Assessing COVID-19 Vaccine Effectiveness in Frail Long-Term Care Facilities Residents in a Middle-Income Country (preprint)

Background: During the COVID-19 pandemic, individuals residing in long-term care facilities (LTCF) are particularly vulnerable to adverse outcomes due to their higher rates of frailty, disabilities, cognitive impairment, dementia, and chronic illnesses. In low and middle-income nations, research on immunizing frail populations is lacking, while most studies on COVID-19 in LTCF come from wealthier nations and may not fully capture the situation in emerging countries.  Methods: We aimed to evaluate the effectiveness of first, second and third COVID-19 vaccine doses, against infections, hospitalizations, and deaths, and their association with frailty, age, sex and chronic disease, among older adults, in a social vulnerability context. This retrospective cohort study, comprises a total of 712 older adults, in a social vulnerability context, of 29 LTCF, in Brazil. Continuous variables were described by medians and interquartile ranges and categorical variables were represented by absolute and relative frequencies. The Mann-Whitney test was used. For evaluating the relation between categorical variables, Pearson's chi-square test was used. When comparing proportions, the Z test of proportion was applied. A significance level of 5% was considered.  Results: Median age was 81.37 years, 72.8% were female, 94.61% were frail, 79.97% had a cognitive impairment, 69.54% had a mobility impairment, 78.37% have, at least, one chronic disease and 72.73% use five or more medications per day. Before the vaccine, mobility impairment was associated with great contamination rates (p=.03); frailty (p=.02) and previous pulmonary disease (p=.03) with symptoms of gravity; frailty (p=.02), pulmonary disease (p=.04) and male sex (p=.02) with emergency care or hospital admission. After the third vaccine dose, only frailty remains associated with admissions (p=.03). The number of positive cases (p=.001), symptomatic patients (p<.001), admissions (p=.001) and deaths (p<.001) were substantially reduced after the three vaccine doses.  Conclusions and Implications: Even in a frail population, the vaccine was effective, in the reduction of positive cases, the number of symptomatic patients, admission to emergency or hospital care and deaths. Before the vaccine, frailty, previous pulmonary disease and male sex were associated with worse outcomes. After the vaccine, frailty remains associated with a major number of admissions.

Estimates of the impact of COVID-19 on mortality of institutionalized elderly in Brazil

Resumo O presente estudo tem como objetivo estimar o impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil. Foram estimados números de óbitos pela doença para o País, Unidades da Federação e Regiões, com base nas estimativas calculadas e efetuadas neste trabalho do percentual de óbitos de idosos que ocorreriam em instituições de longa permanência de acordo com os totais. Essa estimativa foi baseada em informações disponíveis para uma série de países. O percentual ponderado foi de 44,7%. Estimaram-se 107.538 óbitos de idosos nestas instituições no Brasil em 2020, por COVID-19. São previstos maiores números de óbitos na Região Sudeste (48.779 óbitos), seguida da Região Nordeste (28.451 óbitos);São Paulo é a Unidade da Federação que na estimativa será mais afetada (24.500 óbitos). Fica claro o forte impacto da COVID-19 na população idosa residente em instituições de longa permanência para idosos. As estimativas ultrapassam para o país 100 mil idosos, potencialmente os mais frágeis e vulneráveis, e são baseadas em número de óbitos totais conservador, tendo em vista outras estimativas e a situação alarmante de crescimento dos números de óbitos no Brasil. The COVID-19 pandemic poses difficulties for long-term care institutions for the elderly, with increased mortality rates for the residents. This study aims to estimate the impact of COVID-19 on mortality of institutionalized elderly in Brazil. Estimates of the percentage of elderly deaths occurring in care homes were calculated for Brazil, States and Regions using estimates for the total number of deaths. The estimation was based upon information available for other countries. The weighted percentage was 44.7% and 107,538 COVID-19 deaths were estimated for the elderly in these institutions in Brazil in 2020. Higher numbers of deaths were expected in the Southeast Region (48,779 deaths), followed by the Northeast Region (28,451 deaths);São Paulo was the most affected State (24,500 deaths). The strong impact of COVID-19 on the elderly population living in long-term care facilities is clear. Estimates for the country exceeded 100,000 elderly people, potentially the most fragile and vulnerable, and are based upon a conservative number of total deaths, in view of other estimates and the alarming situation of death growth in Brazil from COVID-19.