COVID-19 resources

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Asymptomatic carriage rates and case fatality of SARS-CoV-2 infection in residents and staff in Irish nursing homes

Age and Ageing

Background: SARS-CoV-2 has disproportionately affected nursing homes (NH). In Ireland, the first NH case COVID-19 occurred on 16 March 2020. A national point-prevalence testing programme of all NH residents and staff took place (18 April 2020 to 5 May 2020). Aims: to examine characteristics of NHs across three Irish Community Health Organisations, proportions with COVID-19 outbreaks, staff and resident infection rates symptom profile and resident case fatality. Methods: in total, 45 NHs surveyed, requesting details on occupancy, size, COVID-19 outbreak, outbreak timing, total symptomatic/asymptomatic cases and outcomes for residents from 29 February 2020 to 22 May 2020. Results: surveys were returned from 62.2% (28/45) of NHs (2,043 residents, 2,303 beds). Three-quarters (21/28) had COVID-19 outbreaks (1,741 residents, 1,972 beds). Median time from first COVID-19 case in Ireland to first case in these NHs was 27.0 days. Resident incidence was 43.9% (764/1,741)—40.8% (710/1,741) laboratory confirmed, with 27.2% (193/710) asymptomatic and 3.1% (54/1,741) clinically suspected. Resident case fatality was 27.6% (211/764) for combined laboratory-confirmed/clinically suspected COVID-19. Similar proportions of residents in NHs with ‘early-stage’ (<28 days) versus ‘later-stage’ outbreaks developed COVID-19. Lower proportions of residents in ‘early’ outbreak NHs had recovered compared with those with ‘late’ outbreaks (37.4 versus 61.7%; χ2 = 56.9, P < 0.001). Of 395 NH staff across 12 sites with confirmed COVID-19, 24.7% (99/398) were asymptomatic. There was a significant correlation between the proportion of staff with symptomatic COVID-19 and resident numbers with confirmed/suspected COVID-19 (Spearman’s rho = 0.81, P < 0.001). Conclusion: this study demonstrates the significant impact of COVID-19 on the NH sector. Systematic point-prevalence testing is necessary to reduce risk of transmission from asymptomatic carriers and manage outbreaks in this setting.

Last updated on hub: 07 December 2020

The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016–2020

Age and Ageing

Background: mortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages and insufficient or lack of timely COVID-19 testing. Aim: to analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4 years. Study Design and Setting: This study used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. This study anonymously linked data for Welsh residents to mortality data up to the 14th June 2020. Methods: This study calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. The researchers adjusted HRs for age, gender, social economic status and prior health conditions. Results: survival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1.72 (1.55, 1.90) compared with 2016. Compared with the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2.15 (2.11, 2.20) in 2016–2019 to 2.94 (2.81, 3.08) in 2020. Conclusions: the survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.

Last updated on hub: 07 December 2020

The impact of COVID‐19 pandemic on people with mild cognitive impairment / dementia and on their caregivers

International Journal of Geriatric Psychiatry

he novel coronavirus disease (COVID‐19) was first detected in mainland China in December 2019, and soon it spread throughout the world, with multiple physical and psychological consequences across the affected populations. The aim of the current study was to analyze the impact of COVID‐19 pandemic on older adults with Mild Cognitive Impairment (MCI)/dementia and their caregivers as well. Two hundred and four caregivers took part in the study, completing a self‐reported questionnaire about the person with MCI/dementia and their own, since the lockdown period which started in February and ended in May of 2020 in Greece. Results indicated a significant overall decline of the people with MCI/dementia. Further, the domains in which people with MCI/dementia were mostly affected were: communication, mood, movement, and compliance with the new measures. Caregivers also reported a great increase in their psychological and physical burden during this period, where the available support sources were limited. The pandemic threatens to disrupt the basic routines that promote mental and physical health of both people with MCI/dementia and their caregivers. Further measures to protect and provide support to people who suffer and their families are needed.

Last updated on hub: 07 December 2020

Dementia and the risk of death in elderly patients with COVID‐19 infection: systematic review and meta‐analysis

International Journal of Geriatric Psychiatry

Objectives: The COVID‐19 infection represents a global public health emergency worldwide. Several risk factors have been associated with a poor prognosis among COVID‐19 patients. This study aimed to perform a systemic review and meta‐analysis to evaluate the mortality risk in elderly patients with dementia and COVID‐19 infection. Methods: Literature search was based on Cochrane Library, Embase, PubMed and Google Scholar to locate articles published between December 2019 to July 2020, presenting the number of survived vs deceased patients with dementia and COVID‐19 infection. Results: A total of 233 articles were retrieved; 158 were excluded for not meeting the inclusion criteria, leaving 75 articles to assess for eligibility. After evaluation of the full‐text articles, 8 met the inclusion criteria and were thus included into the final analysis (6493 patients ‐ mean age: 69.6 years). Among COVID‐19 patients, the prevalence of dementia was higher in non survivors compared with survivors (17.5% vs 5.4%, p<0.001). The pooled analysis performed using a random‐effect model showed an increase in the risk of death in COVID‐19 patients with dementia (Odds Ratio3.75; 95% Confidence Interval: 2.54 ‐ 5.54, p<0.0001, I2=49.5%) The Egger's regression test confirmed that there were not statistically evidences of publication bias (t=0.059; p=0.954). Conclusions: The preliminary results suggest that patients with COVID‐19 infection and dementia have a higher mortality risk in the short‐term period compared with infected non‐demented individuals. Due to their intrinsic frailty, dementia patients may require a more aggressive treatment and prompt isolation to improve their short‐term outcome.

Last updated on hub: 07 December 2020

Social policy responses to COVID‐19 in Canada and the United States: explaining policy variations between two liberal welfare state regimes

Social Policy and Administration

Canada and the United States are often grouped together as liberal welfare‐state regimes, with broadly similar levels of social spending. Yet, as the COVID‐19 pandemic reveals, the two countries engage in highly divergent approaches to social policymaking during a massive public health emergency. Drawing on evidence from the first 5 months of the pandemic, this article compares social policy measures taken by the United States and Canadian governments in response to COVID‐19. In general, this paper shows that Canadian responses were both more rapid and comprehensive than those of the United States. This variation, the authors argue, can be explained by analysing the divergent political institutions, pre‐existing policy legacies, and variations in cross‐partisan consensus, which have all shaped national decision‐making in the middle of the crisis.

Last updated on hub: 07 December 2020

Restructuring paradigm in the wake of COVID-19: a study of Kerala model

Journal of Human Behavior in the Social Environment

The novel coronavirus that shook the world population has restructured the world order. While the scientists are grappling hard to find a solution to the imminent problem at hand, the pandemic has thrown the human race into a perplexed stage questioning and mostly changing everything they believed in. The pandemic has replaced human beings as social animal to virtual being. The social distancing mandate required for the survival as propounded by WHO has forced individuals to keep the other humans at bay. The present paper is an attempt to look at the changes the world is facing with respect to the social, cultural, economic, and psychological aspects with a special focus on the internationally acclaimed Kerala model of survival. Kerala, a small state located within the southern peninsula of the country has played an important role in containing the spread of the virus despite its larger population density. The paper focuses on the innovative mechanics followed by the state to curtail the spreading. It also attempts to look at the changes that have been brought in the general human behavior.

Last updated on hub: 07 December 2020

Preventing the transmission of COVID-19 and other coronaviruses in older adults aged 60 years and above living in long-term care: a rapid review

Systematic reviews

Background: The objective of this review was to examine the current guidelines for infection prevention and control (IPAC) of coronavirus disease-19 (COVID-19) or other coronaviruses in adults 60 years or older living in long-term care facilities (LTCF). Methods: EMBASE, MEDLINE, Cochrane library, pre-print servers, clinical trial registries, and relevant grey literature sources were searched until July 31, 2020, using database searching and an automated method called Continuous Active Learning(CAL). All search results were processed using CAL to identify the most likely relevant citations that were then screened by a single human reviewer. Full-text screening, data abstraction, and quality appraisal were completed by a single reviewer and verified by a second. Results: Nine clinical practice guidelines (CPGs) were included. The most common recommendation in the CPGs was establishing surveillance and monitoring systems followed by mandating the use of PPE; physically distancing or cohorting residents; environmental cleaning and disinfection; promoting hand and respiratory hygiene among residents, staff, and visitors; and providing sick leave compensation for staff. Conclusions: Current evidence suggests robust surveillance and monitoring along with support for IPAC initiatives are key to preventing the spread of COVID-19 in LTCF. However, there are significant gaps in the current recommendations especially with regard to the movement of staff between LTCF and their role as possible transmission vectors.

Last updated on hub: 07 December 2020

Building long-term care staff capacity during COVID-19 through just-in-time learning: evaluation of a modified ECHO model

Journal of the American Medical Directors Association

Objectives: The onset of the COVID-19 pandemic significantly challenged the capacity of long-term care (LTC) homes in Canada resulting in new, pressing priorities for leaders and healthcare providers (HCPs) in the care and safety of LTC residents. This study aimed to determine whether Project ECHO® (Extension for Community Healthcare Outcomes) Care of the Elderly Long-Term Care (COE-LTC): COVID-19, a virtual education program, was effective at delivering just-in-time learning and best practices to support LTC teams and residents during the pandemic. Design: Mixed methods evaluation. Setting and Participants: Interprofessional HCPs working in LTC homes or deployed to work in LTC homes primarily in Ontario, Canada, who participated in 12 weekly, 60-minute sessions. Methods: Quantitative and qualitative surveys assessing reach, satisfaction, self-efficacy, practice change, impact on resident care and knowledge sharing. Results: Of the 252 registrants for ECHO COE-LTC: COVID-19, 160 (63.4%) attended at least one weekly session. Nurses and nurse practitioners represented the largest proportion of HCPs (43.8%). Overall, both confidence and comfort level working with residents who were at risk, confirmed or suspected of having COVID-19 increased after participating in the ECHO sessions (effect sizes≥0.7, Wilcoxon signed rank p<.001). Participants also reported impact on intent to change behavior, resident care and knowledge sharing. Conclusions and Implications: The results demonstrate that ECHO COE-LTC: COVID 19 effectively delivered time sensitive information and best practices to support LTC teams and residents. It may be a critical platform during this pandemic and in future crises to deliver just-in-time learning during periods of constantly changing information.

Last updated on hub: 07 December 2020

Implementation of an algorithm of cohort classification to prevent the spread of COVID-19 in nursing homes

Journal of the American Medical Directors Association

Older adults living in nursing homes are the most vulnerable group of the COVID-19 pandemic. There are many difficulties in isolating residents and limiting the spread in this setting. These researchers have developed a simple algorithm with a traffic light shape for resident classification and sectorization within nursing homes, based on basic diagnostic tests, surveillance of symptoms onset and close contact monitoring. The researchers have implemented the algorithm in several centers with good data on adherence. Suggestions for implementation and evaluation are discussed.

Last updated on hub: 07 December 2020

Dilemmas with restrictive visiting policies in Dutch nursing homes during the COVID-19 pandemic: a qualitative analysis of an open-ended questionnaire with elderly care physicians

Journal of the American Medical Directors Association

Objectives: To mitigate the spread of COVID-19, a nationwide restriction for all visitors of residents of long-term care facilities including nursing homes (NHs) was established in the Netherlands. The aim of this study was an exploration of dilemmas experienced by Elderly Care Physicians (ECPs) as a result of the COVID-19 driven restrictive visiting policy. Setting and Participants: ECPs working in Dutch NHs. Methods: A qualitative exploratory study was performed using an open-ended questionnaire. A thematic analysis was applied. Data was collected between April 17 and May 10, 2020. Results: Seventy-six ECPs answered the questionnaire describing a total of 114 cases in which they experienced a dilemma. Thematic analysis revealed four major themes: (1) The need for balancing safety for all through infection prevention measures versus quality of life of the individual residents and their loved ones; (2) The challenge of assessing the dying phase and how the allowed exception to the strict visitor restriction in the dying phase could be implemented; (3) The profound emotional impact on ECPs; (4) Many alternatives for visits highlight the wish to compensate for the absence of face to face contact opportunities. However, given the diversity of NH residents, alternatives were often only suitable for some of them. Conclusions and Implications: ECPs reported that the restrictive visitor policy deeply impacts NHs residents, their loved ones and care professionals. The dilemmas encountered as a result of the policy highlight the wish by ECPs to offer solutions tailored to the individual residents. This study identified an overview of aspects to consider when drafting future visiting policies for NHs during the COVID-19 pandemic.

Last updated on hub: 07 December 2020