Perceptions of COVID-19 vaccines among healthcare assistants: A national survey.

BACKGROUND: Limited COVID-19 vaccination acceptance among healthcare assistants (HCAs) may adversely impact older adults, who are at increased risk for severe COVID-19 infections. Our study objective was to evaluate the perceptions of COVID-19 vaccine safety and efficacy in a sample of frontline HCAs, overall and by race and ethnicity. METHODS: An online survey was conducted from December 2020 to January 2021 through national e-mail listserv and private Facebook page for the National Association of Health Care Assistants. Responses from 155 HCAs, including certified nursing assistants, home health aides, certified medical assistants, and certified medication technicians, were included. A 27-item survey asked questions about experiences and perceptions of COVID-19 vaccines, including how confident they were that COVID-19 vaccines are safe, effective, and adequately tested in people of color. Multivariable regression was used to identify associations with confidence in COVID-19 vaccines. RESULTS: We analyzed data from 155 completed responses. Among respondents, 23.9% were black and 8.4% Latino/a. Most respondents worked in the nursing home setting (53.5%), followed by hospitals (12.9%), assisted living (11.6%), and home care (10.3%). Respondents expressed low levels of confidence in COVID-19 vaccines, with fewer than 40% expressing at least moderate confidence in safety (38.1%), effectiveness (31.0%), or adequate testing in people of color (27.1%). Non-white respondents reported lower levels of confidence in adequate testing of vaccines compared to white respondents. In bivariate and adjusted models, respondents who gave more favorable scores of organizational leadership at their workplace expressed greater confidence in COVID-19 vaccines. CONCLUSION: Frontline HCAs reported low confidence in COVID-19 vaccines. Stronger organizational leadership in the workplace appears to be an important factor in influencing HCA's willingness to be vaccinated. Action is needed to enhance COVID-19 vaccine uptake in this important population with employers playing an important role to build vaccine confidence and trust among employees.

Comparison of hospitalized patients with COVID-19 who did and did not live in residential care facilities in Montréal: a retrospective case series.

BACKGROUND: As in other jurisdictions, the demographics of people infected with SARS-CoV-2 changed in Quebec over the course of the first COVID-19 pandemic wave, and affected those living in residential care facilities (RCFs) disproportionately. We evaluated the association between clinical characteristics and outcomes of hospitalized patients with COVID-19, comparing those did or did not live in RCFs. METHODS: We conducted a retrospective case series of all consecutive adults (≥ 18 yr) admitted to the Jewish General Hospital in Montréal with laboratory-confirmed SARS-CoV-2 infection from Mar. 4 to June 30, 2020, with in-hospital follow-up until Aug. 6, 2020. We collected patient demographics, comorbidities and outcomes (i.e., admission to the intensive care unit, mechanical ventilation and death) from medical and laboratory records and compared patients who did or did not live in public and private RCFs. We evaluated factors associated with the risk of in-hospital death with a Cox proportional hazard model. RESULTS: In total, 656 patients were hospitalized between March and June 2020, including 303 patients who lived in RCFs and 353 patients who did not. The mean age was 72.9 (standard deviation 18.3) years (range 21 to 106 yr); 349 (53.2%) were female and 118 (18.0%) were admitted to the intensive care unit. The overall mortality rate was 23.8% (156/656), but was higher among patients living in RCFs (36.6% [111/303]) compared with those not living in RCFs (12.7% [45/353]). Increased risk of death was associated with age 80 years and older (hazard ratio [HR] 2.39, 95% confidence interval [CI] 1.35-4.24), male sex (HR 1.74, 95% CI 1.25-2.41), the presence of 4 or more comorbidities (HR 2.01, 95% CI 1.18-3.42) and living in an RCF (HR 1.62, 95% CI 1.09-2.39). INTERPRETATION: During the first wave of the COVID-19 epidemic in Montréal, more than one-third of RCF residents hospitalized with SARS-CoV-2 infection died during hospitalization. Policies and practices that prevent future outbreaks of SARS-CoV-2 infection in this setting must be implemented to prevent high mortality in this vulnerable population.

Use of alternative care sites during the COVID-19 pandemic in the city of Buenos Aires, Argentina.

OBJECTIVES: In large cities, where a large proportion of the population live in poverty and overcrowding, orders to stay home to comply with isolation requirements are difficult to fulfil. In this article, the use of alternative care sites (ACSs) for the isolation of patients with confirmed COVID-19 or persons under investigation (PUI) in the City of Buenos Aires during the first wave of COVID-19 are described. STUDY DESIGN: This is a cross-sectional study. METHODS: All patients with COVID-19 and PUI with insufficient housing resources who could not comply with orders to stay home and who were considered at low clinical risk in the initial triage were referred to refurbished hotels in the City of Buenos Aires (Ciudad Autónoma de Buenos Aires [CABA]). ACSs were divided into those for confirmed COVID-19 patients and those for PUI. RESULTS: From March to August 2020, there were 58,143 reported cases of COVID-19 (13,829 of whom lived in slums) in the CABA. For COVID-19 positive cases, 62.1% (n = 8587) of those living in slums and 21.4% (n = 9498) of those living outside the slums were housed in an ACS. In total, 31.1% (n = 18,085) of confirmed COVID-19 cases were housed in ACSs. In addition, 7728 PUI were housed (3178 from the slums) in an ACS. The average length of stay was 9.0 ± 2.5 days for patients with COVID-19 and 1.6 ± 0.7 days for PUI. For the individuals who were housed in an ACS, 1314 (5.1%) had to be hospitalised, 56 were in critical care units (0.22%) and there were 27 deaths (0.1%), none during their stay in an ACS. CONCLUSIONS: Overall, about one-third of all people with COVID-19 were referred to an ACS in the CABA. For slum dwellers, the proportion was >60%. The need for hospitalisation was low and severe clinical events were rare. This strategy reduced the pressure on hospitals so their efforts could be directed to patients with moderate-to-severe disease.

COVID-19 Pandemic in Assisted Living Communities: Results from Seven States.

OBJECTIVE: To describe variations in COVID-19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics. DESIGN: Observational study employing data on confirmed COVID-19 cases and deaths in ALs from seven states, through May 29, 2020. SETTING: Information on COVID-19 cases/deaths in ALs was obtained from state government websites. A national inventory of ALs was used to identify communities with and without COVID-19 cases/deaths. Medicare Beneficiary Summary File identifying AL residents was employed to develop AL characteristics. County-level COVID-19 laboratory-confirmed cases/deaths were obtained from publicly available data. PARTICIPANTS: We found 4,865 ALs (2,647 COVID-19 cases and 777 deaths) in the seven states. After excluding missing data, the sample consisted of 3,994 ALs (82.1%) with 2,542 cases (96.0%) and 675 deaths (86.9%). MAIN OUTCOMES AND MEASURES: Outcomes were AL-level counts of cases and deaths. Covariates were AL characteristics and county-level confirmed COVID-19 cases/deaths. Multivariable two-part models determined the associations of independent variables with the likelihood of at least one case and death in the AL, and with the count of cases (deaths). RESULTS: State case fatality ranged from 3.32% in North Carolina to 9.26% in Connecticut, but for ALs in these states it was 12.89% and 31.59%, respectively. Among ALs with at least one case, midsize communities had fewer cases (incidence rate ratio (IRR) = 0.829; P = .004) than small ALs. ALs with higher proportions of racial/ethnic minorities had more COVID-19 cases (IRR = 1.08; P < .001), as did communities with higher proportions of residents with dementia, chronic obstructive pulmonary disease, and obesity. CONCLUSIONS AND RELEVANCE: ALs with a higher proportion of minorities had more COVID-19 cases. Many of the previously identified individual risk factors are also present in this vulnerable population. The impact of COVID-19 on ALs is as critical as that on nursing homes, and is worth equal attention from policy makers.

High Proportion of Asymptomatic SARS-CoV-2 Infections in 9 Long-Term Care Facilities, Pasadena, California, USA, April 2020.

Our analysis of coronavirus disease prevalence in 9 long-term care facilities demonstrated a high proportion (40.7%) of asymptomatic infections among residents and staff members. Infection control measures in congregate settings should include mass testing-based strategies in concert with symptom screening for greater effectiveness in preventing the spread of severe acute respiratory syndrome coronavirus 2.