Build an Agent-Based Model for COVID-19 Effect of Mitigation Policies

Non-Drug Intervention (NDI) is one of the important means to prevent and control the outbreak of coronavirus disease 2019 (COVID-19), and the implementation of this series of measures plays a key role in the development of the epidemic. The purpose of this paper is to study the impact of different mitigation measures on the situation of the COVID 19, and effectively respond to the prevention and control situation in the "post-epidemic era". The present work is based on the Susceptible-Exposed-Infectious-Remove-Susceptible (SEIRS) Model, and adapted the agent-based model (ABM) to construct the epidemic prevention and control model framework to simulate the COVID-19 epidemic from three aspects: social distance, personal protection, and bed resources. The experiment results show that the above NDI are effective mitigation measures for epidemic prevention and control, and can play a positive role in the recurrence of COVID-19, but a single measure cannot prevent the recurrence of infection peaks and curb the spread of the epidemic;When social distance and personal protection rules are out of control, bed resources will become an important guarantee for epidemic prevention and control. Although the spread of the epidemic cannot be curbed, it can slow down the recurrence of the peak of the epidemic;When people abide by social distance and personal protection rules, the pressure on bed resources will be eased. At the same time, under the interaction of the three measures, not only the death toll can be reduced, but the spread of the epidemic can also be effectively curbed. © 2022 ACM.

Multizone Modelling of SARS-CoV-2 Airborne Transmission in Mechanically Ventilated Buildings

This study contributes to a better understanding of the airborne transmission risks in multizone, mechanically ventilated buildings and how to reduce infection risk. A novel modeling approach combining the Wells-Riley and the US National Institute of Standards and Technology (NIST) CONTAM models was applied to a multizone whole building to simulate exposure and assess the effectiveness of different mitigation measures. A case study for the US Department of Energy large office prototype building was conducted to illustrate the approach. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

Managing indoor air quality in nursery and primary schools with low-cost solutions

This study aimed to evaluate the feasibility of using low-cost solutions to monitor and mitigate PM2.5 and PM10 concentrations in nursery and primary schools in Porto (Portugal). Three periods were considered: i) early 2020 (before COVID-19 pandemic), ii) early 2021 (during COVID-19 pandemic, with mitigation measures to prevent SARS-CoV-2 spread);and iii) in the middle of 2021 (additionally using a low-cost portable air cleaner). PM2.5 and PM10 were continuously monitored with a low-cost sensing device for at least two consecutive days in five classrooms. In general, the lowest PM concentrations were observed in the third period. Concentrations reduced up to 63% from the second to the third period. The application of low-cost solutions for monitoring and mitigating PM levels seems to be an effective tool for managing indoor air in schools. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

Contactless digital financial innovation and global contagious COVID-19 pandemic in low income countries: Evidence from Uganda

Since its outbreak, Covid-19 has led to upsurge in economic inactivity, leaving many households and firms without access to and use of basic services including financial services. Specifically, with the lockdown and curfew, most traditional bank branches remained closed, leaving households without access to quality, affordable, convenient, and safe financial services. This study aims to establish whether contactless digital financial innovation like mobile money can promote access to and use of financial services in the presence of pandemic positive emotions in low-income countries. SmartPLS 3.0 was used to construct the structural equation mediation model with bootstrap based on 2,737 valid responses. It was found that contactless digital financial innovation such as mobile money significantly promotes access to and use of financial services in low-income countries under pandemic situation. Additionally, the findings showed that the use of contactless digital financial innovation promotes Covid-19 standard operating procedures in low-income countries. Cognizant to the role of human behaviour in technology adoption and usage, the structural equation model with bootstrapping revealed a 4 percentage points improvement in Covid-19 standard operating procedures due to the use of contactless mobile money channel. Accordingly, the findings could be useful in the following ways: governments in low-income countries may use it to promote public health concern under pandemic situations. Mobile money can allow individuals to store, send, and receive money during situation of limited or no movements caused by pandemic health restrictions. Besides, the use of contactless digital financial innovation may promote digital commerce in low-income countries under the pandemic situation. Similarly, mobile money can be used to promote government-to-person, person-to-person, person-to-business, and business-to-person payments under emergency situations. The findings may also help governments in low-income countries to rethink about taxes levied on mobile money. © 2023 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.

Cross-Theoretical Compliance: An Integrative Compliance Analysis of COVID-19 Mitigation Responses in Israel

To understand the question why people obey or break rules, different approaches have focused on different theories and subsets of variables. The present research develops a cross-theoretical approach that integrates these perspectives. We apply this in a survey of compliance with COVID-19 pandemic mitigation rules in Israel. The data reveal that compliance in this setting was shaped by a combination of variables originating from legitimacy, capacity, and opportunity theories (but not rational choice or social theories). This demonstrates the importance of moving beyond narrow theoretical perspectives of compliance, to a cross-theoretical understanding—in which different theoretical approaches are systematically integrated.

COVID-19 mitigation measures increase preterm birth and low birth weight in the public healthcare system in Uruguay.

OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on preterm birth (PB) and low birth weight (LBW), comparing public and private healthcare systems of the National Integrated Health System in Uruguay, where the mitigation measures for the COVID-19 pandemic generated an immediate socioeconomic and psychological crisis, which caused a sharp widening of existing socioeconomic inequalities. METHODS: A national observational study was conducted comparing perinatal outcomes in the first 6 months of 2020 (period of the pandemic without pregnancy infections), which was the beginning of the pandemic, with the same period of the previous year 2019 (pre-pandemic period with no mitigation measures) among pregnant women from the public and private health systems. Data were retrieved from the national database (Informatic Perinatal System) and analyzed by healthcare system category. RESULTS: A total of 36 559 deliveries were assessed: 18 563 in the 2019 study period and 17 996 in the 2020 study period. In the public system, there was a significant increase in the risk of LBW (adjusted relative risk [aRR] 1.12, 95% confidence interval [CI] 1.05-1.36) and of the composite outcome (PB or LBW) (aRR 1.15, 95% CI 1.04-1.26). In the private system, by contrast, there was a non-statistically significant decrease of LBW and there were no changes in the incidence of PB and the composite outcome in 2020. CONCLUSION: The different evolution of birth outcomes in the public and private systems suggests an unequal impact of mitigation measures on populations of different socioeconomic levels. Given that no COVID-19 infections were identified in pregnant women during the study period, this research offers an opportunity to differentiate the biologic effects of the virus from the psychological and social impacts derived from containment measures. GOV IDENTIFIER: NCT05087160.

Assessing Transmission Risks of SARS-COV-2 Omicron Variant In U.S. School Facilities and Mitigation Measures

The emergence of the SARS-CoV-2 Omicron variant raises concerns for school operations worldwide. The Omicron variant spread faster than other variants that cause COVID-19, and breakthrough infections are reported in vaccinated people. Schools are hotbeds for the transmission of the highly contagious virus. Therefore it is crucial to understand the risks of Omicron transmission and the effectiveness of different measures to prevent the surge of infection cases. This study estimates the risks of airborne transmission and fomite transmission of Omicron variants using simulations and the data of 11,485 public and private schools in the U.S. It also analyzes the impact of different mitigation measures on limiting airborne transmission and fomite transmission risks in schools. It was found that the Omicron variant caused relatively high infection risks in schools. The risk of airborne transmission is nine times higher than fomite transmission. The effective mitigation measures can significantly decrease the transmission risk. © 2022 IEEE.

Impacts of COVID-19 on small-scale freshwater carp and coastal brackish water shrimp farming in India

The present study was simultaneously conducted in two distantly located areas to assess the impacts of COVID-19 on farming processes, instantaneous financial impacts and mitigation strategies adopted by the farmers in the small scale freshwater carp farming and coastal brackish water shrimp farming sectors in India. Primary data were collected through interview of the farmers with the help of pre-tested structured interview schedules. Though the initial impact in both the sectors were substantial, freshwater carp farmers mitigated the crises comparatively well because of wider option in alternative livelihood, low cost locally available inputs, mobilization of local market, direct door to door vending of live fish and mobilization of women work force from the family in the farming sector. Untapped resource in the form of women's' participation in the freshwater farming practices was noteworthy during the pandemic period which increased polynomially (y = - 1.0714x2 + 7.5286x -2.2;R2 = 0.9648). As the shrimp farming sector was dependent upon external markets and burdened with high cost inputs primarily supplied by the input dealers on credit basis, the sector has to bear the burden most. Garret's Rank analysis revealed that integration with other production sectors ranked first as mitigation perception to the freshwater carp farmers, whereas, to the coastal shrimp farmers, the highest rank was with the perception that everything will be normalized within 2- 3 months naturally. Garret's Rank analysis also revealed that in both the sectors, the farmers most important need was credit from the Govt. source in mitigating COVID-19 like crisis in future. © D. Hait.

Evaluating the Covid-19 Screening Regime for Cross-Border Workers

Global travel and trade have been hit hard by the COVID-19 pandemic. Border closures have impacted both leisure and business travel. The socioeconomic costs of border closure are particularly severe for individuals living and working across state lines, for which previously unhindered passage has been curtailed, and daily commute across borders is now virtually impossible. Here, we examine how the periodic screening of daily cross-border commuters across territories with relatively low COVID-19 incidence will impact the transmission of SARS-CoV-2 across borders using agent-based simulation. We find that periodic testing at practical frequencies of once every 7, 14 or 21 days would reduce the number of infected individuals crossing the border. The unique transmission characteristics of SARS-CoV-2 suggest that periodic testing of populations with low incidence is of limited use in reducing cross-border transmission and is not as cost-effective as other mitigation measures for preventing transmission. © 2022 IEEE.

Driving Factors of Polarization on Twitter During Protests Against COVID-19 Mitigation Measures in Vienna

We conduct the analysis of the Twitter discourse related to the anti-lockdown and anti-vaccination protests during the so-called 4th wave of COVID-19 infections in Austria (particularly in Vienna). We focus on predicting users' protest activity by leveraging machine learning methods and individual driving factors such as language features of users supporting/opposing Corona protests. For evaluation of our methods we utilize novel datasets, collected from discussions about a series of protests on Twitter (40488 tweets related to 20.11.2021;7639 from 15.01.2022 – the two biggest protests as well as 192 from 22.01.2022;8412 from 11.12.2021;3945 from 11.02.2022). We clustered users via the Louvain community detection algorithm on a retweet network into pro- and anti-protest classes. We show that the number of users engaged in the discourse and the share of users classified as pro-protest are decreasing with time. We have created language-based classifiers for single tweets of the two protest sides – random forest, neural networks and a regression-based approach. To gain insights into language-related differences between clusters we also investigated variable importance for a word-list-based modeling approach. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Projection of healthcare demand in Germany and Switzerland urged by Omicron wave (January-March 2022).

In January 2022, after the implementation of broad vaccination programs, the Omicron wave was propagating across Europe. There was an urgent need to understand how population immunity affects the dynamics of the COVID-19 pandemic when the loss of vaccine protection was concurrent with the emergence of a new variant of concern. In particular, assessing the risk of saturation of the healthcare systems was crucial to manage the pandemic and allow a transition towards the endemic course of SARS-CoV-2 by implementing more refined mitigation strategies that shield the most vulnerable groups and protect the healthcare systems. We investigated the epidemic dynamics by means of compartmental models that describe the age-stratified social-mixing and consider vaccination status, type, and waning of the efficacy. In response to the acute situation, our model aimed at (i) providing insight into the plausible scenarios that were likely to occur in Switzerland and Germany in the midst of the Omicron wave, (ii) informing public health authorities, and (iii) helping take informed decisions to minimize negative consequences of the pandemic. Despite the unprecedented numbers of new positive cases, our results suggested that, in all plausible scenarios, the wave was unlikely to create an overwhelming healthcare demand; due to the lower hospitalization rate and the effectiveness of the vaccines in preventing a severe course of the disease. This prediction came true and the healthcare systems in Switzerland and Germany were not pushed to the limit, despite the unprecedentedly large number of infections. By retrospective comparison of the model predictions with the official reported data of the epidemic dynamic, we demonstrate the ability of the model to capture the main features of the epidemic dynamic and the corresponding healthcare demand. In a broader context, our framework can be applied also to endemic scenarios, offering quantitative support for refined public health interventions in response to recurring waves of COVID-19 or other infectious diseases.

Analysis of serological surveys of antibodies to SARS-CoV-2 in the United States to estimate parameters needed for transmission modeling and to evaluate and improve the accuracy of predictions.

Seroprevalence studies can estimate proportions of the population that have been infected or vaccinated, including infections that were not reported because of the lack of symptoms or testing. Based on information from studies in the United States from mid-summer 2020 through the end of 2021, we describe proportions of the population with antibodies to SARS-CoV-2 as functions of age and time. Slices through these surfaces at arbitrary times provide initial and target conditions for simulation modeling. They also provide the information needed to calculate age-specific forces of infection, attack rates, and - together with contact rates - age-specific probabilities of infection on contact between susceptible and infectious people. We modified the familiar Susceptible-Exposed-Infectious-Removed (SEIR) model to include features of the biology of COVID-19 that might affect transmission of SARS-CoV-2 and stratified by age and location. We consulted the primary literature or subject matter experts for contact rates and other parameter values. Using time-varying Oxford COVID-19 Government Response Tracker assessments of US state and DC efforts to mitigate the pandemic and compliance with non-pharmaceutical interventions (NPIs) from a YouGov survey fielded in the US during 2020, we estimate that the efficacy of social-distancing when possible and mask-wearing otherwise at reducing susceptibility or infectiousness was 31% during the fall of 2020. Initialized from seroprevalence among people having commercial laboratory tests for purposes other than SARS-CoV-2 infection assessments on 7 September 2020, our age- and location-stratified SEIR population model reproduces seroprevalence among members of the same population on 25 December 2020 quite well. Introducing vaccination mid-December 2020, first of healthcare and other essential workers, followed by older adults, people who were otherwise immunocompromised, and then progressively younger people, our metapopulation model reproduces seroprevalence among blood donors on 4 April 2021 less well, but we believe that the discrepancy is due to vaccinations being under-reported or blood donors being disproportionately vaccinated, if not both. As experimenting with reliable transmission models is the best way to assess the indirect effects of mitigation measures, we determined the impact of vaccination, conditional on NPIs. Results indicate that, during this period, vaccination substantially reduced infections, hospitalizations and deaths. This manuscript was submitted as part of a theme issue on "Modelling COVID-19 and Preparedness for Future Pandemics."

Understanding public support for COVID-19 pandemic mitigation measures over time: Does it wear out?

Background: COVID-19 mitigation measures intend to protect public health, but their adverse psychological, social, and economic effects weaken public support. Less favorable trade-offs may especially weaken support for more restrictive measures. Support for mitigation measures may also differ between population subgroups who experience different benefits and costs, and decrease over time, a phenomenon termed "pandemic fatigue." Methods: We examined self-reported support for COVID-19 mitigation measures in the Netherlands over 12 consecutives waves of data collection between April 2020 and May 2021 in an open population cohort study. Participants were recruited through community panels of the 25 regional public health services, and through links to the online surveys advertised on social media. The 54,010 unique participants in the cohort study on average participated in 4 waves of data collection. Most participants were female (65%), middle-aged [57% (40-69 years)], highly educated (57%), not living alone (84%), residing in an urban area (60%), and born in the Netherlands (95%). Results: COVID-19 mitigation measures implemented in the Netherlands remained generally well-supported over time [all scores >3 on 5-point scale ranging 1 (low)-5 (high)]. During the whole period studied, support was highest for personal hygiene measures, quarantine and wearing face masks, high but somewhat lower for not shaking hands, testing and self-isolation, and restricting social contacts, and lowest for limiting visitors at home, and not traveling abroad. Women and higher educated people were more supportive of some mitigation measures than men and lower educated people. Older people were more supportive of more restrictive measures than younger people, and support for more socially restrictive measures decreased most over time in higher educated people or in younger people. Conclusions: This study found no support for pandemic fatigue in terms of a gradual decline in support for all mitigation measures in the first year of the pandemic. Rather, findings suggest that support for mitigation measures reflects a balancing of benefits and cost, which may change over time, and differ between measures and population subgroups.

Systematic Review of the Key Factors Influencing the Indoor Airborne Spread of SARS-CoV-2.

The COVID-19 pandemic due to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been plaguing the world since late 2019/early 2020 and has changed the way we function as a society, halting both economic and social activities worldwide. Classrooms, offices, restaurants, public transport, and other enclosed spaces that typically gather large groups of people indoors, and are considered focal points for the spread of the virus. For society to be able to go "back to normal", it is crucial to keep these places open and functioning. An understanding of the transmission modes occurring in these contexts is essential to set up effective infection control strategies. This understanding was made using a systematic review, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA) 2020 guidelines. We analyze the different parameters influencing airborne transmission indoors, the mathematical models proposed to understand it, and discuss how we can act on these parameters. Methods to judge infection risks through the analysis of the indoor air quality are described. Various mitigation measures are listed, and their efficiency, feasibility, and acceptability are ranked by a panel of experts in the field. Thus, effective ventilation procedures controlled by CO2-monitoring, continued mask wearing, and a strategic control of room occupancy, among other measures, are put forth to enable a safe return to these essential places.

Mitigation Measures to Control the Expected Mpox Outbreak in a Developing Country-Pakistani Scenario.

Mpox (previously named Monkeypox) is one of the neglected viral infectious diseases that remained silent for a long period before finally emerging as a threat to the healthcare system in endemic regions of the world in recent years. It has been mostly centered in African countries but has now been reported in other non-endemic regions as well. While keeping a strict eye on COVID pandemic handling, there is a need to remain concerned and alert about viral threats such as Mpox infections in the future. This situation has altered the healthcare system of endemic regions, including Pakistan, to stay vigilant against the expected Mpox outbreaks in the coming months. Though no specific cases have been reported in Pakistan, the healthcare system needs to take mitigation measures to tackle an expected threat before it arrives. This is important in order to avoid another major shock to the health care system of Pakistan. Moreover, since no specific treatment is available for Mpox, we can only rely upon mitigation measures, involving preventive and treatment strategies devised around some already in-use antiviral agents against Mpox viruses. Moreover, there is an imperative need to proactively prepare the healthcare system against Mpox outbreaks, spread awareness, and involve the public in a participatory approach to stay well prepared against any such infection. Moreover, there is a need to utilize financial sources, aids, and funds wisely, to create awareness in the public about such expected healthcare outbreaks in the future.

Using a Dynamic Causal Model to validate previous predictions and offer a 12-month forecast of the long-term effects of the COVID-19 epidemic in the UK.

Background: Predicting the future UK COVID-19 epidemic provides a baseline of a vaccine-only mitigation policy from which to judge the effects of additional public health interventions. A previous 12-month prediction of the size of the epidemic to October 2022 underestimated its sequelae by a fifth. This analysis seeks to explain the reasons for the underestimation before offering new long-term predictions. Methods: A Dynamic Causal Model was used to identify changes in COVID-19 transmissibility and the public's behavioral response in the 12-months to October 2022. The model was then used to predict the future trends in infections, long-COVID, hospital admissions and deaths over 12-months to October 2023. Findings: The model estimated that the secondary attack rate increased from 0.4 to 0.5, the latent period shortened from 2.7 to 2.6 and the incubation period shortened from 2.0 to 1.95 days between October 2021 and October 2022. During this time the model also estimated that antibody immunity waned from 177 to 160 days and T-cell immunity from 205 to 180 days. This increase in transmissibility was associated with a reduction in pathogenicity with the proportion of infections developing acute respiratory distress syndrome falling for 6-2% in the same twelve-month period. Despite the wave of infections, the public response was to increase the tendency to expose themselves to a high-risk environment (e.g., leaving home) each day from 33-58% in the same period.The predictions for October 2023 indicate a wave of infections three times larger this coming year than last year with significant health and economic consequences such as 120,000 additional COVID-19 related deaths, 800,000 additional hospital admissions and 3.5 million people suffering acute-post-COVID-19 syndrome lasting more than 12 weeks. Interpretation: The increase in transmissibility together with the public's response provide plausible explanations for why the model underestimated the 12-month predictions to October 2022. The 2023 projection could well-underestimate the predicted substantial next wave of COVID-19 infection. Vaccination alone will not control the epidemic. The UK COVID-19 epidemic is not over. The results call for investment in precautionary public health interventions.

Validation of a COVID-19 Job Exposure Matrix (COVID-19-JEM) for Occupational Risk of a SARS-CoV-2 Infection at Work: Using Data of Dutch Workers.

OBJECTIVES: A COVID-19 Job Exposure Matrix (COVID-19-JEM) has been developed, consisting of four dimensions on transmission, two on mitigation measures, and two on precarious work. This study aims to validate the COVID-19-JEM by (i) comparing risk scores assigned by the COVID-19-JEM with self-reported data, and (ii) estimating the associations between the COVID-19-JEM risk scores and self-reported COVID-19. METHODS: Data from measurements 2 (July 2020, n = 7690) and 4 (March 2021, n = 6794) of the Netherlands Working Conditions Survey-COVID-19 (NWCS-COVID-19) cohort study were used. Responses to questions related to the transmission risks and mitigation measures of Measurement 2 were used to calculate self-reported risk scores. These scores were compared with the COVID-19-JEM attributed risk scores, by assessing the percentage agreement and weighted kappa (κ). Based on Measurement 4, logistic regression analyses were conducted to estimate the associations between all COVID-19-JEM risk scores and self-reported COVID-19 (infection in general and infected at work). RESULTS: The agreement between the COVID-19-JEM and questionnaire-based risk scores was good (κ ≥ 0.70) for most dimensions, except work location (κ = 0.56), and face covering (κ = 0.41). Apart from the precarious work dimensions, higher COVID-19-JEM assigned risk scores had higher odds ratios (ORs; ranging between 1.28 and 1.80) on having had COVID-19. Associations were stronger when the infection were thought to have happened at work (ORs between 2.33 and 11.62). CONCLUSIONS: Generally, the COVID-19-JEM showed a good agreement with self-reported infection risks and infection rates at work. The next step is to validate the COVID-19-JEM with objective data in the Netherlands and beyond.

Risk factors for COVID-19 among Californians working outside the home, November 2020 - May 2021.

BACKGROUND: Higher incidences of COVID-19 mortality and outbreaks have been found in certain industries and occupations. Workplace factors, including working in close proximity to others and contact with the public can facilitate SARS-CoV-2 transmission, especially without appropriate protective measures. Limited information is available about workers at highest risk for SARS-CoV-2 infection. METHODS: A phone-based, nonprobability study was conducted between November 2020 and May 2021 among California workers who were tested for SARS-CoV-2. Participants were asked about demographics and workplace factors, including industry, occupation, and implementation of COVID-19 mitigation measures. Using the SARS-CoV-2 occupational exposure matrix, three exposure metrics and a combination index were used to categorize occupations. We assessed the association between workplace risks and SARS-CoV-2 test positivity using adjusted logistic regression. RESULTS: We enrolled 451 (13%) of 3475 potentially eligible workers in the study: 212 with positive and 239 with negative SARS-CoV-2 test results. Those working very close to others and with the highest combined exposure index had a positive association with SARS-CoV-2 positivity. Primarily indoor workers had a lower odds of test positivity compared to those with any outdoor work. There was no association between public-facing occupations and test positivity. Participants with employers who implemented mitigation measures in all three control categories-engineering, administrative, and personal protective equipment-had lower odds of test positivity than those with fewer mitigation measures. CONCLUSIONS: Worker groups with higher risk factors should be prioritized for outreach. Assessment of occupational risk factors collectively can provide insight to inform preventative actions for workers, employers, and public health entities.

Assessment of COVID-19 outbreaks in long-term care facilities.

BACKGROUND: The B.1.167.2 (Delta) variant quickly became the predominant circulating SARS-CoV-2 strain in the USA during summer 2021. Missouri identified a high number of outbreaks in long-term care facilities (LTCFs) across the state with low vaccination rates among LTCF staff members and poor adherence to mitigation measures within local communities. AIM: To describe COVID-19 outbreaks that occurred in Missouri LTCFs impacting staff and residents during the surge of the Delta variant. METHODS: Outbreaks of COVID-19 in 178 LTCFs were identified by the Missouri Department of Health and Senior Services. Case data from LTCFs with the highest burden of disease were analysed to assess disease transmission, vaccination status, and outcomes among residents and staff. Additional investigational measures included onsite visits to facilities with recent COVID-19 outbreaks in communities with substantial transmission to assess mitigation measures. FINDINGS: During April 22nd to July 29th, 2021, 159 COVID-19 cases among 72 staff members and 87 residents were identified in 10 LTCFs. More than 74.7% of resident cases were vaccinated compared to 23.6% of staff cases. Vaccinated residents had a lower proportion of hospitalizations and deaths reported compared to unvaccinated residents. Data analysis and contact-tracing efforts from a sample of the facilities suggest that staff members were likely a major factor in introducing SARS-CoV-2 virus into the facilities. Adherence to COVID-19 mitigation measures varied at the visited facilities. CONCLUSION: Data showed that vaccination rates varied between staff cases and resident cases in facilities with high-burden outbreaks. Differences were identified in mitigation practices in at least two facilities.