Single- versus shared-occupancy bedrooms in long-term care homes during the COVID-19 pandemic: A regional cohort study of 355 facilities in British Columbia, Canada

Abstract

Long-term care homes (LTCHs) around the world have been severely impacted by COVID-19 outbreaks with exceptionally high case loads and fatalities relative to the general public. A growing body of researchers, policy makers, and advocates have raised concern that the design and operation of these specialized 24-hour eldercare facilities may be partly responsible for risk of infection from transmissible diseases. While by no means the only factor in healthcare associated infections (HAIs), bedroom occupancy has been suggested as a potential determinant due to the disparities of exposure in shared bedrooms with two or more residents when compared to the isolation provided by single-occupancy bedrooms. This cohort study examines the role of bedroom occupancy on resident attack rates (RAR) in LTCHs in British Columbia (BC), Canada, by linking public health data from the BC Centre for Disease Control (BCCDC) and administrative survey data from the BC Office of the Seniors Advocate (BCOSA). During the observation period which extended from March 5, 2020–February 9, 2022 (707 days), 333 outbreaks were reported at 200 of the 355 BCLTCHs (56.3%). A total of 2,519 staff cases, 4,367 resident cases, and 960 resident deaths were reported (22.0% case fatality rate). Correlation analyses show that single-occupancy bedrooms had a weak, inverse correlation with COVID-19 infections among residents, whereas number of staff cases and highest RAR of any encountered outbreak were strongly correlated with resident infections. Counter to the perception that LTCH residents of shared bedrooms were at far greater risk, these observations suggest the bedroom occupancy was a minor factor contributing to the spread of COVID-19 in BCLTCHs.