COVID-19 Outbreaks in Nursing Homes Despite Full Vaccination with BNT162b2 of a Majority of Residents.

BACKGROUND: It is not known if widespread vaccination can prevent the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in subpopulations at high risk, like older adults in nursing homes (NH). OBJECTIVE: The objective of the study was to know if coronavirus disease 2019 (COVID-19) outbreaks can occur in NH with high vaccination coverage among its residents. METHODS: We identified, using national professional networks, NH that suffered COVID-19 outbreaks despite having completed a vaccination campaign, and asked them to send data, using predefined collecting forms, on the number of residents exposed, their vaccination status and the number, characteristics, and evolution of patients infected. The main outcome was to identify outbreaks occurring in NH with high vaccine coverage. Secondary outcomes were residents' risk of being infected, developing severe disease, or dying from COVID-19 during the outbreak. SARS-CoV-2 infection was defined by a positive reverse transcriptase-polymerase chain reaction. All residents were serially tested whenever cases appeared in a facility. Unadjusted secondary attack rates, relative risks, and vaccine effectiveness during the outbreak were estimated. RESULTS: We identified 31 NH suffering an outbreak during March-April 2021, of which 27 sent data, cumulating 1,768 residents (mean age 88.4, 73.4% women, 78.2% fully vaccinated). BNT162b2 was the vaccine employed in all NH. There were 365 cases of SARS-CoV-2 infection. Median secondary attack rates were 20.0% (IQR 4.4%-50.0%) among unvaccinated residents and 16.7% (IQR 9.5%-29.2%) among fully vaccinated ones. Severe cases developed in 42 of 80 (52.5%) unvaccinated patients, compared with 56 of 248 (22.6%) fully vaccinated ones (relative risks [RR] 4.17, 95% CI: 2.43-7.17). Twenty of the unvaccinated patients (25.0%) and 16 of fully vaccinated ones (6.5%) died from COVID-19 (RR 5.11, 95% CI: 2.49-10.5). Estimated vaccine effectiveness during the outbreak was 34.5% (95% CI: 18.5-47.3) for preventing SARS-CoV-2 infection, 71.8% (58.8-80.7) for preventing severe disease, and 83.1% (67.8-91.1) for preventing death. CONCLUSIONS: Outbreaks of COVID-19, including severe cases and deaths, can still occur in NH despite full vaccination of a majority of residents. Vaccine remains highly effective, however, for preventing severe disease and death. Prevention and control measures for SARS-CoV-2 should be maintained in NH at periods of high incidence in the community.

Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study.

BACKGROUND: Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. OBJECTIVE: This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. METHODS: This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. RESULTS: The protocol (2019-11-22) has been approved by the Comité de Protection des Personnes Nord-Ouest I-Université de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. CONCLUSIONS: The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24665.

First-Dose Coronavirus 2019 Vaccination Coverage among the Residents of Long-Term Care Facilities in France.

BACKGROUND: Long-term care facilities (LTCFs) experienced severe burden from the Coronavirus 2019 (COVID-19), and vaccination against SARS-CoV-2 is a major issue for their residents. OBJECTIVE: The objective of this study was to estimate the vaccination coverage rate among the residents of French LTCFs. METHOD: Participants and settings: 53 medical coordinators surveyed 73 LTCFs during the first-dose vaccination campaign using the BNT162b2 vaccine, conducted by health authorities in January and early February 2021. MEASUREMENTS: in all the residents being in the LTCF at the beginning of the campaign, investigators recorded age, sex, history of clinical or asymptomatic COVID-19, serology for SARS-CoV-2 or severe allergy, current end-of-life situation, infectious or acute disease, refusal of vaccination by the resident or by the representative person of vaccine, and the final status, vaccinated or not. RESULTS: Among the 4,808 residents, the average coverage rate for COVID-19 vaccination was 69%, and 46% of the LTCFs had a coverage rate <70%. Among unvaccinated residents, we observed more frequently a history of COVID-19 or a positive serology for SARS-CoV-2 (44.6 vs. 11.2% among vaccinated residents, p < 0.001), a history of severe allergy (3.7 vs. 0.1%, p < 0.001), end-of-life situation (4.9 vs. 0.3%, p < 0.001), current infectious or acute illness (19.6 vs. 0.3%, p < 0.001), and refusal of vaccination by residents or representative persons (38.9 vs. 0.4%, p < 0.001). CONCLUSIONS: About 3 out of 10 residents remained unvaccinated, and half of the LTCFs had a coverage rate <70%. This suggests that COVID-19 will remain a threat to many LTCFs after the vaccination campaigns.

Chronology of COVID-19 Symptoms in Very Old Patients: Study of a Hospital Outbreak.

BACKGROUND: We wanted to better understand the frequency and temporal distribution of symptoms of COVID-19 in very old patients, which are currently not well defined. METHODS: In an observational, descriptive study, we followed all patients being at three geriatric convalescence and rehabilitation units when a COVID-19 outbreak emerged in those units in March 2020. For those who developed the disease, we recorded any new symptom occurring at diagnosis, in the previous 14 and the following 21 days. A group of SARS-Cov-2-negative patients served as controls. RESULTS: Sixty-nine of the 176 inpatients (mean age: 86 years) were infected by SARS-Cov-2 during the outbreak. At the moment of diagnosis, a majority of patients had fever (71.0%), malaise-asthenia (24.6%), or respiratory symptoms (66.7%). However, 48 patients (69.6% of all SARS-Cov-2 positive patients) also presented, usually several days before, other symptoms: (a) gastrointestinal symptoms (39.1% of all patients, median onset eight days before diagnosis, IQR -9 to +3 days); (b) neurological symptoms (30.4% of all patients, median onset five days before diagnosis, IQR -11 to -3 days), notably delirium (24.6%); and (c) other symptoms, like falls and unexplained decompensation of chronic conditions (29.0% of all patients, median onset four days before diagnosis, IQR -10 to 0). None of those symptoms were observed in similar proportion in 25 control SARS-CoV-2-negative patients, hospitalized during the same period. CONCLUSIONS: Diarrhea, nausea-vomiting, delirium, falls, and unexplained decompensation of chronic conditions were the first symptoms of COVID-19 in a majority of older patients in this cohort, preceding typical symptoms by several days. Recognizing those early symptoms could hasten the diagnosis of COVID-19 in this population.

Coronavirus Disease 2019 in French Residential Care Facilities: A Nationwide Study.

OBJECTIVES: The Coronavirus 2019 (COVID-19) pandemic caused a considerable mortality in long-term care facilities (LTCFs), including residential care setting and nursing homes. This study aimed to estimate COVID-19 incidence and mortality in residential care facilities and to compare them with those recorded in nursing homes. DESIGN: Nationwide observational study conducted by French health authorities. SETTINGS AND PARTICIPANTS: Since March 1, 2020, all LTCFs in France reported all COVID-19 cases and COVID-19-related deaths among their residents. METHODS: Possible cases were those with COVID-19-related symptoms without laboratory confirmation and confirmed cases those with a reverse transcriptase polymerase chain reaction test or serology positive for SARS-CoV-2. We included facilities with at least 1 confirmed case of COVID-19 and estimated the cumulative incidence of COVID-19 cases and mortality due to COVID-19 reported until June 30, 2020, using the maximum bed capacity as a denominator. RESULTS: Of the 2288 residential care facilities, 310 (14%) and, of the 7688 nursing homes, 3110 (40%) reported COVID-19 cases among residents (P < .001). The cumulative incidence of COVID-19 was significantly lower in residential care facilities as compared with nursing homes (1.10 vs 9.97 per 100 beds, P < .001). Mortality due to COVID-19 was also lower in residential care facilities compared with nursing homes (0.07 vs 1.29 per 100 beds, P < .001). Case fatality was lower in residential care facilities (6.49% vs 12.93%, P < .001). CONCLUSION AND IMPLICATIONS: French residential care facilities experienced a much lower burden from COVID-19 than nursing homes. Our findings may inform the implementation of better infection control practices in these settings.

[Confinement of staff with residents in nursing homes: a solution against COVID-19?] / Confinement du personnel d'Ehpad avec les résidents : une solution contre le Covid-19 ?

The Coronarovirus disease 2019 (Covid-19) outbreak strongly affected nursing and was responsible for a high mortality rate. During the pandemic of March-May 2020, 17 French nursing homes organized staff confinement periods with residents 24 hours a day and 7 days a week, to reduce the risk of entry of the SARS-CoV-2 virus into their facilities, in a context where visits to residents were prohibited. By means of a telephone survey of their directors, we observed that 16 nursing homes (94%) had no cases of COVID-19 among the residents, and that mortality from COVID-19 was very low compared to that recorded at the national level by Santé publique France (p<10-4). Moreover, the number of cases of Covid-19 among the staff of these nursing homes was also lower than that recorded by Santé publique France (p<10-4). These establishments experienced certain difficulties which the directors managed to overcome and the investment of these teams was widely appreciated by the families of the residents and through the press.

Coronavirus Disease 2019 Outcomes in French Nursing Homes That Implemented Staff Confinement With Residents.

IMPORTANCE: Coronavirus disease 2019 (COVID-19) is a major threat to nursing homes. During the COVID-19 pandemic wave that hit France in March and April 2020, staff members of some French nursing homes decided to confine themselves with their residents on a voluntary basis to reduce the risk of entry of the severe acute respiratory syndrome coronavirus 2 into the facility. OBJECTIVE: To investigate COVID-19-related outcomes in French nursing homes that implemented voluntary staff confinement with residents. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted in French nursing homes from March 1 to May 11, 2020. Participants included residents and staff members of the nursing homes where staff participated in voluntary self-confinement as well as those of the facilities for elderly people where staff did not practice self-confinement. Rates of COVID-19 cases and mortality in the cohort of nursing homes with self confinement were compared with those derived from a population-based survey of nursing homes conducted by French health authorities. EXPOSURES: Nursing homes with staff who self-confined were identified from the media and included if the confinement period of staff with residents was longer than 7 days. MAIN OUTCOMES AND MEASURES: Mortality related to COVID-19 among residents and COVID-19 cases among residents and staff members. COVID-19 was diagnosed by primary care or hospital physicians on the basis of fever and respiratory signs (eg, cough, dyspnea) or a clinical illness compatible with COVID-19; COVID-19 diagnoses were considered confirmed if real-time reverse transcriptase-polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 on nasopharyngeal swab was positive and considered possible if the test had not been performed or results were negative. Cases of COVID-19 were recorded by a telephone interview with the directors of nursing homes with staff who self-confined and by a nationwide declaration survey to health authorities for all facilities. RESULTS: This study included 17 nursing homes in which 794 staff members confined themselves to the facility with their 1250 residents. The national survey included 9513 facilities with 385 290 staff members and 695 060 residents. Only 1 nursing home with staff who self-confined (5.8%) had cases of COVID-19 among residents, compared with 4599 facilities in the national survey (48.3%) (P < .001). Five residents (0.4%) in the nursing homes with staff who self-confined had confirmed COVID-19, compared with 30 569 residents (4.4%) with confirmed COVID-19 in the national survey (P < .001); no residents of facilities with self-confinement had possible COVID-19, compared with 31 799 residents (4.6%) with possible COVID-19 in the national survey (P < .001). Five residents (0.4%) in the nursing homes with staff who self-confined died of COVID-19, compared with 12 516 (1.8%) in the national survey (odds ratio, 0.22; 95% CI, 0.09-0.53; P < .001). Twelve staff members (1.6%) from the facilties with self-confinement had confirmed or possible COVID-19, compared with 29 463 staff members (7.6%) in the national survey (P < .001). CONCLUSIONS AND RELEVANCE: In this cohort study of French nursing homes during the COVID-19 pandemic, mortality rates related to COVID-19 were lower among nursing homes that implemented staff confinement with residents compared with those in a national survey. These findings suggest that self-confinement of staff members with residents may help protect nursing home residents from mortality related to COVID-19 and residents and staff from COVID-19 infection.