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2.
CMAJ ; 193(28): E1098-E1106, 2021 07 19.
Article in French | MEDLINE | ID: covidwho-1435633

ABSTRACT

CONTEXTE: Le déploiement de mesures de gestion des éclosions de SRAS-CoV-2 dans les établissements de soins de longue durée en Ontario a permis d'en réduire la fréquence et la gravité. Nous décrivons ici les données épidémiologiques et de laboratoire d'une de ces premières éclosions en Ontario afin de déterminer les facteurs associés à son importance et les impacts des interventions progressives de lutte contre les infections appliquées pendant la durée de l'éclosion. MÉTHODES: Nous avons obtenu du bureau de santé la liste des cas et les données de l'éclosion afin de décrire les cas chez les résidents et le personnel, leur gravité et leur distribution dans le temps et à l'intérieur de l'établissement touché. Quand elles étaient disponibles, nous avons obtenu des données concernant les échantillons soumis au laboratoire de Santé publique Ontario et effectué un séquençage complet et une analyse phylogénétique des échantillons viraux de l'éclosion. RÉSULTATS: Sur les 65 résidents de l'établissement de soins de longue durée, 61 (94 %) ont contracté le SRAS-CoV-2, le taux de létalité étant de 45 % (28/61). Parmi les 67 employés initiaux, 34 (51 %) ont contracté le virus, et aucun n'est décédé. Lorsque l'éclosion a été déclarée, 12 employés, 2 visiteurs et 9 résidents présentaient des symptômes. Parmi les résidents, les cas se trouvaient dans 3 des 4 secteurs de l'établissement. L'analyse phylogénétique a montré une forte similitude des séquences; une seule autre souche de SRAS-CoV-2 génétiquement distincte a été identifiée chez un employé à la troisième semaine de l'éclosion. Après le déploiement de toutes les mesures de gestion de l'éclosion, aucun cas n'a été identifié parmi les 26 nouveaux employés appelés en renfort. INTERPRÉTATION: La propagation rapide et non détectée du virus dans un établissement de soins de longue durée a donné lieu à des taux élevés d'infection chez les résidents et le personnel. L'application progressive de mesures de gestion après le pic de l'éclosion a permis d'éviter la contamination du personnel appelé en renfort et fait désormais partie des politiques à long terme de prévention des éclosions en Ontario.


Subject(s)
COVID-19/epidemiology , Long-Term Care/statistics & numerical data , Pandemics , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Ontario/epidemiology , Retrospective Studies , Young Adult
4.
J Am Geriatr Soc ; 69(12): 3377-3388, 2021 12.
Article in English | MEDLINE | ID: covidwho-1365086

ABSTRACT

BACKGROUND: While individuals living in long-term care (LTC) homes have experienced adverse outcomes of SARS-CoV-2 infection, few studies have examined a broad range of predictors of 30-day mortality in this population. METHODS: We studied residents living in LTC homes in Ontario, Canada, who underwent PCR testing for SARS-CoV-2 infection from January 1 to August 31, 2020, and examined predictors of all-cause death within 30 days after a positive test for SARS-CoV-2. We examined a broad range of risk factor categories including demographics, comorbidities, functional status, laboratory tests, and characteristics of the LTC facility and surrounding community were examined. In total, 304 potential predictors were evaluated for their association with mortality using machine learning (Random Forest). RESULTS: A total of 64,733 residents of LTC, median age 86 (78, 91) years (31.8% men), underwent SARS-CoV-2 testing, of whom 5029 (7.8%) tested positive. Thirty-day mortality rates were 28.7% (1442 deaths) after a positive test. Of 59,702 residents who tested negative, 2652 (4.4%) died within 30 days of testing. Predictors of mortality after SARS-CoV-2 infection included age, functional status (e.g., activity of daily living score and pressure ulcer risk), male sex, undernutrition, dehydration risk, prior hospital contacts for respiratory illness, and duration of comorbidities (e.g., heart failure, COPD). Lower GFR, hemoglobin concentration, lymphocyte count, and serum albumin were associated with higher mortality. After combining all covariates to generate a risk index, mortality rate in the highest risk quartile was 48.3% compared with 7% in the first quartile (odds ratio 12.42, 95%CI: 6.67, 22.80, p < 0.001). Deaths continued to increase rapidly for 15 days after the positive test. CONCLUSIONS: LTC residents, particularly those with reduced functional status, comorbidities, and abnormalities on routine laboratory tests, are at high risk for mortality after SARS-CoV-2 infection. Recognizing high-risk residents in LTC may enhance institution of appropriate preventative measures.


Subject(s)
COVID-19/diagnosis , COVID-19/mortality , Long-Term Care/statistics & numerical data , SARS-CoV-2/isolation & purification , Aged , Aged, 80 and over , Artificial Intelligence , COVID-19/prevention & control , COVID-19/transmission , COVID-19 Nucleic Acid Testing , Cause of Death , Comorbidity , Female , Humans , Machine Learning , Male , Nursing Homes , Ontario/epidemiology , Pandemics/prevention & control , Predictive Value of Tests , Risk Factors , SARS-CoV-2/genetics , Severity of Illness Index
6.
Sci Rep ; 11(1): 12530, 2021 06 15.
Article in English | MEDLINE | ID: covidwho-1270676

ABSTRACT

Older adults are the main victims of the novel COVID-19 coronavirus outbreak and elderly in Long Term Care Facilities (LTCFs) are severely hit in terms of mortality. This paper presents a quantitative study of the impact of COVID-19 outbreak in Italy during first stages of the epidemic, focusing on the effects on mortality increase among older adults over 80 and its correlation with LTCFs. The study of growth patterns shows a power-law scaling regime for the first stage of the pandemic with an uneven behaviour among different regions as well as for the overall mortality increase according to the different impact of COVID-19. However, COVID-19 incidence rate does not fully explain the differences of mortality impact in older adults among different regions. We define a quantitative correlation between mortality in older adults and the number of people in LTCFs confirming the tremendous impact of COVID-19 on LTCFs. In addition a correlation between LTCFs and undiagnosed cases as well as effects of health system dysfunction is also observed. Our results confirm that LTCFs did not play a protective role on older adults during the pandemic, but the higher the number of elderly people living in LTCFs the greater the increase of both general and COVID-19 related mortality. We also observed that the handling of the crises in LTCFs hampered an efficient tracing of COVID-19 spread and promoted the increase of deaths not directly attributed to SARS-CoV-2.


Subject(s)
COVID-19/epidemiology , Long-Term Care/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/mortality , Humans , Incidence , Italy/epidemiology , Multivariate Analysis , Nursing Homes/statistics & numerical data
7.
J Aging Soc Policy ; 33(4-5): 444-458, 2021.
Article in English | MEDLINE | ID: covidwho-1228341

ABSTRACT

Japan's initial response to COVID-19 was similar to that of the US. However, the number of deaths in Japan has remained very low. Japan also stands out for the relatively low incidence of viral transmission in Long-Term Care Facilities (LTCFs) compared to both European countries and the United States. We argue that Japan's institutional decision to lockdown Long-Term Care facilities as early as mid-February - weeks earlier than most European countries and the US - contributed to lowering the number of deaths in LTCFs. We highlight a few lessons from the Japanese experience: (i) the presence of hierarchically organized government agencies whose sole missions are elderly care; (ii) the presence of effective communication channels between LTCFs and the regulatory authorities; and (iii) the well-established routine protocols of prevention and control in LTCFs.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/standards , Long-Term Care/statistics & numerical data , Nursing Homes/statistics & numerical data , Aged , COVID-19/mortality , Health Policy , Humans , Japan/epidemiology , Public Health
8.
J Aging Soc Policy ; 33(4-5): 459-473, 2021.
Article in English | MEDLINE | ID: covidwho-1221330

ABSTRACT

Preventing the spread of COVID-19 in long-term care homes is critical for the health of residents who live in these institutions. As a result, broad policies restricting visits to these facilities were put in place internationally. While well meaning, these policies have exacerbated the ongoing social isolation crisis present in long-term care homes prior to the COVID-19 pandemic. This perspective highlights the dominant COVID-19 LTC policies from six countries, and proposes five strategies to address or mitigate social isolation during the COVID-19 pandemic that can also be applied in a post-pandemic world.


Subject(s)
COVID-19/epidemiology , Health Policy , Internationality , Long-Term Care/statistics & numerical data , Nursing Homes/statistics & numerical data , Social Isolation/psychology , Brazil , China , Humans , North America
9.
BMC Infect Dis ; 21(1): 418, 2021 May 04.
Article in English | MEDLINE | ID: covidwho-1216884

ABSTRACT

BACKGROUND: The Dutch province of Limburg borders the German district of Heinsberg, which had a large cluster of COVID-19 cases linked to local carnival activities before any cases were reported in the Netherlands. However, Heinsberg was not included as an area reporting local or community transmission per the national case definition at the time. In early March, two residents from a long-term care facility (LTCF) in Sittard, a Dutch town located in close vicinity to the district of Heinsberg, tested positive for COVID-19. In this study we aimed to determine whether cross-border introduction of the virus took place by analysing the LTCF outbreak in Sittard, both epidemiologically and microbiologically. METHODS: Surveys and semi-structured oral interviews were conducted with all present LTCF residents by health care workers during regular points of care for information on new or unusual signs and symptoms of disease. Both throat and nasopharyngeal swabs were taken from residents suspect of COVID-19, based on regional criteria, for the detection of SARS-CoV-2 by Real-time Polymerase Chain Reaction. Additionally, whole genome sequencing was performed using a SARS-CoV-2 specific amplicon-based Nanopore sequencing approach. Moreover, twelve random residents were sampled for possible asymptomatic infections. RESULTS: Out of 99 residents, 46 got tested for COVID-19. Out of the 46 tested residents, nineteen (41%) tested positive for COVID-19, including 3 asymptomatic residents. CT-values for asymptomatic residents seemed higher compared to symptomatic residents. Eleven samples were sequenced, along with three random samples from COVID-19 patients hospitalized in the regional hospital at the time of the LTCF outbreak. All samples were linked to COVID-19 cases from the cross-border region of Heinsberg, Germany. CONCLUSIONS: Sequencing combined with epidemiological data was able to virtually prove cross-border transmission at the start of the Dutch COVID-19 epidemic. Our results highlight the need for cross-border collaboration and adjustment of national policy to emerging region-specific needs along borders in order to establish coordinated implementation of infection control measures to limit the spread of COVID-19.


Subject(s)
COVID-19/epidemiology , Long-Term Care/statistics & numerical data , Nursing Homes/statistics & numerical data , SARS-CoV-2/genetics , Aged , Aged, 80 and over , COVID-19/etiology , COVID-19/virology , Cross-Sectional Studies , Disease Outbreaks , Female , Germany , Health Personnel , Humans , Infection Control , Male , Middle Aged , Netherlands/epidemiology , Real-Time Polymerase Chain Reaction , Whole Genome Sequencing
10.
Prev Med ; 148: 106564, 2021 07.
Article in English | MEDLINE | ID: covidwho-1189064

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) has caused severe outbreaks in Canadian long-term care facilities (LTCFs). In Canada, over 80% of COVID-19 deaths during the first pandemic wave occurred in LTCFs. We sought to evaluate the effect of mitigation measures in LTCFs including frequent testing of staff, and vaccination of staff and residents. We developed an agent-based transmission model and parameterized it with disease-specific estimates, temporal sensitivity of nasopharyngeal and saliva testing, results of vaccine efficacy trials, and data from initial COVID-19 outbreaks in LTCFs in Ontario, Canada. Characteristics of staff and residents, including contact patterns, were integrated into the model with age-dependent risk of hospitalization and death. Estimates of infection and outcomes were obtained and 95% credible intervals were generated using a bias-corrected and accelerated bootstrap method. Weekly routine testing of staff with 2-day turnaround time reduced infections among residents by at least 25.9% (95% CrI: 23.3%-28.3%), compared to baseline measures of mask-wearing, symptom screening, and staff cohorting alone. A similar reduction of hospitalizations and deaths was achieved in residents. Vaccination averted 2-4 times more infections in both staff and residents as compared to routine testing, and markedly reduced hospitalizations and deaths among residents by 95.9% (95% CrI: 95.4%-96.3%) and 95.8% (95% CrI: 95.5%-96.1%), respectively, over 200 days from the start of vaccination. Vaccination could have a substantial impact on mitigating disease burden among residents, but may not eliminate the need for other measures before population-level control of COVID-19 is achieved.


Subject(s)
COVID-19/prevention & control , Disease Outbreaks/prevention & control , Long-Term Care/statistics & numerical data , COVID-19/epidemiology , Humans , Ontario/epidemiology , SARS-CoV-2 , Systems Analysis
11.
J Hum Nutr Diet ; 34(4): 660-669, 2021 08.
Article in English | MEDLINE | ID: covidwho-1140262

ABSTRACT

BACKGROUND: During the global COVID-19 pandemic, UK dietitians have delivered the best care to help patients recover from the infection. The present study examined the development and evaluation of care pathways to manage nutritional care of patients following COVID-19 infection prior to and after discharge. METHODS: Registered UK dietitians completed an online questionnaire comprising 26 questions about the development of a pathway, its use, evaluation and training needs. RESULTS: Of 57 responses from organisations, 37 (65%) were involved in the planning/management of nutritional care. Only 19 responses had a new or adapted COVID-19 pathway. Of these, 74% reported involvement of dietetic services, 47% reported > 1 eligibility criteria for pathway inclusion and 53% accepted all positive or suspected cases. All respondents used nutritional screening, first-line dietary advice (food first) and referral for further advice and monitoring. Weight and food intake were the most used outcome measure. All pathways addressed symptoms related to nutrition, with the most common being weight loss with poor appetite, not being hungry and skipping meals in 84% of pathways. Over half of respondents (54%) planned to evaluate their pathway and 83% reported that they were 'very or reasonably confident' in their team's nutritional management of COVID-19. Less than half (42%) reported on training needs. CONCLUSIONS: Despite challenges encountered, pathways were developed and implemented. Dietitians had adapted to new ways of working to manage nutritional care in patients prior to and after discharge from hospital following COVID-19 infection. Further work is needed to develop strategies for evaluation of their impact.


Subject(s)
COVID-19/diet therapy , Critical Pathways , Nutrition Therapy/statistics & numerical data , Nutritionists/statistics & numerical data , Patient Discharge , Humans , Length of Stay , Long-Term Care/methods , Long-Term Care/statistics & numerical data , Nutrition Therapy/methods , SARS-CoV-2 , Surveys and Questionnaires , United Kingdom
12.
Sci Rep ; 10(1): 20834, 2020 11 30.
Article in English | MEDLINE | ID: covidwho-1060282

ABSTRACT

Since December 2019, coronavirus disease 2019 (COVID-19) pandemic has spread from China all over the world and many COVID-19 outbreaks have been reported in long-term care facilities (LCTF). However, data on clinical characteristics and prognostic factors in such settings are scarce. We conducted a retrospective, observational cohort study to assess clinical characteristics and baseline predictors of mortality of COVID-19 patients hospitalized after an outbreak of SARS-CoV-2 infection in a LTCF. A total of 50 patients were included. Mean age was 80 years (SD, 12 years), and 24/50 (57.1%) patients were males. The overall in-hospital mortality rate was 32%. At Cox regression analysis, significant predictors of in-hospital mortality were: hypernatremia (HR 9.12), lymphocyte count < 1000 cells/µL (HR 7.45), cardiovascular diseases other than hypertension (HR 6.41), and higher levels of serum interleukin-6 (IL-6, pg/mL) (HR 1.005). Our study shows a high in-hospital mortality rate in a cohort of elderly patients with COVID-19 and hypernatremia, lymphopenia, CVD other than hypertension, and higher IL-6 serum levels were identified as independent predictors of in-hospital mortality. Given the small population size as major limitation of our study, further investigations are necessary to better understand and confirm our findings in elderly patients.


Subject(s)
COVID-19/diagnosis , COVID-19/mortality , Hospital Mortality , Long-Term Care/statistics & numerical data , Aged , Aged, 80 and over , Cardiovascular Diseases/complications , China/epidemiology , Cytokine Release Syndrome/pathology , Female , Hospitalization , Humans , Hypernatremia/complications , Interleukin-6/blood , Lymphopenia/complications , Male , Nursing Homes , Risk Factors , SARS-CoV-2
14.
Prev Med ; 143: 106328, 2021 02.
Article in English | MEDLINE | ID: covidwho-933538

ABSTRACT

Given the high concentration of COVID-19 cases in long-term care (LTC) facilities in the United States, individuals working in these facilities are at heightened risk of SARS-CoV-2 exposure. Using data from the nationally-representative 2017 and 2018 National Health Interview Surveys on adults who reported working in LTC facilities, this study examines the extent to which LTC workers are also at increased risk or potentially at increased risk for severe illness from COVID-19 including hospitalization, intubation, or death. We used the Centers for Disease Control and Prevention's list of conditions placing individuals in these risk categories to the extent possible. We also examined the sociodemographic characteristics of LTC workers by occupation and COVID-19 illness severity risk status. One percent (552 out of 52,159) of the weighted NHIS sample worked in LTC facilities. Workers in LTC facilities were disproportionately Black, female, and low income. Half of LTC workers (50%) were at increased risk of severe illness from COVID-19 and another 19.6% were potentially at increased risk. There were few significant differences in demographic characteristics between risk groups, though those at increased risk had lower educational attainment and recent trouble affording prescription medications. Despite the high degree of vulnerability of both LTC residents and workers to severe illness from COVID-19, many LTC facilities still have inadequate supplies of personal protective equipment and COVID-19 tests. Given that state budget deficits due to the COVID-19 pandemic limit the potential for state actions, enhanced federal efforts are needed to protect LTC residents and staff from COVID-19.


Subject(s)
COVID-19/transmission , Disease Transmission, Infectious/statistics & numerical data , Health Personnel/statistics & numerical data , Long-Term Care/statistics & numerical data , Nursing Homes/statistics & numerical data , Pandemics/statistics & numerical data , Risk Assessment/statistics & numerical data , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , SARS-CoV-2 , United States
15.
Biomed Res Int ; 2020: 8870249, 2020.
Article in English | MEDLINE | ID: covidwho-930417

ABSTRACT

The COVID-19 pandemic had a great negative impact on nursing homes, with massive outbreaks being reported in care facilities all over the world, affecting not only the residents but also the care workers and visitors. Due to their advanced age and numerous underlying diseases, the inhabitants of long-term care facilities represent a vulnerable population that should benefit from additional protective measures against contamination. Recently, multiple countries such as France, Spain, Belgium, Canada, and the United States of America reported that an important fraction from the total number of deaths due to the SARS-CoV-2 infection emerged from nursing homes. The scope of this paper was to present the latest data regarding the COVID-19 spread in care homes worldwide, identifying causes and possible solutions that would limit the outbreaks in this overlooked category of population. It is the authors' hope that raising awareness on this matter would encourage more studies to be conducted, considering the fact that there is little information available on the impact of the SARS-CoV-2 pandemic on nursing homes. Establishing national databases that would register all nursing home residents and their health status would be of great help in the future not only for managing the ongoing pandemic but also for assessing the level of care that is needed in this particularly fragile setting.


Subject(s)
COVID-19/epidemiology , Long-Term Care/statistics & numerical data , Nursing Homes/statistics & numerical data , Belgium/epidemiology , COVID-19/virology , Canada/epidemiology , France/epidemiology , Health Personnel , Humans , Risk Factors , SARS-CoV-2/isolation & purification , Spain/epidemiology , United States/epidemiology
16.
CMAJ Open ; 8(4): E627-E636, 2020.
Article in English | MEDLINE | ID: covidwho-840782

ABSTRACT

BACKGROUND: Congregate settings have been disproportionately affected by coronavirus disease 2019 (COVID-19). Our objective was to compare testing for, diagnosis of and death after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across 3 settings (residents of long-term care homes, people living in shelters and the rest of the population). METHODS: We conducted a population-based prospective cohort study involving individuals tested for SARS-CoV-2 in the Greater Toronto Area between Jan. 23, 2020, and May 20, 2020. We sourced person-level data from COVID-19 surveillance and reporting systems in Ontario. We calculated cumulatively diagnosed cases per capita, proportion tested, proportion tested positive and case-fatality proportion for each setting. We estimated the age- and sex-adjusted rate ratios associated with setting for test positivity and case fatality using quasi-Poisson regression. RESULTS: Over the study period, a total of 173 092 individuals were tested for and 16 490 individuals were diagnosed with SARS-CoV-2 infection. We observed a shift in the proportion of cumulative cases from all cases being related to travel to cases in residents of long-term care homes (20.4% [3368/16 490]), shelters (2.3% [372/16 490]), other congregate settings (20.9% [3446/16 490]) and community settings (35.4% [5834/16 490]), with cumulative travel-related cases at 4.1% (674/16490). Cumulatively, compared with the rest of the population, the diagnosed cases per capita was 64-fold and 19-fold higher among long-term care home and shelter residents, respectively. By May 20, 2020, 76.3% (21 617/28 316) of long-term care home residents and 2.2% (150 077/6 808 890) of the rest of the population had been tested. After adjusting for age and sex, residents of long-term care homes were 2.4 (95% confidence interval [CI] 2.2-2.7) times more likely to test positive, and those who received a diagnosis of COVID-19 were 1.4-fold (95% CI 1.1-1.8) more likely to die than the rest of the population. INTERPRETATION: Long-term care homes and shelters had disproportionate diagnosed cases per capita, and residents of long-term care homes diagnosed with COVID-19 had higher case fatality than the rest of the population. Heterogeneity across micro-epidemics among specific populations and settings may reflect underlying heterogeneity in transmission risks, necessitating setting-specific COVID-19 prevention and mitigation strategies.


Subject(s)
COVID-19/diagnosis , COVID-19/transmission , Disease Outbreaks/prevention & control , SARS-CoV-2/genetics , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/virology , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Canada/epidemiology , Female , Homeless Persons/statistics & numerical data , Humans , Long-Term Care/statistics & numerical data , Male , Middle Aged , Outcome Assessment, Health Care , Prospective Studies , Travel/statistics & numerical data , Travel-Related Illness
17.
Age Ageing ; 50(1): 16-20, 2021 01 08.
Article in English | MEDLINE | ID: covidwho-780321

ABSTRACT

In the COVID-19 pandemic, patients who are older and residents of long-term care facilities (LTCF) are at greatest risk of worse clinical outcomes. We reviewed discharge criteria for hospitalised COVID-19 patients from 10 countries with the highest incidence of COVID-19 cases as of 26 July 2020. Five countries (Brazil, Mexico, Peru, Chile and Iran) had no discharge criteria; the remaining five (USA, India, Russia, South Africa and the UK) had discharge guidelines with large inter-country variability. India and Russia recommend discharge for a clinically recovered patient with two negative reverse transcription polymerase chain reaction (RT-PCR) tests 24 h apart; the USA offers either a symptom based strategy-clinical recovery and 10 days after symptom onset, or the same test-based strategy. The UK suggests that patients can be discharged when patients have clinically recovered; South Africa recommends discharge 14 days after symptom onset if clinically stable. We recommend a unified, simpler discharge criteria, based on current studies which suggest that most SARS-CoV-2 loses its infectivity by 10 days post-symptom onset. In asymptomatic cases, this can be taken as 10 days after the first positive PCR result. Additional days of isolation beyond this should be left to the discretion of individual clinician. This represents a practical compromise between unnecessarily prolonged admissions and returning highly infectious patients back to their care facilities, and is of particular importance in older patients discharged to LTCFs, residents of which may be at greatest risk of transmission and worse clinical outcomes.


Subject(s)
COVID-19 , Disease Transmission, Infectious/prevention & control , Long-Term Care , Patient Discharge , Patient Transfer , Skilled Nursing Facilities/statistics & numerical data , Aged , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , Convalescence , Female , Hospitalization/statistics & numerical data , Humans , Internationality , Long-Term Care/methods , Long-Term Care/statistics & numerical data , Male , Needs Assessment , Patient Discharge/standards , Patient Discharge/trends , Patient Transfer/methods , Patient Transfer/standards , Quality Improvement/organization & administration , SARS-CoV-2/isolation & purification
18.
J Am Geriatr Soc ; 68(8): 1657-1660, 2020 08.
Article in English | MEDLINE | ID: covidwho-767516

ABSTRACT

OBJECTIVES: Long-term care (LTC) facilities are particularly dangerous places for the spread of COVID-19 given that they house vulnerable high-risk populations. Transmission-based precautions to protect residents, employees, and families alike must account for potential risks posed by LTC workers' second jobs and unpaid care work. This observational study describes the prevalence of their (1) second jobs, and (2) unpaid care work for dependent children and/or adult relatives (double- and triple-duty caregiving) overall and by occupational group (registered nurses [RNs], licensed practical nurses [LPNs], or certified nursing assistants [CNAs]). DESIGN: A descriptive secondary analysis of data collected as part of the final wave of the Work, Family and Health Study. SETTING: Thirty nursing home facilities located throughout the northeastern United States. PARTICIPANTS: A subset of 958 essential facility-based LTC workers involved in direct patient care. MEASUREMENTS: We present information on LTC workers' demographic characteristics, health, features of their LTC occupation, additional paid work, wages, and double- or triple-duty caregiving roles. RESULTS: Most LTC workers were CNAs, followed by LPNs and RNs. Overall, more than 70% of these workers agreed or strongly agreed with this statement: "When you are sick, you still feel obligated to come into work." One-sixth had a second job, where they worked an average of 20 hours per week, and more than 60% held double- or triple-duty caregiving roles. Additional paid work and unpaid care work characteristics did not significantly differ by occupational group, although the prevalence of second jobs was highest and accompanying work hours were longest among CNAs. CONCLUSION: LTC workers commonly hold second jobs along with double- and triple-duty caregiving roles. To slow the spread of COVID-19, both the paid and unpaid activities of these employees warrant consideration in the identification of appropriate clinical, policy, and informal supports. J Am Geriatr Soc 68:1657-1660, 2020.


Subject(s)
Caregivers/statistics & numerical data , Coronavirus Infections/prevention & control , Employment/statistics & numerical data , Long-Term Care/statistics & numerical data , Occupations/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Betacoronavirus , COVID-19 , Female , Health Services Needs and Demand , Humans , Licensed Practical Nurses/statistics & numerical data , Male , New England , Nurses/statistics & numerical data , Nursing Assistants/statistics & numerical data , Nursing Homes , SARS-CoV-2 , Work-Life Balance
19.
CMAJ Open ; 8(3): E514-E521, 2020.
Article in English | MEDLINE | ID: covidwho-725389

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak increases the importance of strategies to enhance urgent medical care delivery in long-term care (LTC) facilities that could potentially reduce transfers to emergency departments. The study objective was to model resource requirements to deliver virtual urgent medical care in LTC facilities. METHODS: We used data from all general medicine inpatient admissions at 7 hospitals in the Greater Toronto Area, Ontario, Canada, over a 7.5-year period (Apr. 1, 2010, to Oct. 31, 2017) to estimate historical patterns of hospital resource use by LTC residents. We estimated an upper bound of potentially avoidable transfers by combining data on short admissions (≤ 72 h) with historical data on the proportion of transfers from LTC facilities for which patients were discharged from the emergency department without admission. Regression models were used to extrapolate future resource requirements, and queuing models were used to estimate physician staffing requirements to perform virtual assessments. RESULTS: There were 235 375 admissions to general medicine wards, and residents of LTC facilities (age 16 yr or older) accounted for 9.3% (n = 21 948) of these admissions. Among the admissions of residents of LTC facilities, short admissions constituted 24.1% (n = 5297), and for 99.8% (n = 5284) of these admissions, the patient received laboratory testing, for 86.9% (n = 4604) the patient received plain radiography, for 41.5% (n = 2197) the patient received computed tomography and for 81.2% (n = 4300) the patient received intravenous medications. If all patients who have short admissions and are transferred from the emergency department were diverted to outpatient care, the average weekly demand for outpatient imaging per hospital would be 2.6 ultrasounds, 11.9 computed tomographic scans and 23.9 radiographs per week. The average daily volume of urgent medical virtual assessments would range from 2.0 to 5.8 per hospital. A single centralized virtual assessment centre staffed by 2 or 3 physicians would provide services similar in efficiency (measured by waiting time for physician assessment) to 7 separate centres staffed by 1 physician each. INTERPRETATION: The provision of acute medical care to LTC residents at their facility would probably require rapid access to outpatient diagnostic imaging, within-facility access to laboratory services and intravenous medication and virtual consultations with physicians. The results of this study can inform efforts to deliver urgent medical care in LTC facilities in light of a potential surge in COVID-19 cases.


Subject(s)
COVID-19/diagnosis , Health Resources/supply & distribution , Physicians/supply & distribution , SARS-CoV-2/genetics , Skilled Nursing Facilities/statistics & numerical data , Telemedicine/statistics & numerical data , Aged , Aged, 80 and over , Ambulatory Care , COVID-19/epidemiology , COVID-19/virology , Cross-Sectional Studies , Diagnostic Imaging/statistics & numerical data , Disease Outbreaks/prevention & control , Disease Outbreaks/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Hospitalization/trends , Humans , Long-Term Care/statistics & numerical data , Male , Middle Aged , Ontario/epidemiology , Patient Transfer/statistics & numerical data , Retrospective Studies , Skilled Nursing Facilities/organization & administration , Workforce/statistics & numerical data
20.
JAMA Netw Open ; 3(7): e2015957, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-663597

ABSTRACT

Importance: The coronavirus disease 2019 (COVID-19) pandemic has been particularly severe among individuals residing in long-term care (LTC) facilities. As of April 10, 2020, half of Canada's COVID-19 deaths had occurred in LTC facilities. Objective: To better understand trends and risk factors associated with COVID-19 death in LTC facilities in Ontario, Canada. Design, Setting, and Participants: This cohort study of 627 LTC facilities included 269 total individuals who died of COVID-19 in Ontario to April 11, 2020, and 83 individuals who died of COVID-19 in Ontario LTC facilities to April 7, 2020. Because population denominators were not available for LTC residents, they were approximated as the total number of LTC facility beds in Ontario (79 498), assuming complete occupancy. Exposures: Confirmed or suspected COVID-19 outbreaks; confirmed COVID-19 infection among residents and staff, diagnosed by real-time polymerase chain reaction testing. Main Outcomes and Measures: COVID-19-specific mortality incidence rate ratios (IRRs) for LTC residents were calculated with community-living Ontarians older than 69 years as the comparator group. Count-based regression methods were used to model temporal trends and to identify associations of infection risk among staff and residents with subsequent LTC resident death. Model-derived IRRs for COVID-19-specific mortality were generated through bootstrap resampling (1000 replicates) to generate median and 95% credible intervals for IRR over time. Results: Of 627 LTC facilities, 272 (43.4%) reported COVID-19 infection in residents or staff. Of 1 731 315 total individuals older than 69 years living in Ontario during the study period, 229 (<0.1%) died; of 79 498 potential residents in LTC facilities, 83 (0.1%) died. The IRR for COVID-19-related death in LTC residents was 13.1 (95% CI, 9.9-17.3) compared with community-living adults older than 69 years. The IRR increased sharply over time and was 87.3 (95% credible interval, 6.4-769.8) by April 11, 2020. Infection among LTC staff was associated with death among residents with a 6-day lag (eg, adjusted IRR for death per infected staff member, 1.17; 95% CI, 1.11-1.26). Conclusions and Relevance: In this cohort study of COVID-19-related deaths during the pandemic in Ontario, Canada, mortality risk was concentrated in LTC residents and increased during a short period. Early identification of risk requires a focus on testing, providing personal protective equipment to staff, and restructuring the LTC workforce to prevent the movement of COVID-19 between facilities.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/mortality , Long-Term Care/statistics & numerical data , Pneumonia, Viral/mortality , Aged , Aged, 80 and over , COVID-19 , Cohort Studies , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Disease Outbreaks/prevention & control , Humans , Long-Term Care/trends , Ontario/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Risk Factors , SARS-CoV-2
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