Abstract
Background: Outbreaks of Coronavirus 2019 (COVID-19) in Long-Term Care Facilities (LTCFs) have resulted mainly from disease transmission by asymptomatic health care workers (HCW's). It is not known whether routine COVID-19 screening tests carried out on HCW's would reduce mortality of LTCF residents. Since mid-July 2020, the Israeli national LTCF defense program – "Senior Shield" - has used weekly COVID-19 PCR tests on all LTCF employees. Methods: A nationwide, government funded, screening program on all LTCF personnel for four months during the second COVID-19 wave. We evaluated differences between the two waves in the national LTCF's system with regard to hospitalizations and mortality. Estimation of national health system predicted outcomes, in the absence of this weekly screening plan, was calculated. Findings: COVID-19 tests were taken weekly in all 1,107 LTCFs which includes 62,159 HCWs and 100,046 residents. A median of 55,282 (range – 16,249) tests were performed each week. Turnaround time from sampling to result was less than 24 hours in 95% of tests. Compared to the first wave, in which 45.3% of national mortality was attributed to the LTCF's, the second wave saw a 33.8% reduction in this mortality ratio. Estimation of national health system outcomes during the second wave showed that the activation of the screening program reduced hospital load by 35% and prevented 30% of national mortality from COVID-19.Interpretation: Routine weekly COVID-19 PCR testing of all LTCF employees may reduce national hospitalizations and mortality.Funding Statement: None to declare. Declaration of Interests: None to declare.Ethics Approval Statement: The study was determined to be exempt by the Institutional Review Board of Soroka University Medical Center and thus informed consent was not required (0429-20-SOR).
Highlights
Background Outbreaks ofCoronavirus 2019 (COVID-19) in Long-Term Care Facilities (LTCFs) have resulted mainly from disease transmission by asymptomatic health care workers (HCW's)
Estimation of national health system outcomes during the second wave showed that the activation of the screening program reduced hospital load by 35% and prevented 30% of national mortality from COVID-19
The employee screening tests were positive in 0.05–1.5% of cases and the weekly percentage of positive screening tests was similar to the incidence of COVID-19 in the general population during the second wave
Summary
Background Outbreaks ofCoronavirus 2019 (COVID-19) in Long-Term Care Facilities (LTCFs) have resulted mainly from disease transmission by asymptomatic health care workers (HCW's). Most LTCFs are overcrowded and are poorly prepared to implement infection control policies owing to a shortage of staff, personal protective equipment and the relatively low level of HCW training [5,6,7,8]. These factors make LTCFs extremely vulnerable to deadly COVID-19 outbreaks [9,10]. Public pressure, as well as expert opinion led the government to establish a dedicated national level task force with the aim of protecting the LTCF sector from the spread of COVID-19, in mid-April 2020
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