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Whelan M, Galipeau Y, White-Al Habeeb N, Konforte D, Abou El Hassan M, Booth RA, Arnold C, Langlois MA, Pelchat M. Cross-sectional Characterization of SARS-CoV-2 Antibody Levels and Decay Rates Following Infection of Unvaccinated Elderly Individuals. Open Forum Infect Dis 2023; 10:ofad384. [PMID: 37547857 PMCID: PMC10404006 DOI: 10.1093/ofid/ofad384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
Background SARS-CoV-2 infections have disproportionally burdened elderly populations with excessive mortality. While several contributing factors exists, questions remain about the quality and duration of humoral antibody-mediated responses resulting from infections in unvaccinated elderly individuals. Methods Residual serum/plasma samples were collected from individuals undergoing routine SARS-CoV-2 polymerase chain reaction testing in a community laboratory in Canada. The samples were collected in 2020, before vaccines became available. IgG, IgA, and IgM antibodies against SARS-CoV-2 nucleocapsid, trimeric spike, and its receptor-binding domain were quantified via a high-throughput chemiluminescent enzyme-linked immunosorbent assay. Neutralization efficiency was also quantified through a surrogate high-throughput protein-based neutralization assay. Results This study analyzed SARS-CoV-2 antibody levels in a large cross-sectional cohort (N = 739), enriched for elderly individuals (median age, 82 years; 75% >65 years old), where 72% of samples tested positive for SARS-CoV-2 by polymerase chain reaction. The age group ≥90 years had higher levels of antibodies than that <65 years. Neutralization efficiency showed an age-dependent trend, where older persons had higher levels of neutralizing antibodies. Antibodies targeting the nucleocapsid had the fastest decline. IgG antibodies targeting the receptor-binding domain remained stable over time, potentially explaining the lack of neutralization decay observed in this cohort. Conclusions Despite older individuals having the highest levels of antibodies postinfection, they are the cohort in which antibody decay was the fastest. Until a better understanding of correlates of protection is acquired, along with the protective role of nonneutralizing antibodies, booster vaccinations remain important in this demographic.
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Affiliation(s)
- Marilyn Whelan
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Yannick Galipeau
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | - Mohamed Abou El Hassan
- LifeLabs Medical Laboratory Services, Etobicoke, Canada
- Department of Pathology, Dalhousie University, Halifax, Canada
| | - Ronald A Booth
- Department of Pathology and Laboratory Medicine and the Eastern Ontario Regional Laboratory Association, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Corey Arnold
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Marc-André Langlois
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Centre for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, Canada
| | - Martin Pelchat
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Centre for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, Canada
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Resnick B, Boltz M, Galik E, Fix S, Holmes S, Zhu S. Model Testing of the Factors That Influence Performance of Function Focused Care and Function Among Assisted Living Residents. J Appl Gerontol 2022; 41:401-410. [PMID: 35067104 PMCID: PMC8792441 DOI: 10.1177/0733464820976435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
The purpose of this study was to test a model of factors associated with participating in function focused care. Function focused care is a philosophy of care in which residents are encouraged to engage in functional and physical activities during care interactions. This was a secondary data analysis using data from the Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) study. Residents (n = 550) were recruited from 59 AL settings. The majority were female (n = 380, 69%) and White (n = 536, 97%). Model testing was done. Comorbidities, quality of interactions, environments, profit status, cognitive impairment, depression, and function were associated with function focused care and accounted for 17% of the variance. Next steps should include intervening on changeable factors (e.g., environments) and adding factors to better explain performance of function focused care such as motivation, resilience, and staff satisfaction.
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Affiliation(s)
| | - Marie Boltz
- Pennsylvania State University, University Park, USA
| | | | - Steven Fix
- University of Maryland School of Nursing, Baltimore, USA
| | | | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, USA
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Schmidt AJ, García Y, Pinheiro D, Reichert TA, Nuño M. Using Non-Pharmaceutical Interventions and High Isolation of Asymptomatic Carriers to Contain the Spread of SARS-CoV-2 in Nursing Homes. Life (Basel) 2022; 12:180. [PMID: 35207468 PMCID: PMC8877375 DOI: 10.3390/life12020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 11/25/2022] Open
Abstract
More than 40% of the deaths recorded in the first wave of the SARS-CoV-2 pandemic were linked to nursing homes. Not only are the residents of long-term care facilities (LTCFs) typically older and more susceptible to endemic infections, the facilities' high degree of connection to wider communities makes them especially vulnerable to local COVID-19 outbreaks. In 2008, in the wake of the SARS-CoV-1 and MERS epidemics and anticipating an influenza pandemic, we created a stochastic compartmental model to evaluate the deployment of non-pharmaceutical interventions (NPIs) in LTCFs during influenza epidemics. In that model, the most effective NPI by far was a staff schedule consisting of 5-day duty periods with onsite residence, followed by an 4-to-5 day off-duty period with a 3-day quarantine period just prior to the return to work. Unlike influenza, COVID-19 appears to have significant rates of pre-symptomatic transmission. In this study, we modified our prior modeling framework to include new parameters and a set of NPIs to identify and control the degree of pre-symptomatic transmission. We found that infections, deaths, hospitalizations, and ICU utilization were projected to be high and largely irreducible, even with rigorous application of all defined NPIs, unless pre-symptomatic carriers can be identified and isolated at high rates. We found that increasingly rigorous application of NPIs is likely to significantly decrease the peak of infections; but even with complete isolation of symptomatic persons, and a 50% reduction in silent transmission, the attack rate is projected to be nearly 95%.
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Affiliation(s)
- Alec J. Schmidt
- Deparment of Public Health Sciences, University of California Davis, Davis, CA 95616, USA
| | - Yury García
- Centro de Investigación en Matemática Pura y Aplicada (CIMPA), University of Costa Rica, San José 11501, Costa Rica;
| | - Diego Pinheiro
- Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, CA 95817, USA;
| | | | - Miriam Nuño
- Deparment of Public Health Sciences, University of California Davis, Davis, CA 95616, USA
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Gleich S, Turlik V, Schmidt S, Wohlrab D. [COVID-19 deaths among residents of inpatient nursing homes in Munich-causes and places of death]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1136-1145. [PMID: 34379132 PMCID: PMC8356210 DOI: 10.1007/s00103-021-03395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/01/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The new infectious disease COVID-19 first appeared in China in December 2019. So far, a systematic evaluation of death certificates of COVID-19-associated deaths of residents in inpatient nursing homes has not been presented. METHODS Death certificates of all deaths in Munich in the death period from 1 March to 31 July 2020 were analyzed. Inclusion criteria were the presence of "Corona, COVID-19, SARS-CoV-2" on the death certificates. Standardized, anonymized data entry was performed. The collected data were analyzed descriptively. RESULTS During the study period, a total of 5840 persons died, 281 (4.8%) of whom died of confirmed COVID-19 disease. Of those, 72 deaths involved residents of Munich nursing facilities. The most frequent causes of death were respiratory insufficiency (54 cases) and multiple organ failure (9 cases). On the death certificates, an average of two preexisting diseases had been reported; the average age at death was 88 years. All deaths of nursing home residents occurred in association with nosocomial COVID-19 outbreaks, which affected one-third of the facilities. The vast majority of these homes did not have a COVID-19 hygiene plan in place at the time. DISCUSSION One quarter of all COVID-19 deaths in Munich occurred in the context of nosocomial outbreaks in elderly, chronically ill residents of nursing facilities. Evidence of inadequate risk assessment and inadequate hygiene management emerged. In the opinion of the authors, the appropriate structures for adequate hygiene management must be created and a hygiene regulation must be issued in which the tasks and responsibilities of the facility operators are defined.
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Affiliation(s)
- Sabine Gleich
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland.
| | - Verena Turlik
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland
| | - Susann Schmidt
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland
| | - Doris Wohlrab
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland
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The Impact of COVID-19 Pandemic on Long-Term Care Facilities Worldwide: An Overview on International Issues. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8870249. [PMID: 33204723 PMCID: PMC7656236 DOI: 10.1155/2020/8870249] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/30/2020] [Indexed: 01/21/2023]
Abstract
The COVID-19 pandemic had a great negative impact on nursing homes, with massive outbreaks being reported in care facilities all over the world, affecting not only the residents but also the care workers and visitors. Due to their advanced age and numerous underlying diseases, the inhabitants of long-term care facilities represent a vulnerable population that should benefit from additional protective measures against contamination. Recently, multiple countries such as France, Spain, Belgium, Canada, and the United States of America reported that an important fraction from the total number of deaths due to the SARS-CoV-2 infection emerged from nursing homes. The scope of this paper was to present the latest data regarding the COVID-19 spread in care homes worldwide, identifying causes and possible solutions that would limit the outbreaks in this overlooked category of population. It is the authors' hope that raising awareness on this matter would encourage more studies to be conducted, considering the fact that there is little information available on the impact of the SARS-CoV-2 pandemic on nursing homes. Establishing national databases that would register all nursing home residents and their health status would be of great help in the future not only for managing the ongoing pandemic but also for assessing the level of care that is needed in this particularly fragile setting.
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Temkin-Greener H, Guo W, Mao Y, Cai X, Li Y. COVID-19 Pandemic in Assisted Living Communities: Results from Seven States. J Am Geriatr Soc 2020; 68:2727-2734. [PMID: 32955107 PMCID: PMC7537218 DOI: 10.1111/jgs.16850] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe variations in COVID‐19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics. DESIGN Observational study employing data on confirmed COVID‐19 cases and deaths in ALs from seven states, through May 29, 2020. SETTING Information on COVID‐19 cases/deaths in ALs was obtained from state government websites. A national inventory of ALs was used to identify communities with and without COVID‐19 cases/deaths. Medicare Beneficiary Summary File identifying AL residents was employed to develop AL characteristics. County‐level COVID‐19 laboratory‐confirmed cases/deaths were obtained from publicly available data. PARTICIPANTS We found 4,865 ALs (2,647 COVID‐19 cases and 777 deaths) in the seven states. After excluding missing data, the sample consisted of 3,994 ALs (82.1%) with 2,542 cases (96.0%) and 675 deaths (86.9%). MAIN OUTCOMES AND MEASURES Outcomes were AL‐level counts of cases and deaths. Covariates were AL characteristics and county‐level confirmed COVID‐19 cases/deaths. Multivariable two‐part models determined the associations of independent variables with the likelihood of at least one case and death in the AL, and with the count of cases (deaths). RESULTS State case fatality ranged from 3.32% in North Carolina to 9.26% in Connecticut, but for ALs in these states it was 12.89% and 31.59%, respectively. Among ALs with at least one case, midsize communities had fewer cases (incidence rate ratio (IRR) = 0.829; P = .004) than small ALs. ALs with higher proportions of racial/ethnic minorities had more COVID‐19 cases (IRR = 1.08; P < .001), as did communities with higher proportions of residents with dementia, chronic obstructive pulmonary disease, and obesity. CONCLUSIONS AND RELEVANCE ALs with a higher proportion of minorities had more COVID‐19 cases. Many of the previously identified individual risk factors are also present in this vulnerable population. The impact of COVID‐19 on ALs is as critical as that on nursing homes, and is worth equal attention from policy makers.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Wenhan Guo
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Yunjiao Mao
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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O'Neill D, Briggs R, Holmerová I, Samuelsson O, Gordon AL, Martin FC. COVID-19 highlights the need for universal adoption of standards of medical care for physicians in nursing homes in Europe. Eur Geriatr Med 2020; 11:645-650. [PMID: 32557250 PMCID: PMC7298916 DOI: 10.1007/s41999-020-00347-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/07/2020] [Indexed: 12/17/2022]
Abstract
The nursing home sector has seen a disproportionately high number of deaths as part of the COVID-19 pandemic. This reflects, in part, the frailty and vulnerability of older people living in care homes but has also, in part, been a consequence of the failure to include care homes in the systematic planning of a response to COVID, as well as a measure of neglect of standards and quality improvement in the sector. In response, the EUGMS published a set of medical standards of care developed in consultation with experts across its member national societies in 2015. The standards consisted of seven core principles of medical care for physicians working in nursing homes as a first step in developing a programme of clinical, academic and policy engagement in improving medical care for older people who are living and frequently also dying as residents in nursing homes. The gravity of the concerns arising for nursing home care from the COVID-19 pandemic, as well as emerging insights on care improvement in nursing homes indicate that an update of these medical standards is timely. This was performed by the writing group from the original 2015 guidelines and is intended as an interim measure pending a more formal review incorporating a systematic review of emerging literature and a Delphi process.
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Affiliation(s)
- Desmond O'Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, D24 NR0A, Ireland.
| | | | | | | | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
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Affiliation(s)
- Aoife Fallon
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland; Aoife Fallon, Specialist Registrar; Tim Dukelow, Specialist Registrar; Sean P Kennelly, Professor; Desmond O’Neill, Professor
| | - Tim Dukelow
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland; Aoife Fallon, Specialist Registrar; Tim Dukelow, Specialist Registrar; Sean P Kennelly, Professor; Desmond O’Neill, Professor
| | - Sean P Kennelly
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland; Aoife Fallon, Specialist Registrar; Tim Dukelow, Specialist Registrar; Sean P Kennelly, Professor; Desmond O’Neill, Professor
| | - Desmond O’Neill
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland; Aoife Fallon, Specialist Registrar; Tim Dukelow, Specialist Registrar; Sean P Kennelly, Professor; Desmond O’Neill, Professor
- Correspondence to Prof O’Neill, Department of Medical Gerontology, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland. Email ; Telephone +353 1 414 3215; Fax +353 1 414 3244
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Huhtinen E, Quinn E, Hess I, Najjar Z, Gupta L. Understanding barriers to effective management of influenza outbreaks by residential aged care facilities. Australas J Ageing 2018; 38:60-63. [PMID: 30537166 PMCID: PMC6590128 DOI: 10.1111/ajag.12595] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To identify the perceived barriers to the implementation of the Australian national guidelines on influenza outbreak management with Sydney Local Health District (SLHD) residential aged care facility (RACF) staff. METHODS All SLHD RACFs were invited to participate in a telephone interview. The questionnaire collected information about demographic characteristics and participants' level of agreement with statements regarding perceived barriers to implementing the national guidelines for influenza outbreak management. RESULTS Twenty-eight of 61 RACFs (46%) participated in the study. The three most common barriers identified were as follows: scepticism towards staff influenza vaccination (n = 13, 46%); the effort required to read the national guidelines (n = 11, 39%); and lack of infrastructure to physically separate residents during an outbreak (n = 10, 36%). CONCLUSIONS We recommend implementing and evaluating programmes which address misconceptions about influenza vaccination amongst RACF staff. Further, all RACF staff, including care staff, should receive targeted education on the role of infection control in influenza outbreak management.
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Affiliation(s)
- Essi Huhtinen
- Sydney Local Health District, Public Health Unit, Sydney, New South Wales, Australia
| | - Emma Quinn
- Sydney Local Health District, Public Health Unit, Sydney, New South Wales, Australia.,School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Isabel Hess
- Sydney Local Health District, Public Health Unit, Sydney, New South Wales, Australia
| | - Zeina Najjar
- Sydney Local Health District, Public Health Unit, Sydney, New South Wales, Australia
| | - Leena Gupta
- Sydney Local Health District, Public Health Unit, Sydney, New South Wales, Australia
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