Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 10 de 10
Filter
1.
MMWR Morb Mortal Wkly Rep ; 69(32): 1089-1094, 2020 Aug 14.
Article in English | MEDLINE | ID: covidwho-1389851

ABSTRACT

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly in nursing homes once it is introduced (1,2). To prevent outbreaks, more data are needed to identify sources of introduction and means of transmission within nursing homes. Nursing home residents who receive hemodialysis (dialysis) might be at higher risk for SARS-CoV-2 infections because of their frequent exposures outside the nursing home to both community dialysis patients and staff members at dialysis centers (3). Investigation of a COVID-19 outbreak in a Maryland nursing home (facility A) identified a higher prevalence of infection among residents undergoing dialysis (47%; 15 of 32) than among those not receiving dialysis (16%; 22 of 138) (p<0.001). Among residents with COVID-19, the 30-day hospitalization rate among those receiving dialysis (53%) was higher than that among residents not receiving dialysis (18%) (p = 0.03); the proportion of dialysis patients who died was 40% compared with those who did not receive dialysis (27%) (p = 0.42).Careful consideration of infection control practices throughout the dialysis process (e.g., transportation, time spent in waiting areas, spacing of machines, and cohorting), clear communication between nursing homes and dialysis centers, and coordination of testing practices between these sites are critical to preventing COVID-19 outbreaks in this medically vulnerable population.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Dialysis/adverse effects , Disease Outbreaks , Nursing Homes , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Aged , COVID-19 , Humans , Maryland/epidemiology , Pandemics
2.
Vaccine ; 39(29): 3844-3851, 2021 06 29.
Article in English | MEDLINE | ID: covidwho-1253724

ABSTRACT

BACKGROUND: The devastating impact of the SARS-CoV-2 pandemic prompted the development and emergency use authorization of two mRNA vaccines in early 2020. Vaccine trials excluded nursing home (NH) residents, limiting adverse event data that directly apply to this population. METHODS: To prospectively monitor for potential adverse events associated with vaccination, we used Electronic Health Record (EHR) data from Genesis HealthCare, the largest NH provider in the United States. EHR data on vaccinations and pre-specified adverse events were updated daily and monitored for signal detection among residents of 147 facilities who received the first dose of vaccine between December 18, 2020 and January 3, 2021. For comparison, unvaccinated residents during the same time period were included from 137 facilities that started vaccinating at least 15 days after the vaccinating-facilities. RESULTS: As of January 3, 2021, 8553 NH residents had received one dose of SARS-CoV-2 vaccine and by February 20, 2021, 8371 residents had received their second dose of vaccine; 11,072 were included in the unvaccinated comparator group. No significant associations were noted for neurologic outcomes, anaphylaxis, or cardiac events. CONCLUSIONS: No major safety problems were detected following the first or second dose of the vaccine to prevent COVID-19 in the study cohort from December 18, 2020 through March 7, 2021.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , Nursing Homes , RNA, Messenger , SARS-CoV-2 , United States , Vaccination
3.
Front Med (Lausanne) ; 8: 670370, 2021.
Article in English | MEDLINE | ID: covidwho-1247878

ABSTRACT

Background: The emergency use authorization for coronavirus disease 2019 (COVID-19) vaccines brought both hopes and concerns to the Americans and others. We aimed to estimate the mortality rate of COVID-19 vaccination and presented characteristics of deaths following COVID-19 vaccination. Methods: Data on deaths following COVID-19 vaccination were obtained from the Vaccine Adverse Event Reporting System (VAERS) from December 11, 2020 through January 8, 2021. The Centers for Disease Control and Prevention (CDC) COVID Data Tracker was used to identify the total number of people receiving COVID-19 vaccines during the same period to estimate the mortality rate. Stratified analysis was conducted by the location of vaccination. Results: As of January 8, 2021, 55 deaths were reported, and the mortality rate of COVID-19 vaccination was 8.2 per million population. A total of 37 deaths were reported among long-term care facility residents, and the mortality rate was 53.4 per million population. Top reported comorbidities associated with deaths included hypertension, dementia, chronic obstructive pulmonary disease (COPD), diabetes, and heart failure. In addition, dementia was more likely to be associated with deaths vaccinated at long-term care facilities than at other locations. Conclusion: The benefits of COVID-19 vaccines outweigh the potential risks in older frail populations, and our findings do not support actions to exclude older adults from being vaccinated. However, continued monitoring of COVID-19 vaccination is still warranted.

4.
Ageing Res Rev ; 69: 101373, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1242880

ABSTRACT

The coronavirus disease 19 (COVID-19) is relevant in older people. Attention was given to the nursing homes in which frailer people are usually admitted. In this review, we discuss the approaches for daily problems found in nursing home as geriatricians and potentially new research directions. We start with the problem of the older people affected by dementia and Behavioral and Psychological Symptoms of Dementia for which also the execution of a simple diagnostic test (such as nasopharyngeal swab) could be problematic. Another important problem is the management of wandering patients for which the re-organization of the spaces and vaccination could be the solutions. The relationship with families is another important problem, also from a medico-legal point of view, that can be faced using video conferencing tools. Moreover, we discussed the importance of stratifying prognosis in older nursing home residents for the best management and therapeutically approach, including palliative care, also using telemedicine and the inclusion of prognostic tools in daily clinical practice. Finally, we approached the therapeutical issues in older people that suggests the necessity of future research for finding older-friendly medications.


Subject(s)
COVID-19 , Dementia , Aged , Dementia/therapy , Geriatricians , Humans , Nursing Homes , SARS-CoV-2
5.
MMWR Morb Mortal Wkly Rep ; 70(8): 283-288, 2021 Feb 26.
Article in English | MEDLINE | ID: covidwho-1102702

ABSTRACT

Two coronavirus disease 2019 (COVID-19) vaccines are currently authorized for use in the United States. The Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine on December 11, 2020, and for the Moderna COVID-19 vaccine on December 18, 2020; each is administered as a 2-dose series. The Advisory Committee on Immunization Practices issued interim recommendations for Pfizer-BioNTech and Moderna COVID-19 vaccines on December 12, 2020 (1), and December 19, 2020 (2), respectively; initial doses were recommended for health care personnel and long-term care facility (LTCF) residents (3). Safety monitoring for these vaccines has been the most intense and comprehensive in U.S. history, using the Vaccine Adverse Event Reporting System (VAERS), a spontaneous reporting system, and v-safe,* an active surveillance system, during the initial implementation phases of the COVID-19 national vaccination program (4). CDC conducted descriptive analyses of safety data from the first month of vaccination (December 14, 2020-January 13, 2021). During this period, 13,794,904 vaccine doses were administered, and VAERS received and processed† 6,994 reports of adverse events after vaccination, including 6,354 (90.8%) that were classified as nonserious and 640 (9.2%) as serious.§ The symptoms most frequently reported to VAERS were headache (22.4%), fatigue (16.5%), and dizziness (16.5%). A total of 113 deaths were reported to VAERS, including 78 (65%) among LTCF residents; available information from death certificates, autopsy reports, medical records, and clinical descriptions from VAERS reports and health care providers did not suggest any causal relationship between COVID-19 vaccination and death. Rare cases of anaphylaxis after receipt of both vaccines were reported (4.5 reported cases per million doses administered). Among persons who received Pfizer-BioNTech vaccine, reactions reported to the v-safe system were more frequent after receipt of the second dose than after the first. The initial postauthorization safety profiles of the two COVID-19 vaccines in current use did not indicate evidence of unexpected serious adverse events. These data provide reassurance and helpful information regarding what health care providers and vaccine recipients might expect after vaccination.


Subject(s)
COVID-19 Vaccines/adverse effects , Adolescent , Adult , Adverse Drug Reaction Reporting Systems , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , United States , Young Adult
6.
Allergol Immunopathol (Madr) ; 49(1): 113-117, 2021.
Article in English | MEDLINE | ID: covidwho-1059653

ABSTRACT

BACKGROUND: Spain has been severely affected by the COVID-19 epidemic, with 195,944 persons infected and 20,453 deaths at the time of writing. Older people with respiratory or cardiac conditions are most at risk. OBJECTIVE: The aim was to compare respiratory symptoms in nursing home residents and patients with uncontrolled asthma, who are considered vulnerable to COVID-19. METHODS: We studied 134 nursing home residents and 139 patients with uncontrolled asthma, groups vulnerable to COVID-19. Demographic characteristics, clinical manifestations, outcomes, key laboratory results, and radiological images were collected from medical records. COVID-19 infection was detected by polymerase chain reaction (PCR). RESULTS: Thirteen (9.3%) patients with uncontrolled asthma, all receiving inhaled corticosteroids were infected by COVID-19. Eighty (60%) nursing home residents were infected; only 28, all of whom had received inhaled corticosteroids, had a good prognosis. CONCLUSIONS: Early treatment with inhaled corticosteroids may be helpful in COVID-19 infection. Persons with an allergy might have some protective mechanisms against coronavirus.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Asthma/drug therapy , COVID-19/prevention & control , Administration, Inhalation , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adult , Aged , Aged, 80 and over , Asthma/virology , COVID-19/diagnostic imaging , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Nursing Homes , Prognosis , Spain
7.
BMJ Open ; 10(12): e041577, 2020 12 10.
Article in English | MEDLINE | ID: covidwho-971723

ABSTRACT

OBJECTIVE: To investigate possible relationships between pre-existing medical conditions (including common comorbidities and chronic medications) and risk for suffering COVID-19 disease in middle-aged and older adults. DESIGN: Population-based retrospective cohort study. SETTING: Twelve primary care centres (PCCs) in Tarragona (Spain). PARTICIPANTS: 79 083 people (77 676 community-dwelling and 1407 nursing-home residents), who were all individuals aged >50 years affiliated to the 12 participating PCCs. OUTCOMES: Baseline cohort characteristics (age, sex, vaccinations, comorbidities and chronic medications) were established at study start (1st. March 2020) and primary outcome was time to COVID-19 confirmed by PCR among cohort members throughout the epidemic period (from 1st. March 2020 to 23rd. May 2020). Risk for suffering COVID-19 was evaluated by Cox regression, estimating multivariable HRs adjusted for age, sex, comorbidities and medications use. RESULTS: During the study period, 2324 cohort members were PCR-tested, with 1944 negative and 380 positive results, which means an incidence of 480.5 PCR-confirmed COVID-19 cases per 100 000 persons-period. Assessing the total study cohort, only age (HR 1.02; 95% CI 1.01 to 1.03; p=0.002), nursing-home residence (HR 21.83; 95% CI 16.66 to 28.61; p<0.001) and receiving diuretics (HR 1.35; 95% CI 1.04 to 1.76; p=0.026) appeared independently associated with increased risk. Smoking (HR 0.62; 95% CI 0.41 to 0.93; p=0.022), ACE inhibitors (HR 0.68; 95% CI 0.47 to 0.99; p=0.046) and antihistamine (HR 0.47; 95% CI 0.22 to 1.01; p=0.052) were associated with a lower risk. Among community-dwelling individuals, cancer (HR 1.52; 95% CI 1.03 to 2.24; p=0.035), chronic respiratory disease (HR 1.82; 95% CI 1.08 to 3.07; p=0.025) and cardiac disease (HR 1.53; 95% CI 1.06 to 2.19; p=0.021) emerged to be also associated with an increased risk. Receiving ACE inhibitors (HR 0.66; 95% CI 0.44 to 0.99; p=0.046) and influenza vaccination (HR 0.63; 95% CI 0.44 to 0.91; p=0.012) was associated with decreased risk. CONCLUSION: Age, nursing-home residence and multiple comorbidities appear predisposing for COVID-19. Conversely, receiving ACE inhibitors, antihistamine and influenza vaccination could be protective, which should be closely investigated in further studies specifically focused on these concerns.


Subject(s)
COVID-19/epidemiology , Comorbidity , Pharmaceutical Preparations/administration & dosage , Aged , Aged, 80 and over , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Female , Heart Diseases/epidemiology , Humans , Influenza Vaccines/therapeutic use , Male , Middle Aged , Nursing Homes , Proportional Hazards Models , Retrospective Studies , Risk Factors , Spain/epidemiology
8.
J Am Geriatr Soc ; 68(12): 2716-2720, 2020 12.
Article in English | MEDLINE | ID: covidwho-840738

ABSTRACT

BACKGROUND/OBJECTIVES: Infection screening tools classically define fever as 38.0°C (100.4°F). Frail older adults may not mount the same febrile response to systemic infection as younger or healthier individuals. We evaluate temperature trends among nursing home (NH) residents undergoing diagnostic SARS-CoV-2 testing and describe the diagnostic accuracy of temperature measurements for predicting test-confirmed SARS-CoV-2 infection. DESIGN: Retrospective cohort study evaluating diagnostic accuracy of pre-SARS-CoV-2 testing temperature changes. SETTING: Two separate NH cohorts tested diagnostically (e.g., for symptoms) for SARS-CoV-2. PARTICIPANTS Veterans residing in Veterans Affairs (VA) managed NHs and residents in a private national chain of community NHs. MEASUREMENTS: For both cohorts, we determined the sensitivity, specificity, and Youden's index with different temperature cutoffs for SARS-CoV-2 polymerase chain reaction results. RESULTS: The VA cohort consisted of 1,301 residents in 134 facilities from March 1, 2020, to May 14, 2020, with 25% confirmed for SARS-CoV-2. The community cohort included 3,368 residents spread across 282 facilities from February 18, 2020, to June 9, 2020, and 42% were confirmed for SARS-CoV-2. The VA cohort was younger, less White, and mostly male. A temperature testing threshold of 37.2°C has better sensitivity for SARS-CoV-2, 76% and 34% in the VA and community NH, respectively, versus 38.0°C with 43% and 12% sensitivity, respectively. CONCLUSION: A definition of 38.0°C for fever in NH screening tools should be lowered to improve predictive accuracy for SARS-CoV-2 infection. Stakeholders should carefully consider the impact of adopting lower testing thresholds on testing availability, cost, and burden on staff and residents. Temperatures alone have relatively low sensitivity/specificity, and we advocate any threshold be used as part of a screening tool, along with other signs and symptoms of infection.


Subject(s)
Aging/physiology , Body Temperature/physiology , COVID-19 , Nursing Homes/statistics & numerical data , Thermography , Veterans Health Services/statistics & numerical data , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19 Testing/methods , Dimensional Measurement Accuracy , Female , Homes for the Aged/statistics & numerical data , Humans , Male , Mass Screening/methods , Mass Screening/standards , SARS-CoV-2 , Sensitivity and Specificity , Thermography/methods , Thermography/standards , Thermography/statistics & numerical data , United States/epidemiology
9.
J Am Med Dir Assoc ; 21(10): 1384-1386, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-744077

ABSTRACT

OBJECTIVES: Lung ultrasonographic (LUS) imaging may play an important role in the management of patients with COVID-19-associated lung injury, particularly in some special populations. However, data regarding the prognostic role of the LUS in nursing home residents, one of the populations most affected by COVID-19, are not still available. DESIGN: Retrospective. SETTINGS AND PARTICIPANTS: Nursing home residents affected by COVID-19 were followed up with an LUS from April 8 to May 14, 2020, in Chioggia, Venice. METHODS: COVID-19 was diagnosed through a nasopharyngeal swab. LUS results were scored using a 12-zone method. For each of the 12 zones (2 posterior, 2 anterior, 2 lateral, for both left and right lungs), the possible score ranged from 0 to 3 (1 = presence of B lines, separated, with <50% of space from the pleural line; 2 = presence of B lines, separated, with >50% of space from the pleural line; 3 = lung thickening with tissuelike aspect). The total score ranged from 0 to 36. Mortality was assessed using administrative data. Data regarding accuracy (and related parameters) were reported. RESULTS: Among 175 nursing home residents, 48 (mean age: 84.1 years; mainly female) were affected by COVID-19. Twelve died during the follow-up period. The mean LUS score was 3. The area under the curve of LUS in predicting mortality was 0.603 [95% confidence interval (CI): 0.419-0.787], and it increased to 0.725 (95% CI: 0.41-0.99) after including follow-up LUS controls. Taking an LUS score ≥4 as exposure variable and mortality as outcome, the sensitivity was 58.33% and specificity 63.89%, with a positive likelihood ratio of 1.62 and a negative of 0.65. CONCLUSIONS AND IMPLICATIONS: LUS is able to significantly predict mortality in nursing home residents affected by COVID-19, suggesting that this simple tool can be routinely used in this setting instead of more invasive techniques available only in hospital.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Lung/diagnostic imaging , Nursing Homes/organization & administration , Pneumonia, Viral/diagnostic imaging , Aged , Aged, 80 and over , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Female , Humans , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , Ultrasonography
10.
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 , COVID-19 , 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 , SARS-CoV-2 , Sensitivity and Specificity , Ultrasonography/instrumentation , Ultrasonography/methods , Wireless Technology
SELECTION OF CITATIONS
SEARCH DETAIL