SARS-CoV-2 cases reported from long-term residential facilities (care homes) in South Africa: A retrospective cohort study

ABSTRACT

Introduction/ Background: Long-term care facilities (LTCFs) experienced a large burden of SARS-CoV-2 due the COVID-19 pandemic. The purpose of this study was to describe the temporal trends as well as the characteristics and risk factors for mortality among residents and staff testing positive for SARS-CoV-2 in LTCFs across South Africa. Methods: We implemented a retrospective cohort analysis of SARS-CoV-2 positive cases in LTCFs across South Africa from 5 March 2020- 31 July 2021. We analysed 45 LTCFs from the DATCOV sentinel surveillance system in South Africa. Outbreaks in LTCFs were defined as large if more than one third of residents and staff had been infected or there were more than 20 cases that were epidemiologically linked. Multivariable logistic regression was used to assess risk factors for mortality amongst LTCF residents. Results: Total of 2,324 SARS-CoV-2 cases were reported;1,504 (65%) were residents and 820 (35%) staff. Ten (26%) reported one outbreak and 29 (74%) reported more than one outbreak, while 15 (38%) reported small outbreaks and 24 (62%) large outbreaks. There were 1,259 cases during the first COVID-19 wave, 362 during wave two, and 299 during wave three. Among residents, 9% died and among staff 0.5% died. Factors associated with mortality among residents were age 40-59 years, 60-79 years and ≥80 years compared to <40 years. Compared to pre-wave 1, there was a lower risk of mortality across waves. Impact There is currently very little literature on the impact of COVID-19 in LTCFs in low- and middle-income countries (LMIC). This study will impact by adding knowledge to SARS-CoV-2 in LTCFs in a LMIC. Conclusion: Sentinel LTCFs in South Africa shows an encouraging trend of decreasing numbers of outbreaks, cases, and risk for mortality since the first wave. LTCFs have likely learnt from international experience and adopted national protocols, including improved measures to limit transmission and early and appropriate clinical care.