Epidemiology and Clinical Features of COVID-19 Outbreaks in Aged Care Facilities: A Systematic Review and Meta-Analysis

Abstract

Background: COVID-19 outbreaks in aged care facilities often have devastating consequences; however, the epidemiology of such outbreaks is not well defined. We aimed to define the epidemiology of COVID-19 outbreaks in aged care facilities by systematically reviewing the literature published during the current COVID-19 pandemic. Methods: We searched 11 key bibliographic databases to locate literature published on COVID-19 in aged care facilities between December 2019 and September 2020. All original studies reporting extractable epidemiological data on COVID-19 outbreaks as part of outbreak investigations or non-outbreak surveillance of aged care residents were included in this systematic review and meta-analysis. Findings: We identified 50 studies from 14 countries across four continents reporting data on 214,462 residents in 8,503 care homes with 25,590 confirmed cases of COVID-19. Aged care residents from a distinct vulnerable population with single-facility attack rates of 44% [95% CI 31–57%] and case fatality rates of 23% [95% CI 18–28%]. Of the cases, 32% [95% CI 28–35%] were asymptomatic. The rate of hospitalization among residents was 37% [95% CI 35–39%]. Data from 22 outbreaks identified a resident as the index case in 54% of outbreaks and a staff member in 46%. Interpretation: The clinical presentation of COVID-19 varies widely in aged care residents, from asymptomatic to highly serious cases. In the absence of a vaccine, preventing the introduction of COVID-19 into aged care facilities is key. Rapid diagnosis, identification of primary and secondary cases and close contacts and their isolation and quarantine are of paramount importance.Funding: Queensland Advancing Clinical Research Fellowship awarded to Prof. Gulam Khandaker by Queensland Health’s Health Innovation, Investment and Research Office (HIRO), Office of the Director-General.Declaration of Interests: The authors declare no competing interests.