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: 21 January 2021

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: we used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020.Methodswe calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We 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: 21 January 2021

Care homes and COVID-19 in Hong Kong: how the lessons from SARS were used to good effect

Age and Ageing

In Hong Kong, about 15% of older people (aged 80 and above) live in care homes, one of the highest proportions in the world. During the spread of severe acute respiratory syndrome in 2003, the crude fatality rate for older people in care homes that were infected was 72%. After taking the advice of a team of international experts, the Hong Kong Government implemented comprehensive preventive measures to cope with the future epidemics. This commentary evaluates the effectiveness of these measures in coping with both influenza outbreaks and COVID-19 and suggests the lessons learnt are relevant to both developed and less developed countries? Lockdown in care homes is very effective under two conditions. Healthcare workers must wear surgical masks in the care home. Hospitals must adopt a strict policy to prevent virus transmission by discharged patients. Care homes situated within high-rise residential towers are particularly vulnerable to COVID-19 transmission; their residents can more easily be infected by asymptomatic carriers from the community. Airborne virus can also be transmitted more swiftly in care homes with open-plan layouts. Lockdown had been shown to significantly reduce influenza outbreaks in care homes. On the other hand, lockdown causes loneliness to residents. Care homes allow residents to move freely within the care home though with the risk of spreading the virus by resident who is an asymptomatic carrier. Finally, lockdown may cause family members to have guilty feelings. Family members can only make video call or window visit to residents.

Last updated on hub: 21 January 2021

The need for improved discharge criteria for hospitalised patients with COVID-19 – implications for patients in long-term care facilities

Age and Ageing

In the COVID-19 pandemic, patients who are older and residents of long-term care facilities (LTCF) are at greatest risk of worse clinical outcomes. We reviewed discharge criteria for hospitalised COVID-19 patients from 10 countries with the highest incidence of COVID-19 cases as of 26 July 2020. Five countries (Brazil, Mexico, Peru, Chile and Iran) had no discharge criteria; the remaining five (USA, India, Russia, South Africa and the UK) had discharge guidelines with large inter-country variability. India and Russia recommend discharge for a clinically recovered patient with two negative reverse transcription polymerase chain reaction (RT-PCR) tests 24 h apart; the USA offers either a symptom based strategy—clinical recovery and 10 days after symptom onset, or the same test-based strategy. The UK suggests that patients can be discharged when patients have clinically recovered; South Africa recommends discharge 14 days after symptom onset if clinically stable. We recommend a unified, simpler discharge criteria, based on current studies which suggest that most SARS-CoV-2 loses its infectivity by 10 days post-symptom onset. In asymptomatic cases, this can be taken as 10 days after the first positive PCR result. Additional days of isolation beyond this should be left to the discretion of individual clinician. This represents a practical compromise between unnecessarily prolonged admissions and returning highly infectious patients back to their care facilities, and is of particular importance in older patients discharged to LTCFs, residents of which may be at greatest risk of transmission and worse clinical outcomes.

Last updated on hub: 21 January 2021

Reflections on practice during a pandemic: how do we continue to ensure effective communication during the COVID‐19 pandemic?

Child Abuse Review

This report sets out the reflections of a practice mentor to social workers across the Children and Families Service in Gwynedd on how communication has been affected in social work due to the pandemic. As part of the Effective Child Protection Project, the role involves offering individual and group support, and reflective opportunities to social workers. The paper explains how practice and communication has changed and adapted to respond to the challenges posed by the pandemic.

Last updated on hub: 21 January 2021

Screening for economic hardship for child welfare-involved families during the COVID-19 pandemic: a rapid partnership response

Child Abuse and Neglect

Background: Pandemics have a wide range of economic, health and social consequences related to both the spread of a disease and efforts made by government leaders to contain it which may be particularly detrimental for the child welfare-involved population. This is because child welfare agencies serve some of the highest needs children and families. A significant proportion of these families face economic hardship, and as a result of containment measures for COVID-19, more families inevitably will. Objective: Given the range of negative consequences related to the pandemic and the evolving supports available to families, child protection workers needed a clinical tool to guide and support work with families informed by an understanding of economic hardship. The objective of this paper is to report on the development and implementation strategy of a tool to be used for practice intervention during the pandemic. Methods: Action research methodology was utilized in the creation of the clinical tool. The tool’s development and implementation occurred through an academic/child welfare sector partnership involving child welfare agencies representing diverse regions and populations in Ontario, Canada. Factor analysis of representative child welfare data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 (OIS-2018) on economic hardship was used to inform the development of questions on the clinical tool. Results: The development and implementation strategy of the clinical tool are described, including the results from analyses of the OIS-2018. Conclusions: Future directions for the project are discussed, including considerations for using this tool beyond the pandemic.

Last updated on hub: 21 January 2021

Telemental health for child trauma treatment during and post-COVID-19: limitations and considerations

Child Abuse and Neglect

The ongoing COVID-19 pandemic has led to unprecedented disruptions and stress in the lives of children and families internationally. Heightened family stress and turmoil can increase risk for, and exacerbate, child maltreatment. As a result, child maltreatment experts are concerned that there will be an influx of children requiring trauma assessment and treatment during and after COVID-19. As physical distancing measures have been implemented and will likely persist into 2021, organizations providing trauma treatment to children and their families have had to rapidly pivot to telemental health to maintain service delivery with clients. While the benefits of telemental health have been identified, including reduced barriers to access, increased cost effectiveness, and broad availability of services, there are unique limitations to its implementation within a child maltreatment population, such as challenges with attention and emotion regulation skills, difficulties identifying dissociative symptoms, and increased time with perpetrators of abuse due to shelter in place orders. These limitations are exacerbated for children and families who are most marginalized and facing the highest levels of social and economic barriers. Lack of access to reliable technology, lack of a private or confidential space for sessions, and reluctance to process trauma in the absence of a safe environment, are all barriers to conducting effective trauma treatment over telemental health. This article discusses both the benefits and barriers to telemental health in a child maltreatment population and offers considerations for child trauma service provision, program development, and policy during and post the COVID-19 pandemic.

Last updated on hub: 21 January 2021

Rapid return of children in residential care to family as a result of COVID-19: scope, challenges, and recommendations

Child Abuse and Neglect

Background: As a result of the COVID-19 pandemic, some governments have mandated that residential care providers rapidly return children and youth to family. Objective: The goal of the present study was to better understand the scope and characteristics of rapid return, and to provide data-informed recommendations for service providers working with this population. Participants and setting: Representatives from 67 non-government organizations (NGOs) providing residential care that were government-mandated to rapidly return children and youth to family completed a brief online survey. They collectively serve 12,494 children in 14 nations. Methods: Using a mixed methods design, results examined 1) characteristics of the rapid return mandate, 2) preparation received by children and families, 3) support services provided since the return, and 4) primary concerns for children and families. Results: Data revealed that rapid return was characterized by compressed timelines that did not allow for adequate child and family assessment and preparation. However, all respondents indicated they believed at least some families would be able to remain intact safely with appropriate support. Primary concerns for children and families related to unresolved antecedents to separation, lack of economic capacity, limited monitoring, and lack of access to education. Conclusions: Based on the findings, 9 recommendations were made for service providers working with children and families that have been rapidly reunified as a result of the COVID-19 pandemic.

Last updated on hub: 21 January 2021

"Oh, this is actually okay": understanding how one state child welfare training system adapted to the COVID-19 pandemic

Child Abuse and Neglect

Background: Training for new and existing child protection system (CPS) caseworkers is critical to developing and maintaining a competent workforce that effectively works towards safety, permanency, and wellbeing outcomes for children in the system. The COVID-19 pandemic required a shift to virtual training to continue training CPS professionals safely. Objective: The purpose of our project was to determine if there were differences in learning outcomes between learners who completed training in the usual delivery methods (Pre-COVID) and the fully virtual delivery methods (Post-COVID). We also sought to understand any factors that facilitated or impeded successful virtual training during the pandemic. Participants and setting: Caseworkers-in-training completed learning and satisfaction assessments through standard continuing quality improvement efforts. Training facilitators, course developers, and leadership completed qualitative interviews. Methods: We assessed quantitative differences in one US state in learner knowledge, satisfaction, and behaviors before and during the COVID-19 pandemic and conducted a qualitative thematic analysis of interviews with training system employees. Results: Overall, there were limited differences in learner outcomes before and after the transition to virtual training delivery. Across the employee interviews, three main themes emerged: organizational culture facilitated the transition, external constraints caused challenges during the transition, and there were opportunities to evolve training practices positively. Conclusions: The shift to a virtual learning environment had little impact on learner knowledge or satisfaction. Employee perspectives indicated that the pre-COVID investment in organizational culture has substantial dividends for performance during the crisis.

Last updated on hub: 21 January 2021

Data-informed recommendations for services providers working with vulnerable children and families during the COVID-19 pandemic

Child Abuse and Neglect

Background: The COVID-19 pandemic and associated response measures have led to unprecedented challenges for service providers working with vulnerable children and families around the world. Objective: The goal of the present study was to better understand the impact of the pandemic and associated response measures on vulnerable children and families and provide data-informed recommendations for public and private service providers working with this population. Participants and Setting: Representatives from 87 non-government organizations (NGOs) providing a variety of direct services (i.e. residential care, family preservation, foster care, etc.) to 454,637 vulnerable children and families in 43 countries completed a brief online survey. Methods: Using a mixed methods design, results examined 1) ways in which children and families have been directly impacted by COVID-19, 2) the impact of the pandemic on services provided by NGOs, 3) government responses and gaps in services for this population during the pandemic, and 4) strategies that have been effective in filling these gaps. Results: Data revealed that the pandemic and restrictive measures were associated with increased risk factors for vulnerable children and families, including not having access to vital services. The NGOs experienced government restrictions, decreased financial support, and inability to adequately provide services. Increased communication and supportive activities had a positive impact on both NGO staff and the families they serve. Conclusions: Based on the findings, ten recommendations were made for service providers working with vulnerable children and families during the COVID-19 pandemic.

Last updated on hub: 21 January 2021