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1.
Psychiatry Res ; 291: 113294, 2020 09.
Article in English | MEDLINE | ID: covidwho-640985

ABSTRACT

To cope with Covid-19 and limits its spread among residents, retirement homes have prohibited physical contact between residents and families and friend and, in some cases, even between residents or between residents and caregivers. We investigated the effects of measures against Covid-19 on the mental health of participants with Alzheimer's disease (AD) who live in retirement homes in France. We instructed on-site caregivers to assess depression and anxiety in participants with mild AD who live in retirement homes. Fifty-eight participants consented to participate in the study. The participants rated their depression and anxiety during and before the Covid-19 crisis. Participants reported higher depression (p = .005) and anxiety (p = .004) during than before the Covid-19 crisis. These increases can be attributed to the isolation of the residents and/or to the drastic changes in their daily life and care they receive. While, in their effort to prevent infections, retirement homes are forced to physically separate residents from the outside world and to drastically reduce residents' activities, these decisions are likely to come at a cost to residents with AD and their mental health.


Subject(s)
Alzheimer Disease/complications , Anxiety/diagnosis , Coronavirus Infections , Depression/diagnosis , Homes for the Aged , Pandemics , Pneumonia, Viral , Aged , Aged, 80 and over , Alzheimer Disease/psychology , Anxiety/complications , Anxiety/psychology , Betacoronavirus , Caregivers , Depression/complications , Depression/psychology , Female , France , Humans , Male , Nursing Homes , Severity of Illness Index
2.
Monaldi Arch Chest Dis ; 90(3)2020 Sep 02.
Article in English | MEDLINE | ID: covidwho-740518

ABSTRACT

Lung Ultrasound (LUS) is regarded to be potentially useful to diagnose lung injury in older adults living in nursing homes with suspected COVID-19 pneumonia. We aimed at evaluating presence lung injury among senior nursing home residents by LUS performed with portable wireless scanner echography. The study population consisted of 150 residents with a mean age of 88 years (85% female) residing in 12 nursing homes in Northern Italy. Subjects had to have a history of recent onset of symptoms compatible with COVID-19 pneumonia or have been exposed to the contagion of patients carrying the disease. COVID-19 testing was performed with SARS-CoV-2 nasal-pharyngeal (NP) swabs. Positive subjects to LUS scanning were considered those with non-coascelent B-lines in >3 zones, coalescent B-lines in >3 zones and with iperdensed patchy non-consolidated lungs. Sixty-three percent had positive NP testing and 65% had LUS signs of pulmonary injury. LUS had a sensitivity of 79% in predicting positive NP testing. Sixteen percent of residents tested negative for SARSCoV-2 carried the signs of COVID-19 lung injury at LUS. There were 92 patients (61%) with current or recent symptoms.Positivity to LUS scanning was reported in 73% of residents with symptoms, while it was 53% in those without (P=0.016). A positive NP testing was observed in 66% of residents with symptoms and in 57% of those without (P=0.27). We conclude that assessment of LUS by portable wireless scanner echography can be profitability utilized to diagnose lung injury among senior nursing home residents with or without symptoms compatible with COVID-19 pneumonia.


Subject(s)
Coronavirus Infections , Lung Injury/diagnostic imaging , Pandemics , Pneumonia, Viral/diagnosis , Point-of-Care Testing , Ultrasonography , Aged, 80 and over , Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Female , Homes for the Aged/statistics & numerical data , Humans , Italy/epidemiology , Male , Nursing Homes/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Predictive Value of Tests , Sensitivity and Specificity , Ultrasonography/instrumentation , Ultrasonography/methods , Wireless Technology
3.
Cien Saude Colet ; 25(9): 3445-3458, 2020 Sep.
Article in English, Portuguese | MEDLINE | ID: covidwho-740438

ABSTRACT

An infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the 2019 Novel Coronavirus Disease (COVID-19) pandemic has unveiled a hitherto hidden reality: the vulnerability of the population living in long-term care facilities for the elderly (LTCF). To date, several scientific publications have revealed a concentration of up to 60% of deaths attributed to COVID-19 in such institutions. Most LTFC residents share the primary risk factors currently associated with increased morbimortality due to the COVID-19 infection. It is crucial to define actions to prevent SARS-CoV-2 spread in this environment, besides the usual measures of social distancing and isolation of the carriers of this disease. This paper proposes strategies for the investigation of this infection in LTCF residents and workers using laboratory tests available in Brazil. The early identification of individuals with SARS-CoV-2, who may actively and continuously spread the virus, allows adopting measures aimed at interrupting the local transmission cycle of this infection.


Subject(s)
Clinical Laboratory Techniques , Coronavirus Infections/epidemiology , Homes for the Aged/statistics & numerical data , Mass Screening/methods , Pneumonia, Viral/epidemiology , Aged , Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/prevention & control , Health Personnel , Humans , Long-Term Care , Pandemics/prevention & control , Pneumonia, Viral/mortality , Pneumonia, Viral/prevention & control , Vulnerable Populations
4.
Cien Saude Colet ; 25(9): 3437-3444, 2020 Sep.
Article in English, Portuguese | MEDLINE | ID: covidwho-740426

ABSTRACT

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.


Subject(s)
Coronavirus Infections/mortality , Homes for the Aged/statistics & numerical data , Long-Term Care , Pneumonia, Viral/mortality , Aged , Aged, 80 and over , Brazil/epidemiology , Computer Simulation , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Humans , Institutionalization/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology
5.
Tidsskr Nor Laegeforen ; 140(11)2020 08 18.
Article in English, Norwegian | MEDLINE | ID: covidwho-724817

ABSTRACT

BACKGROUND: Nursing home residents are generally old and frail, and at high risk that COVID-19 will take a serious course. Outbreaks of COVID-19 have not previously been described in Norway, and it is important to identify mechanisms for spread of the infection and course of disease for nursing home residents with this pandemic disease. MATERIAL AND METHOD: We included residents from three nursing homes with outbreaks of COVID-19 in a retrospective observational study, and we retrieved information on the number of staff for whom SARS-CoV-2 was confirmed or who were placed in quarantine. We present resident characteristics, course of disease and mortality associated with COVID-19 in the nursing homes, as well as providing a brief description of the outbreaks. RESULTS: Forty residents were included, 26 of whom were women. The average age was 86.2 years. Thirty-seven of the residents had atypical symptoms, nine of them were asymptomatic at the time of diagnosis, and 21 died during the coronavirus infection. Contact tracing indicated that the outbreaks may have originated from staff in the pre-symptomatic or early and mild phase of the disease. SARS-CoV-2 was detected in forty-two staff members, and a further 115 were placed in quarantine. INTERPRETATION: Many residents had atypical disease presentation, and the mortality from COVID-19 was high. Spread of infection may have originated from staff, also before they displayed obvious symptoms, and contributed to extensive spread of SARS-CoV-2 in the three nursing homes.


Subject(s)
Coronavirus Infections/epidemiology , Homes for the Aged/statistics & numerical data , Nursing Homes/statistics & numerical data , Pneumonia, Viral/epidemiology , Aged, 80 and over , Betacoronavirus , Disease Outbreaks , Female , Humans , Male , Norway/epidemiology , Pandemics , Retrospective Studies
6.
Semergen ; 46 Suppl 1: 26-34, 2020 Aug.
Article in Spanish | MEDLINE | ID: covidwho-724076

ABSTRACT

Rest homes for the elderly have been particularly hit during the crisis due the current COVID-19 pandemic. At the time of writing this article, more than 17,500 elderly people that lived in Care Homes have died due to coronavirus, more than 66% of the deaths. The infection and mortality rates in the institutionalised population are high. This is due to the advanced age, immune system deficit, and the presence of comorbidities, as well as because there are frail, because they live with other residents and carers in a closed institution, and transmission is easy in the context of a highly contagious and virulent virus. The elderly often have more severe forms of the disease. Atypical presentations are more frequent in the elderly and can delay the diagnosis. The Polymer Chain Reaction (PCR) test in the first 7 days for the detection of SARS-CoV-2 viral RNA is considered the test of reference ('Gold standard'). The criteria for referring to a hospital site from Care Homes should take into account an assessment of comorbidity, the severity, the presence of severe cognitive impairment, and the dependency or necessity of ventilatory support in seriously ill patients. The social-health centres should have contingency plans available in order to offer a response when cases of COVID-19 appear. Isolation during pandemics may have important physical and psychosocial consequences in the residents. It is necessary to reflect and claim a new residential model from a person-centered care approach that seeks the integration of health and social services.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Homes for the Aged , Nursing Homes , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Primary Health Care , Aged , Algorithms , Humans , Pandemics
8.
JAMA Netw Open ; 3(8): e2017533, 2020 Aug 03.
Article in English | MEDLINE | ID: covidwho-712540

ABSTRACT

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.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Homes for the Aged , Nursing Homes , Nursing Staff , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Social Isolation , Adult , Aged , Aged, 80 and over , Coronavirus , Coronavirus Infections/mortality , Coronavirus Infections/virology , France/epidemiology , Humans , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Retrospective Studies , Skilled Nursing Facilities , Surveys and Questionnaires
9.
JMIR Public Health Surveill ; 6(3): e21163, 2020 07 17.
Article in English | MEDLINE | ID: covidwho-690445

ABSTRACT

BACKGROUND: The coronavirus disease (COVID-19) pandemic has caused an unprecedented worldwide public health crisis that requires new management approaches. COVIDApp is a mobile app that was adapted for the management of institutionalized individuals in long-term care facilities. OBJECTIVE: The aim of this paper is to report the implementation of this innovative tool for the management of long-term care facility residents as a high-risk population, specifically for early identification and self-isolation of suspected cases, remote monitoring of mild cases, and real-time monitoring of the progression of the infection. METHODS: COVIDApp was implemented in 196 care centers in collaboration with 64 primary care teams. The following parameters of COVID-19 were reported daily: signs/symptoms; diagnosis by reverse transcriptase-polymerase chain reaction; absence of symptoms for ≥14 days; total deaths; and number of health care workers isolated with suspected COVID-19. The number of at-risk centers was also described. RESULTS: Data were recorded from 10,347 institutionalized individuals and up to 4000 health care workers between April 1 and 30, 2020. A rapid increase in suspected cases was seen until day 6 but decreased during the last two weeks (from 1084 to 282 cases). The number of confirmed cases increased from 419 (day 6) to 1293 (day 22) and remained stable during the last week. Of the 10,347 institutionalized individuals, 5,090 (49,2%) remained asymptomatic for ≥14 days. A total of 854/10,347 deaths (8.3%) were reported; 383 of these deaths (44.8%) were suspected/confirmed cases. The number of isolated health care workers remained high over the 30 days, while the number of suspected cases decreased during the last 2 weeks. The number of high-risk long-term care facilities decreased from 19/196 (9.5%) to 3/196 (1.5%). CONCLUSIONS: COVIDApp can help clinicians rapidly detect and remotely monitor suspected and confirmed cases of COVID-19 among institutionalized individuals, thus limiting the risk of spreading the virus. The platform shows the progression of infection in real time and can aid in designing new monitoring strategies.


Subject(s)
Coronavirus Infections/prevention & control , Homes for the Aged , Mobile Applications , Nursing Homes , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Aged , Coronavirus Infections/epidemiology , Diffusion of Innovation , Humans , Long-Term Care , Pneumonia, Viral/epidemiology , Spain/epidemiology
12.
J Aging Soc Policy ; 32(4-5): 358-364, 2020.
Article in English | MEDLINE | ID: covidwho-658417

ABSTRACT

Older people are especially vulnerable to COVID-19, including and especially people living in long-term care facilities. In this Perspective, we discuss the impact of the COVID-19 pandemic on long-term care policy in Canada. More specifically, we use the example of recent developments in Quebec, where a tragedy in a specific facility is acting as a dramatic "focusing event". It draws attention to the problems facing long-term care facilities, considering existing policy legacies and the opening of a "policy window" that may facilitate comprehensive reforms in the wake of the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Homes for the Aged/organization & administration , Long-Term Care/organization & administration , Nursing Homes/organization & administration , Pneumonia, Viral/epidemiology , Policy , Betacoronavirus , Canada/epidemiology , Homes for the Aged/standards , Humans , Interinstitutional Relations , Long-Term Care/standards , Nursing Homes/standards , Pandemics , Private Sector/organization & administration , Public Sector/organization & administration , Quality of Life , State Medicine/organization & administration
14.
JMIR Public Health Surveill ; 6(3): e21163, 2020 07 17.
Article in English | MEDLINE | ID: covidwho-633994

ABSTRACT

BACKGROUND: The coronavirus disease (COVID-19) pandemic has caused an unprecedented worldwide public health crisis that requires new management approaches. COVIDApp is a mobile app that was adapted for the management of institutionalized individuals in long-term care facilities. OBJECTIVE: The aim of this paper is to report the implementation of this innovative tool for the management of long-term care facility residents as a high-risk population, specifically for early identification and self-isolation of suspected cases, remote monitoring of mild cases, and real-time monitoring of the progression of the infection. METHODS: COVIDApp was implemented in 196 care centers in collaboration with 64 primary care teams. The following parameters of COVID-19 were reported daily: signs/symptoms; diagnosis by reverse transcriptase-polymerase chain reaction; absence of symptoms for ≥14 days; total deaths; and number of health care workers isolated with suspected COVID-19. The number of at-risk centers was also described. RESULTS: Data were recorded from 10,347 institutionalized individuals and up to 4000 health care workers between April 1 and 30, 2020. A rapid increase in suspected cases was seen until day 6 but decreased during the last two weeks (from 1084 to 282 cases). The number of confirmed cases increased from 419 (day 6) to 1293 (day 22) and remained stable during the last week. Of the 10,347 institutionalized individuals, 5,090 (49,2%) remained asymptomatic for ≥14 days. A total of 854/10,347 deaths (8.3%) were reported; 383 of these deaths (44.8%) were suspected/confirmed cases. The number of isolated health care workers remained high over the 30 days, while the number of suspected cases decreased during the last 2 weeks. The number of high-risk long-term care facilities decreased from 19/196 (9.5%) to 3/196 (1.5%). CONCLUSIONS: COVIDApp can help clinicians rapidly detect and remotely monitor suspected and confirmed cases of COVID-19 among institutionalized individuals, thus limiting the risk of spreading the virus. The platform shows the progression of infection in real time and can aid in designing new monitoring strategies.


Subject(s)
Coronavirus Infections/prevention & control , Homes for the Aged , Mobile Applications , Nursing Homes , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Aged , Coronavirus Infections/epidemiology , Diffusion of Innovation , Humans , Long-Term Care , Pneumonia, Viral/epidemiology , Spain/epidemiology
15.
J Am Geriatr Soc ; 68(8): 1647-1652, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-633783

ABSTRACT

BACKGROUND/OBJECTIVES: Nursing home (NH) residents are a vulnerable population, susceptible to respiratory disease outbreaks such as coronavirus disease 2019 (COVID-19). Poor outcome in COVID-19 is at least partly attributed to hypercoagulability, resulting in a high incidence of thromboembolic complications. It is unknown whether commonly used antithrombotic therapies may protect the vulnerable NH population with COVID-19 against mortality. This study aimed to investigate whether the use of oral antithrombotic therapy (OAT) was associated with a lower mortality in NH residents with COVID-19. DESIGN: A retrospective case series. SETTING: Fourteen NH facilities from the NH organization Envida, Maastricht, the Netherlands PARTICIPANTS: A total of 101 NH residents with COVID-19 were enrolled. MEASUREMENTS: The primary outcome was all-cause mortality. The association between age, sex, comorbidity, OAT, and mortality was assessed using logistic regression analysis. RESULTS: Overall mortality was 47.5% in NH residents from 14 NH facilities. Age, comorbidity, and medication use were comparable among NH residents who survived and who died. OAT was associated with a lower mortality in NH residents with COVID-19 in the univariable analysis (odds ratio (OR) = 0.89; 95% confidence interval (CI) = 0.41-1.95). However, additional adjustments for sex, age, and comorbidity attenuated this difference. Mortality in males was higher compared with female residents (OR = 3.96; 95% CI = 1.62-9.65). Male residents who died were younger compared with female residents (82.2 (standard deviation (SD) = 6.3) vs 89.1 (SD = 6.8) years; P < .001). CONCLUSION: NH residents in the 14 facilities we studied were severely affected by the COVID-19 pandemic, with a mortality of 47.5%. Male NH residents with COVID-19 had worse outcomes than females. We did not find evidence for any protection against mortality by OAT, necessitating further research into strategies to mitigate poor outcome of COVID-19 in vulnerable NH populations. J Am Geriatr Soc 68:1647-1652, 2020.


Subject(s)
Betacoronavirus , Coronavirus Infections/mortality , Fibrinolytic Agents/therapeutic use , Pneumonia, Viral/mortality , Thromboembolism/mortality , Aged , Aged, 80 and over , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Female , Homes for the Aged , Humans , Incidence , Male , Netherlands/epidemiology , Nursing Homes , Odds Ratio , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , Retrospective Studies , Sex Factors , Thromboembolism/drug therapy , Thromboembolism/virology
17.
Emerg Infect Dis ; 26(9)2020 Sep.
Article in English | MEDLINE | ID: covidwho-611845

ABSTRACT

During the coronavirus disease pandemic in Spain, from April 10-24, 2020, a total of 5,869 persons were screened for severe acute respiratory syndrome coronavirus 2 at nursing homes. Among residents, 768 (23.9%) tested positive; among staff, 403 (15.2%). Of those testing positive, 69.7% of residents and 55.8% of staff were asymptomatic.


Subject(s)
Asymptomatic Infections/epidemiology , Betacoronavirus , Coronavirus Infections/epidemiology , Homes for the Aged/statistics & numerical data , Nursing Homes/statistics & numerical data , Pneumonia, Viral/epidemiology , Aged , Aged, 80 and over , Coronavirus Infections/virology , Female , Humans , Male , Pandemics , Pneumonia, Viral/virology , Spain/epidemiology
19.
Eur Geriatr Med ; 11(4): 645-650, 2020 08.
Article in English | MEDLINE | ID: covidwho-601643

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.


Subject(s)
Coronavirus Infections/therapy , Delivery of Health Care/standards , Homes for the Aged/organization & administration , Nursing Homes/organization & administration , Physicians/standards , Pneumonia, Viral/therapy , Aged , Aged, 80 and over , Cause of Death , Coronavirus Infections/epidemiology , Delphi Technique , Europe , Female , Geriatric Assessment/methods , Health Services Needs and Demand , Humans , Male , Pandemics , Patient Care Team/standards , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians'/standards , Survival Analysis
20.
J Am Med Dir Assoc ; 21(7): 909-914.e2, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-598618

ABSTRACT

OBJECTIVES: Angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and HMG-CoA reductase inhibitors ("statins") have been hypothesized to affect COVID-19 severity. However, up to now, no studies investigating this association have been conducted in the most vulnerable and affected population groups (ie, older adults residing in nursing homes). The objective of this study was to explore the association of ACEi/ARB and/or statins with clinical manifestations in COVID-19-infected older adults residing in nursing homes. DESIGN: We undertook a retrospective multicenter cohort study to analyze the association between ACEi/ARB and/or statin use with clinical outcome of COVID-19. The outcomes were (1) serious COVID-19 defined as long-stay hospital admission or death within 14 days of disease onset, and (2) asymptomatic (ie, no disease symptoms in the whole study period while still being diagnosed by polymerase chain reaction). SETTING AND PARTICIPANTS: A total of 154 COVID-19-positive subjects were identified, residing in 1 of 2 Belgian nursing homes that experienced similar COVID-19 outbreaks. MEASURES: Logistic regression models were applied with age, sex, functional status, diabetes, and hypertension as covariates. RESULTS: We found a statistically significant association between statin intake and the absence of symptoms during COVID-19 (odds ratio [OR] 2.91; confidence interval [CI] 1.27-6.71), which remained statistically significant after adjusting for covariates (OR 2.65; CI 1.13-6.68). Although the effects of statin intake on serious clinical outcome were in the same beneficial direction, these were not statistically significant (OR 0.75; CI 0.24-1.87). There was also no statistically significant association between ACEi/ARB and asymptomatic status (OR 2.72; CI 0.59-25.1) or serious clinical outcome (OR 0.48; CI 0.10-1.97). CONCLUSIONS AND IMPLICATIONS: Our data indicate that statin intake in older, frail adults could be associated with a considerable beneficial effect on COVID-19 clinical symptoms. The role of statins and renin-angiotensin system drugs needs to be further explored in larger observational studies as well as randomized clinical trials.


Subject(s)
Angiotensin Receptor Antagonists/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Aged , Aged, 80 and over , Belgium/epidemiology , Cause of Death , Cohort Studies , Female , Geriatric Assessment , Homes for the Aged/statistics & numerical data , Humans , Logistic Models , Male , Nursing Homes/statistics & numerical data , Odds Ratio , Pandemics/statistics & numerical data , Retrospective Studies , Risk Assessment , Severity of Illness Index , Survival Rate , Treatment Outcome
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