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Zhang J, Yu Y, Petrovic M, Pei X, Tian QB, Zhang L, Zhang WH. Impact of the COVID-19 pandemic and corresponding control measures on long-term care facilities: a systematic review and meta-analysis. Age Ageing 2023; 52:6987654. [PMID: 36668818 DOI: 10.1093/ageing/afac308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/04/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks. OBJECTIVE To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staff. METHOD We conducted a systematic search of six databases for articles published between December 2019 and 5 November 2021, and performed meta-analyses and subgroup analyses to identify the impact of COVID-19 on LTCFs and the association between control measures and infection rate. RESULTS We included 108 studies from 19 countries. These studies included 1,902,044 residents and 255,498 staff from 81,572 LTCFs, among whom 296,024 residents and 36,807 staff were confirmed SARS-CoV-2 positive. The pooled infection rate was 32.63% (95%CI: 30.29 ~ 34.96%) for residents, whereas it was 10.33% (95%CI: 9.46 ~ 11.21%) for staff. In LTCFs that cancelled visits, new patient admissions, communal dining and group activities, and vaccinations, infection rates in residents and staff were lower than the global rate. We reported the residents' hospitalisation rate to be 29.09% (95%CI: 25.73 ~ 32.46%), with a case-fatality rate of 22.71% (95%CI: 21.31 ~ 24.11%) and mortality rate of 15.81% (95%CI: 14.32 ~ 17.30%). Significant publication biases were observed in the residents' case-fatality rate and the staff infection rate, but not in the infection, hospitalisation, or mortality rate of residents. CONCLUSION SARS-CoV-2 infection rates would be very high among LTCF residents and staff without appropriate control measures. Cancelling visits, communal dining and group activities, restricting new admissions, and increasing vaccination would significantly reduce the infection rates.
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Affiliation(s)
- Jun Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium.,The Research Center for Medical Sociology, Tsinghua University, 100084 Beijing, China
| | - Yushan Yu
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Xiaomei Pei
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 050017 Shijiazhuang, Hebei, China
| | - Qing-Bao Tian
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, 710061 Xi'an, Shaanxi, China
| | - Lei Zhang
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne 3053, Australia.,Central Clinical School, Faculty of Medicine, Monash University, Melbourne 3800, Australia.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 450001 Zhengzhou, Henan, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium.,School of Public Health, Université libre de Bruxelles (ULB), Bruxelles 1070, Belgium
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Paap KC, van Loon AM, Koene FM, van Buul LW, Jurriaans S, Smalbrugge M, de Jong MD, Hertogh CMPM. Clinical evaluation of single-swab sampling for rapid COVID-19 detection in outbreak settings in Dutch nursing homes. Eur Geriatr Med 2022; 13:711-718. [PMID: 34797552 PMCID: PMC8602523 DOI: 10.1007/s41999-021-00584-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/01/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE To assess whether one swab can be used to perform both the antigen-detection rapid diagnostic test (Ag-RDT) and reverse transcriptase polymerase chain reaction (RT-PCR) for COVID-19 detection during an outbreak in the nursing home (NH) setting. METHODS The single-swab method (SSM), where the Ag-RDT is performed with the transport medium used for RT-PCR, was evaluated in three Dutch NHs and compared to the laboratory setting. We collected Ag-RDT and RT-PCR results, NH resident characteristics and symptomatology. In addition, two focus groups were held with the involved care professionals to gain insight into the feasibility of the SMM in the NH setting. RESULTS In the NH setting, the SSM had a sensitivity of 51% and a specificity of 89% compared to RT-PCR. These were lower than in the laboratory setting (69% and 100% respectively). Yet, when stratified for cycle threshold values, the sensitivity became comparable between the settings. Symptoms occurred more frequent in the Ag-RDT+ group than Ag-RDT- group. Resident characteristics did not differ between these groups. Based on the focus groups, the SSM was feasible to perform if certain requirements, such as availability of staff, equipment and proper training, were met. However, the rapid availability of the test results were perceived as a dilemma. CONCLUSION The advantages and disadvantages need to be considered before implementation of the SSM can be recommended in the NH setting. For the vulnerable NH residents, it is important to find the right balance between effective testing policy and the burden this imposes.
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Affiliation(s)
- Kelly C Paap
- Department of Medicine for Older People, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Amsta Healthcare Organization, Amsterdam, The Netherlands
| | - Anouk M van Loon
- Department of Medicine for Older People, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Fleur M Koene
- Department of Medical Microbiology, Amsterdam University Medical Center, 1105 AZ, Amsterdam, The Netherlands
- Public Health Laboratory, Department of Infectious Diseases, Public Health Service of Amsterdam, 1018 WT, Amsterdam, The Netherlands
| | - Laura W van Buul
- Department of Medicine for Older People, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Suzanne Jurriaans
- Department of Medical Microbiology, Amsterdam University Medical Center, 1105 AZ, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology, Amsterdam University Medical Center, 1105 AZ, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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