amongst larger (vs. small) homes (OR 13.3, 95% CI 11.5 to 15.4) and belonging to a large provider/brand (OR 1.2, 95% CI 1.1 to 1.3). There was no significant association with for-profit status of providers. CONCLUSIONS To limit excess mortality, policy should be targeted at care homes to minimise the risk of ingress of disease and limit subsequent transmission. Our findings provide specific characteristic targets for further research on mechanisms and policy priority.
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Affiliation(s)
- Marcello Morciano
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK.
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK.
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Ian Hall
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, UK
- Department of Mathematics, University of Manchester, Manchester, M13 9PL, UK
| | - Alex J Turner
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
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106
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Bolcato M, Trabucco Aurilio M, Di Mizio G, Piccioni A, Feola A, Bonsignore A, Tettamanti C, Ciliberti R, Rodriguez D, Aprile A. The Difficult Balance between Ensuring the Right of Nursing Home Residents to Communication and Their Safety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052484. [PMID: 33802378 PMCID: PMC7967622 DOI: 10.3390/ijerph18052484] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 12/22/2022]
Abstract
The COVID-19 epidemic has had a profound impact on healthcare systems worldwide. The number of infections in nursing homes for the elderly particularly is significantly high, with a high mortality rate as a result. In order to contain infection risks for both residents and employees of such facilities, the Italian government passed emergency legislation during the initial stages of the pandemic to restrict outside visitor access. On 30 November 2020, the Italian President of the Council of Ministers issued a new decree recognizing the social and emotional value of visits to patients from family and friends. In addition, it indicated prevention measures for the purposes of containing the infection risk within nursing homes for the elderly. This article comments on these new legislative provisions from the medicolegal perspective, providing indications that can be used in clinical practice.
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Affiliation(s)
- Matteo Bolcato
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
- Correspondence: (M.B.); (M.T.A.); Tel.: +39-0499941096 (M.B.); +39-081-778-316 (M.T.A.)
| | - Marco Trabucco Aurilio
- Department of Medicine and Health Sciences “V. Tiberio,” University of Molise, 86100 Campobasso, Italy
- Correspondence: (M.B.); (M.T.A.); Tel.: +39-0499941096 (M.B.); +39-081-778-316 (M.T.A.)
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), Catholic University of Rome-Teaching Hospital Foundation A, 00168 Rome, Italy;
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy;
| | - Alessandro Bonsignore
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (A.B.); (C.T.)
| | - Camilla Tettamanti
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (A.B.); (C.T.)
| | - Rosagemma Ciliberti
- Department of Health Sciences, Section of History of Medicine and Bioethics, University of Genova, 16126 Genova, Italy;
| | - Daniele Rodriguez
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
| | - Anna Aprile
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
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107
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Shallcross L, Burke D, Abbott O, Donaldson A, Hallatt G, Hayward A, Hopkins S, Krutikov M, Sharp K, Wardman L, Thorne S. Factors associated with SARS-CoV-2 infection and outbreaks in long-term care facilities in England: a national cross-sectional survey. THE LANCET. HEALTHY LONGEVITY 2021; 2:e129-e142. [PMID: 33655236 PMCID: PMC7906733 DOI: 10.1016/s2666-7568(20)30065-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have occurred in long-term care facilities (LTCFs) worldwide, but the reasons why some facilities are particularly vulnerable to outbreaks are poorly understood. We aimed to identify factors associated with SARS-CoV-2 infection and outbreaks among staff and residents in LTCFs. METHODS We did a national cross-sectional survey of all LTCFs providing dementia care or care to adults aged 65 years or older in England between May 26 and June 19, 2020. The survey collected data from managers of eligible LTCFs on LTCF characteristics, staffing factors, the use of disease control measures, and the number of confirmed cases of infection among staff and residents in each LTCF. Survey responses were linked to individual-level SARS-CoV-2 RT-PCR test results obtained through the national testing programme in England between April 30 and June 13, 2020. The primary outcome was the weighted period prevalence of confirmed SARS-CoV-2 infections in residents and staff reported via the survey. Multivariable logistic regression models were fitted to identify factors associated with infection in staff and residents, an outbreak (defined as at least one case of SARS-CoV-2 infection in a resident or staff member), and a large outbreak (defined as LTCFs with more than a third of the total number of residents and staff combined testing positive, or with >20 residents and staff combined testing positive) using data from the survey and from the linked survey-test dataset. FINDINGS 9081 eligible wLTCFs were identified, of which 5126 (56·4%) participated in the survey, providing data on 160 033 residents and 248 594 staff members. The weighted period prevalence of infection was 10·5% (95% CI 9·9-11·1) in residents and 3·8% (3·4-4·2) in staff members. 2724 (53·1%) LTCFs reported outbreaks, and 469 (9·1%) LTCFs reported large outbreaks. The odds of SARS-CoV-2 infection in residents (adjusted odds ratio [aOR] 0·80 [95% CI 0·75-0·86], p<0·0001) and staff (0·70 [0·65-0·77], p<0·0001), and of large outbreaks (0·59 [0·38-0·93], p=0·024) were significantly lower in LTCFs that paid staff statutory sick pay compared with those that did not. Each one unit increase in the staff-to-bed ratio was associated with a reduced odds of infection in residents (0·82 [0·78-0·87], p<0·0001) and staff (0·63 [0·59-0·68], p<0·0001. The odds of infection in residents (1·30 [1·23-1·37], p<0·0001) and staff (1·20 [1·13-1·29], p<0·0001), and of outbreaks (2·56 [1·94-3·49], p<0·0001) were significantly higher in LTCFs in which staff often or always cared for both infected or uninfected residents compared with those that cohorted staff with either infected or uninfected residents. Significantly increased odds of infection in residents (1·01 [1·01-1·01], p<0·0001) and staff (1·00 [1·00-1·01], p=0·0005), and of outbreaks (1·08 [1·05-1·10], p<0·0001) were associated with each one unit increase in the number of new admissions to the LTCF relative to baseline (March 1, 2020). The odds of infection in residents (1·19 [1·12-1·26], p<0·0001) and staff (1·19 [1·10-1·29], p<0·0001), and of large outbreaks (1·65 [1·07-2·54], p=0·024) were significantly higher in LTCFs that were for profit versus those that were not for profit. Frequent employment of agency nurses or carers was associated with a significantly increased odds of infection in residents (aOR 1·65 [1·56-1·74], p<0·0001) and staff (1·85 [1·72-1·98], p<0·0001), and of outbreaks (2·33 [1·72-3·16], p<0·0001) and large outbreaks (2·42 [1·67-3·51], p<0·0001) compared with no employment of agency nurses or carers. Compared with LTCFs that did not report difficulties in isolating residents, those that did had significantly higher odds of infection in residents (1·33 [1·28-1·38], p<0·0001) and staff (1·48 [1·41-1·56], p<0·0001), and of outbreaks (1·84 [1·48-2·30], p<0·0001) and large outbreaks (1·62 [1·24-2·11], p=0·0004). INTERPRETATION Half of LTCFs had no cases of SARS-CoV-2 infection in the first wave of the pandemic. Reduced transmission from staff is associated with adequate sick pay, minimal use of agency staff, an increased staff-to-bed ratio, and staff cohorting with either infected or uninfected residents. Increased transmission from residents is associated with an increased number of new admissions to the facility and poor compliance with isolation procedures. FUNDING UK Government Department of Health and Social Care.
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Affiliation(s)
- Laura Shallcross
- UCL Institute of Health Informatics, University College London, London, UK
| | | | | | | | | | - Andrew Hayward
- UCL Institute of Epidemiology and Healthcare, University College London, London, UK
| | | | - Maria Krutikov
- UCL Institute of Health Informatics, University College London, London, UK
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Hashan MR, Smoll N, King C, Ockenden-Muldoon H, Walker J, Wattiaux A, Graham J, Booy R, Khandaker G. Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis. EClinicalMedicine 2021; 33:100771. [PMID: 33681730 PMCID: PMC7917447 DOI: 10.1016/j.eclinm.2021.100771] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 outbreaks in aged care facilities (ACFs) often have devastating consequences. However, epidemiologically these outbreaks are not well defined. We aimed to define such outbreaks in ACFs by systematically reviewing literature published during the current COVID-19 pandemic. METHODS We searched 11 bibliographic databases for literature published on COVID-19 in ACFs between December 2019 and September 2020. Original studies reporting extractable epidemiological data as part of outbreak investigations or non-outbreak surveillance of ACFs were included in this systematic review and meta-analysis. PROSPERO registration: CRD42020211424. FINDINGS We identified 5,148 publications and selected 49 studies from four continents reporting data on 214,380 residents in 8,502 ACFs with 25,567 confirmed cases of COVID-19. Aged care residents form a distinct vulnerable population with single-facility attack rates of 45% [95% CI 32-58%] and case fatality rates of 23% [95% CI 18-28%]. Of the cases, 31% [95% CI 28-34%] were asymptomatic. The rate of hospitalization amongst residents was 37% [95% CI 35-39%]. Data from 21 outbreaks identified a resident as the index case in 58% of outbreaks and a staff member in 42%. Findings from the included studies were heterogeneous and of low to moderate quality in risk of bias assessment. INTERPRETATION The clinical presentation of COVID-19 varies widely in ACFs residents, from asymptomatic to highly serious cases. Preventing the introduction of COVID-19 into ACFs is key, and both residents and staff are a priority group for COVID-19 vaccination. Rapid diagnosis, identification of primary and secondary cases and close contacts plus their isolation and quarantine are of paramount importance. FUNDING Queensland Advancing Clinical Research Fellowship awarded to Prof. Gulam Khandaker by Queensland Health's Health Innovation, Investment and Research Office (HIRO), Office of the Director-General.
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Affiliation(s)
- Mohammad Rashidul Hashan
- Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Nicolas Smoll
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Catherine King
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Hannah Ockenden-Muldoon
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Jacina Walker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Andre Wattiaux
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Julieanne Graham
- Medical Services Team, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Liu M, Maxwell CJ, Armstrong P, Schwandt M, Moser A, McGregor MJ, Bronskill SE, Dhalla IA. La COVID-19 dans les foyers de soins de longue durée en Ontario et en Colombie-Britannique. CMAJ 2021; 193:E263-E269. [PMID: 33593958 PMCID: PMC8034325 DOI: 10.1503/cmaj.201860-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael Liu
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Colleen J Maxwell
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Pat Armstrong
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Michael Schwandt
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Andrea Moser
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Margaret J McGregor
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Susan E Bronskill
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Irfan A Dhalla
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
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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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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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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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Brown KA, Jones A, Daneman N, Chan AK, Schwartz KL, Garber GE, Costa AP, Stall NM. Association Between Nursing Home Crowding and COVID-19 Infection and Mortality in Ontario, Canada. JAMA Intern Med 2021. [PMID: 33165560 DOI: 10.1101/2020.06.23.20137729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
IMPORTANCE Nursing home residents have been disproportionately affected by coronavirus disease 2019 (COVID-19). Prevention recommendations emphasize frequent testing of health care personnel and residents, but additional strategies are needed. OBJECTIVE To develop a reproducible index of nursing home crowding and determine whether crowding was associated with COVID-19 cases and mortality in the first months of the COVID-19 epidemic. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study included more than 78 000 residents across more than 600 nursing homes in Ontario, Canada, and was conducted from March 29 to May 20, 2020. EXPOSURES The nursing home crowding index equaled the mean number of residents per bedroom and bathroom. MAIN OUTCOMES AND MEASURES The cumulative incidence of COVID-19 cases confirmed by a validated nucleic acid amplification assay and mortality per 100 residents; the introduction of COVID-19 into a home (≥1 resident case) was a negative tracer. RESULTS Of 623 homes in Ontario, we obtained complete information on 618 homes (99%) housing 78 607 residents (women, 54 160 [68.9%]; age ≥85 years, 42 919 [54.6%]). A total of 5218 residents (6.6%) developed COVID-19 infection, and 1452 (1.8%) died of COVID-19 infection as of May 20, 2020. COVID-19 infection was distributed unevenly across nursing homes; 4496 infections (86%) occurred in 63 homes (10%). The crowding index ranged across homes from 1.3 (mainly single-occupancy rooms) to 4.0 (exclusively quadruple occupancy rooms); 308 homes (50%) had a high crowding index (≥2). Incidence in high crowding index homes was 9.7% vs 4.5% in low crowding index homes (P < .001), while COVID-19 mortality was 2.7% vs 1.3%, respectively (P < .001). The likelihood of COVID-19 introduction did not differ (high = 31.3% vs low = 30.2%; P = .79). After adjustment for regional, nursing home, and resident covariates, the crowding index remained associated with an increased incidence of infection (relative risk [RR] = 1.73, 95% CI, 1.10-2.72) and mortality (RR, 1.69; 95% CI, 0.99-2.87). A propensity score analysis yielded similar conclusions for infection (RR, 2.09; 95% CI, 1.30-3.38) and mortality (RR, 1.83; 95% CI, 1.09-3.08). Simulations suggested that converting all 4-bed rooms to 2-bed rooms would have averted 998 COVID-19 cases (19.1%) and 263 deaths (18.1%). CONCLUSIONS AND RELEVANCE In this cohort of Canadian nursing homes, crowding was common and crowded homes were more likely to experience larger and deadlier COVID-19 outbreaks.
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Affiliation(s)
- Kevin A Brown
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Division of Infectious Diseases, Toronto, Ontario, Canada
- The Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adrienne K Chan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Division of Infectious Diseases, Toronto, Ontario, Canada
- The Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- St. Joseph's Health System, Toronto, Ontario, Canada
| | - Gary E Garber
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Health System, Toronto, Ontario, Canada
| | - Nathan M Stall
- The Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System and the University Health Network, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
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Abstract
Healthcare workers (HCWs) in Ontario, Canada have faced unprecedented risks during the COVID-19 pandemic. They have been infected at an elevated rate compared to the general public. HCWs have argued for better protections with minimal success. A worldwide shortage of N95s and comparable respirators appears to have influenced guidelines for protection, which stand at odds with increasing scientific evidence. In-depth interviews were conducted with ten frontline HCWs about their concerns. They reported that the risk of contracting COVID-19 and infecting family members has created intense anxiety. This, in conjunction with understaffing and an increased workload, has resulted in exhaustion and burnout. HCWs feel abandoned by their governments, which failed to prepare for an inevitable epidemic, despite recommendations. The knowledge that they are at increased risk of infection due to lack of protection has resulted in anger, frustration, fear, and a sense of violation that may have long-lasting implications.Sacrifié: Le personnel de la santé ontarien à l'époque de la COVID-19RésuméEn Ontario, au Canada, le personnel de la santé a eu à faire face à des risques sans précédent durant la pandémie de COVID-19. On y a constaté un taux d'infection plus élevé chez les travailleuses et travailleurs de la santé (TTS) qu'au sein de la population en général. Les TTS ont revendiqué des moyens de protection améliorés, sans grand succès. Une pénurie mondiale de masques respirateurs de type N95 ou similaires semble avoir joué sur les directives en matière de protection, qui ne cadrent pas avec une accumulation de preuves scientifiques. Lors d'entretiens en profondeur, dix TTS de première ligne ont été invités à donner leur avis sur la situation. à les entendre, le risque de contracter la COVID-19 et d'infecter les membres de leur famille leur cause beaucoup d'anxiété. Associée à un manque de personnel et à une charge de travail accrue, cette anxiété se traduit par un épuisement physique et professionnel. Les TTS se sentent abandonnés par leurs gouvernements, qui ont manqué de se préparer à l'inévitabilité d'une épidémie, malgré ce qui leur avait été recommandé. Leur réalisation d'être exposés à un plus grand risque d'infection par manque d'équipement de protection s'est muée en colère, frustration et peur, et en un sentiment de violation de leurs droits dont on peut craindre qu'il subsiste fort longtemps.
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Affiliation(s)
- James T. Brophy
- University of Windsor, ON, Canada
- University of Stirling, Scotland
- Athabasca University, AB, Canada
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Brown KA, Jones A, Daneman N, Chan AK, Schwartz KL, Garber GE, Costa AP, Stall NM. Association Between Nursing Home Crowding and COVID-19 Infection and Mortality in Ontario, Canada. JAMA Intern Med 2021; 181:229-236. [PMID: 33165560 PMCID: PMC7653540 DOI: 10.1001/jamainternmed.2020.6466] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/18/2020] [Indexed: 12/29/2022]
Abstract
Importance Nursing home residents have been disproportionately affected by coronavirus disease 2019 (COVID-19). Prevention recommendations emphasize frequent testing of health care personnel and residents, but additional strategies are needed. Objective To develop a reproducible index of nursing home crowding and determine whether crowding was associated with COVID-19 cases and mortality in the first months of the COVID-19 epidemic. Design, Setting, and Participants This population-based retrospective cohort study included more than 78 000 residents across more than 600 nursing homes in Ontario, Canada, and was conducted from March 29 to May 20, 2020. Exposures The nursing home crowding index equaled the mean number of residents per bedroom and bathroom. Main Outcomes and Measures The cumulative incidence of COVID-19 cases confirmed by a validated nucleic acid amplification assay and mortality per 100 residents; the introduction of COVID-19 into a home (≥1 resident case) was a negative tracer. Results Of 623 homes in Ontario, we obtained complete information on 618 homes (99%) housing 78 607 residents (women, 54 160 [68.9%]; age ≥85 years, 42 919 [54.6%]). A total of 5218 residents (6.6%) developed COVID-19 infection, and 1452 (1.8%) died of COVID-19 infection as of May 20, 2020. COVID-19 infection was distributed unevenly across nursing homes; 4496 infections (86%) occurred in 63 homes (10%). The crowding index ranged across homes from 1.3 (mainly single-occupancy rooms) to 4.0 (exclusively quadruple occupancy rooms); 308 homes (50%) had a high crowding index (≥2). Incidence in high crowding index homes was 9.7% vs 4.5% in low crowding index homes (P < .001), while COVID-19 mortality was 2.7% vs 1.3%, respectively (P < .001). The likelihood of COVID-19 introduction did not differ (high = 31.3% vs low = 30.2%; P = .79). After adjustment for regional, nursing home, and resident covariates, the crowding index remained associated with an increased incidence of infection (relative risk [RR] = 1.73, 95% CI, 1.10-2.72) and mortality (RR, 1.69; 95% CI, 0.99-2.87). A propensity score analysis yielded similar conclusions for infection (RR, 2.09; 95% CI, 1.30-3.38) and mortality (RR, 1.83; 95% CI, 1.09-3.08). Simulations suggested that converting all 4-bed rooms to 2-bed rooms would have averted 998 COVID-19 cases (19.1%) and 263 deaths (18.1%). Conclusions and Relevance In this cohort of Canadian nursing homes, crowding was common and crowded homes were more likely to experience larger and deadlier COVID-19 outbreaks.
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Affiliation(s)
- Kevin A. Brown
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Division of Infectious Diseases, Toronto, Ontario, Canada
- The Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adrienne K. Chan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Division of Infectious Diseases, Toronto, Ontario, Canada
- The Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- St. Joseph’s Health System, Toronto, Ontario, Canada
| | - Gary E. Garber
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew P. Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Health System, Toronto, Ontario, Canada
| | - Nathan M. Stall
- The Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System and the University Health Network, Toronto, Ontario, Canada
- Women’s College Hospital, Toronto, Ontario, Canada
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Baral S, Chandler R, Prieto RG, Gupta S, Mishra S, Kulldorff M. Leveraging epidemiological principles to evaluate Sweden's COVID-19 response. Ann Epidemiol 2021; 54:21-26. [PMID: 33242596 PMCID: PMC7682427 DOI: 10.1016/j.annepidem.2020.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 12/21/2022]
Abstract
In the response to COVID-19, countries have implemented response strategies along a continuum of population- and venue-level specificity ranging from suppression to mitigation strategies. Suppression strategies generally include population-wide shelter-in-place mandates or lockdowns, closure of nonessential physical venues, travel bans, testing and contact tracing, and quarantines. Sweden followed a mitigation strategy focused on risk-tailored approaches to mitigate specific acquisition risks among the elderly, minimizing the disruption to education and the delivery of other health care services, and recommendations for social distancing to minimize the disease burden. To date, Sweden has reported higher case counts and attributable mortality than other Scandinavian countries and lower than other Northern European countries. However, there are several limitations with comparison given heterogeneity in testing strategies, suspected and confirmed case definitions, and assessment of attributable mortality. The decisions in Sweden also reflect social priorities such as equity being a foundational principle of Swedish social systems. Consistently, in-person education for those aged less than 16 years continued throughout. Notably, the mitigation strategy did not eliminate the inequitable impacts of COVID-19 cases and mortality in Sweden with higher-exposure and generally lower-income occupations being associated with higher risks intersecting with these communities often residing in more dense multigenerational households. From January 1 to November 15, there has been a 1.8% increase in all-cause mortality in 2020 compared with the average of 2015-2019, representing an excess of 14.3 deaths per 100,000 population. However, the final assessment of excess deaths in Sweden in 2020 including stratification by age and integration of secular trends can only be calculated in the coming years. In response to increasing cases in the fall of 2020, Sweden has continued to leverage business-oriented regulations and public-oriented guidelines for social distancing rather than police-enforced mandates. Ultimately, pandemics present no winners. Countries have implemented a range of different COVID-19 prevention and mitigation strategies responsive to their own priorities and legal systems including equity and the balancing of competing health priorities. Given these varied approaches, countries that pursued elimination, suppression, or mitigation strategies can collaboratively learn from both successes and challenges of the different strategies to inform COVID-19 and future pandemic responses.
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Affiliation(s)
- Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
| | | | - Ruth Gil Prieto
- Department of Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Sunetra Gupta
- Department of Zoology, University of Oxford, Oxford, UK
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Martin Kulldorff
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Harvard Medical School, Boston, MA
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Klasa K, Galaitsi S, Wister A, Linkov I. System models for resilience in gerontology: application to the COVID-19 pandemic. BMC Geriatr 2021; 21:51. [PMID: 33446109 PMCID: PMC7807229 DOI: 10.1186/s12877-020-01965-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023] Open
Abstract
The care needs for aging adults are increasing burdens on health systems around the world. Efforts minimizing risk to improve quality of life and aging have proven moderately successful, but acute shocks and chronic stressors to an individual's systemic physical and cognitive functions may accelerate their inevitable degradations. A framework for resilience to the challenges associated with aging is required to complement on-going risk reduction policies, programs and interventions. Studies measuring resilience among the elderly at the individual level have not produced a standard methodology. Moreover, resilience measurements need to incorporate external structural and system-level factors that determine the resources that adults can access while recovering from aging-related adversities. We use the National Academies of Science conceptualization of resilience for natural disasters to frame resilience for aging adults. This enables development of a generalized theory of resilience for different individual and structural contexts and populations, including a specific application to the COVID-19 pandemic.
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Affiliation(s)
- Katarzyna Klasa
- University of Michigan School of Public Health, Ann Arbor, USA
| | - Stephanie Galaitsi
- United States Army Corps of Engineers, Engineering Research and Development Center, Vicksburg, USA
| | - Andrew Wister
- Gerontology Research Centre, Simon Fraser University, Burnaby, Canada.
| | - Igor Linkov
- United States Army Corps of Engineers, Engineering Research and Development Center, Vicksburg, USA
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118
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Waldner D, Harrison R, Johnstone J, Saxinger L, Webster D, Sligl W. COVID-19 epidemiology in Canada from January to December 2020: the pre-vaccine era. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This paper summarizes COVID-19 disease epidemiology in Canada in the pre-vaccine era—from January through to December 2020. Canadian case numbers, risk factors, disease presentations (including severe and critical disease), and outcomes are described. Differences between provinces and territories in geography, population size and density, health demographics, and pandemic impact are highlighted. Key concepts in public health response and mitigation are reviewed, including masking, physical distancing, hand washing, and the promotion of outdoor interactions. Adequate investment in public health infrastructure is stressed, and regional differences in screening and testing strategies are highlighted. The spread of COVID-19 in Canadian workplaces, long-term care homes, and schools is described and lessons learned emphasized. The impact of COVID-19 on vulnerable populations in Canada—including Indigenous Peoples, ethnic minorities and newcomers, people who use drugs, people who are homeless, people who are incarcerated, and people with disabilities—is described. Sex and gender disparities are also highlighted. Author recommendations include strategies to reduce transmission (such as test–trace–isolate), the establishment of nationally standardized definitions and public reporting, the protection of high risk and vulnerable populations, and the development of a national strategy on vaccine allocation.
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Affiliation(s)
| | | | | | | | | | - Wendy Sligl
- University of Alberta, Edmonton, AB T6G 2B7, Canada
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119
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Malikov K, Huang Q, Shi S, Stall NM, Tuite AR, Hillmer MP. Temporal Associations between Community Incidence of COVID-19 and Nursing Home Outbreaks in Ontario, Canada. J Am Med Dir Assoc 2020; 22:260-262. [PMID: 33476568 PMCID: PMC7749642 DOI: 10.1016/j.jamda.2020.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/12/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Kamil Malikov
- Capacity Planning and Analytics Division, Ontario Ministry of Health, Toronto, Canada
| | - Qing Huang
- Capacity Planning and Analytics Division, Ontario Ministry of Health, Toronto, Canada
| | - Shengli Shi
- Capacity Planning and Analytics Division, Ontario Ministry of Health, Toronto, Canada
| | - Nathan M Stall
- Department of Medicine, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Canada; Division of General Internal Medicine and Geriatrics, Sinai Health System and the University Health Network, Toronto, Canada
| | - Ashleigh R Tuite
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Michael P Hillmer
- Capacity Planning and Analytics Division, Ontario Ministry of Health, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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120
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Zhang XS, Duchaine C. SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles. Clin Microbiol Rev 2020; 34:e00184-20. [PMID: 33115724 PMCID: PMC7605309 DOI: 10.1128/cmr.00184-20] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Since the beginning of the COVID-19 pandemic, there has been intense debate over SARS-CoV-2's mode of transmission and appropriate personal protective equipment for health care workers in low-risk settings. The objective of this review is to identify and appraise the available evidence (clinical trials and laboratory studies on masks and respirators, epidemiological studies, and air sampling studies), clarify key concepts and necessary conditions for airborne transmission, and shed light on knowledge gaps in the field. We find that, except for aerosol-generating procedures, the overall data in support of airborne transmission-taken in its traditional definition (long-distance and respirable aerosols)-are weak, based predominantly on indirect and experimental rather than clinical or epidemiological evidence. Consequently, we propose a revised and broader definition of "airborne," going beyond the current droplet and aerosol dichotomy and involving short-range inhalable particles, supported by data targeting the nose as the main viral receptor site. This new model better explains clinical observations, especially in the context of close and prolonged contacts between health care workers and patients, and reconciles seemingly contradictory data in the SARS-CoV-2 literature. The model also carries important implications for personal protective equipment and environmental controls, such as ventilation, in health care settings. However, further studies, especially clinical trials, are needed to complete the picture.
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Affiliation(s)
- X Sophie Zhang
- Department of General Medicine, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- CHSLD Bruchési and CHSLD Jean De La Lande, Montreal, Canada
- GMF-U Faubourgs, Montreal, Canada
- Centre de Recherche et d'Aide aux Narcomanes, Montreal, Canada
| | - Caroline Duchaine
- Department of Biochemistry, Microbiology, and Bioinformatics, Université Laval, Quebec City, Canada
- Quebec Heart and Lung Institute-Université Laval (CRIUCPQ), Quebec City, Canada
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121
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Liu M, Maxwell CJ, Armstrong P, Schwandt M, Moser A, McGregor MJ, Bronskill SE, Dhalla IA. COVID-19 in long-term care homes in Ontario and British Columbia. CMAJ 2020; 192:E1540-E1546. [PMID: 32998943 DOI: 10.1503/cmaj.201860] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michael Liu
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Colleen J Maxwell
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Pat Armstrong
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Michael Schwandt
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Andrea Moser
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Margaret J McGregor
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Susan E Bronskill
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Irfan A Dhalla
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
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122
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McGregor MJ, Harrington C. COVID-19 and long-term care facilities: Does ownership matter? CMAJ 2020; 192:E961-E962. [PMID: 32699007 DOI: 10.1503/cmaj.201714] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Margaret J McGregor
- Department of Family Practice (McGregor), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (McGregor), Vancouver Coastal Health Research Institute, Vancouver, BC; University of California San Francisco (Harrington), San Francisco, Calif.
| | - Charlene Harrington
- Department of Family Practice (McGregor), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (McGregor), Vancouver Coastal Health Research Institute, Vancouver, BC; University of California San Francisco (Harrington), San Francisco, Calif
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123
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Lombardo FL, Salvi E, Lacorte E, Piscopo P, Mayer F, Ancidoni A, Remoli G, Bellomo G, Losito G, D'Ancona F, Canevelli M, Onder G, Vanacore N. Adverse Events in Italian Nursing Homes During the COVID-19 Epidemic: A National Survey. Front Psychiatry 2020; 11:578465. [PMID: 33132938 PMCID: PMC7561357 DOI: 10.3389/fpsyt.2020.578465] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/25/2020] [Indexed: 01/10/2023] Open
Abstract
Older people living in nursing homes (NHs) are particularly vulnerable in the ongoing COVID-19 pandemic, due to the high prevalence of chronic diseases and disabilities (e.g., dementia). The phenomenon of adverse events (AEs), intended as any harm or injury resulting from medical care or to the failure to provide care, has not yet been investigated in NHs during the pandemic. We performed a national survey on 3,292 NHs, either public or providing services both privately and within the national health system, out of the 3,417 NHs covering the whole Italian territory. An online questionnaire was addressed to the directors of each facility between March 24 and April 27, 2020. The list of NHs was provided by the Dementia Observatory, an online map of Italian services for people with dementia, which was one of the objectives of the implementation of the Italian National Dementia Plan. About 26% of residents in the Italian NHs for older people listed within the Dementia Observatory site had dementia. The objective of our study was to report the frequency of AEs that occurred during the months when SARS-CoV-2 spreading rate was at its highest in the Italian NHs and to identify which conditions and attributes were most associated with the occurrence of AEs by means of multivariate regression logistic analysis. Data are referred to 1,356 NHs that participated in the survey. The overall response rate was 41.2% over a time-period of six weeks (from March 24 to May 5). About one third of the facilities (444 out of 1,334) (33.3%) reported at least 1 adverse event, with a total of 2,000 events. Among the included NHs, having a bed capacity higher than the median of 60 beds (OR=1.57, CI95% 1.17-2.09; p=0.002), an observed increased in the use of psychiatric drugs (OR=1.80, CI95% 1.05-3.07; p=0.032), adopting physical restraint measures (OR=1.97, CI95% 1.47-2.64; p<0.001), residents hospitalized due to flu-like symptoms (OR =1.73, CI95% 1.28-2.32; p<0.001), and being located in specific geographic areas (OR=3.59, CI95% 1.81-7.08; OR = 2.90, CI95% 1.45-5.81 and OR = 4.02, CI05% 2.01-8.04 for, respectively, North-West, North-East and Centre vs South, p<0.001) were all factors positively associated to the occurrence of adverse events in the facility. Future recommendations for the management and care of residents in NHs during the COVID-19 pandemic should include specific statements for the most vulnerable populations, such as people with dementia.
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Affiliation(s)
- Flavia L Lombardo
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Emanuela Salvi
- National Center for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Eleonora Lacorte
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Paola Piscopo
- Department of Neuroscience, Italian National Institute of Health, Rome, Italy
| | - Flavia Mayer
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Antonio Ancidoni
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Giulia Remoli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Guido Bellomo
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Gilda Losito
- Unit of Health Care and Deprivation of Liberty, Rome, Italy
| | - Fortunato D'Ancona
- Department of Infectious Diseases, Italian National Institute of Health, Rome, Italy
| | - Marco Canevelli
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
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