Coronavirus Disease 2019 Outcomes in French Nursing Homes That Implemented Staff Confinement With Residents.
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, ANDPARTICIPANTS:
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 ANDMEASURES:
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 385â¯290 staff members and 695â¯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 30â¯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 31â¯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 12â¯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 29â¯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.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pneumonia, Viral
/
Social Isolation
/
Coronavirus Infections
/
Pandemics
/
Betacoronavirus
/
Homes for the Aged
/
Nursing Homes
/
Nursing Staff
Type of study:
Cohort study
/
Observational study
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Prognostic study
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Randomized controlled trials
Limits:
Adult
/
Aged
/
Humans
Country/Region as subject:
Europa
Language:
English
Journal:
JAMA Netw Open
Year:
2020
Document Type:
Article
Affiliation country:
Jamanetworkopen.2020.17533
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