The Efficacy of COVID-19 Vaccination in Mortality Among Multi-Ethnic Long-Term Care Residents in New Zealand.

The rollout of COVID-19 vaccines to Ontario’s long-term care (LTC) homes has substantially reduced SARS-CoV-2 infections, COVID-19 hospitalizations, and COVID-19 deaths among LTC residents and health care workers. Completing and maximizing the uptake of the full COVID-19 vaccine series according to recommended schedules will maximize the safety and well-being of Ontario’s LTC residents and staff.

Excess Mortality in Long-Term Care Residents With and Without Personal Contact With Family or Friends During the COVID-19 Pandemic

COVID-19 mortality among kidney transplant candidates is strongly associated with social determinants of health.

Counting the global COVID-19 dead

Sir, India rolled out COVID-19 vaccination with ChAdOx1 (Oxford AstraZeneca's vaccine manufactured by Serum Institute of India Limited, Pune) and BBV152 (Bharat Biotech Limited, Hyderabad) on January 16, 20211. Healthcare and frontline workers were prioritized for vaccination in the first phase. The vaccination was further extended to other high-risk groups including individuals aged >60 yr and those aged >45 yr with comorbidities (since March 1, 2021), and all individuals aged >45 yr (April 1, 2021)2. Since May 1, 2021, COVID-19 vaccination has been extended to all individuals aged between 18-44 yr2. By May 20, 2021, >140 million individuals received one and 40 million individuals received two vaccine doses3. India started to witness the second wave of COVID-19 since February 2021, with increasing number of cases reported in all States, including Tamil Nadu4. Information regarding the real world effectiveness of COVID-19 vaccines, especially for severe disease is currently unavailable in India, although a few studies have been initiated recently. Such data would also be useful for addressing the issue of vaccine hesitancy. The Tamil Nadu Police department has been documenting vaccination of its workforce (as aggregate numbers with 0, 1 and 2 doses), and COVID-19 deaths during the second wave along with details of the date of hospitalization and vaccination (as a line-list). In the present study, these data (personal communication) were used to estimate the incidence of deaths due to COVID-19 among vaccinated and unvaccinated police personnel. The incidence of mortality among vaccinated and unvaccinated individuals were compared to calculate the relative risk of mortality associated with COVID-19 vaccination, along with 95 per cent confidence interval (CI) using OpenEpi software (https://www.openepi.com/Menu/OE_Menu.htm). The effectiveness of vaccination in preventing COVID-19 deaths was estimated using 1- Relative Risk formula5. There are 117,524 police personnel working with Department of Police in Tamil Nadu. Between February 1, 2021 and May 14, 2021, 32,792 received one dose, 67,673 received two-doses while the 17,059 did not receive any vaccine dose (Table). Thirty-one COVID-19 deaths were reported among these police personnel between April 13, 2021 and May 14, 2021 (median age: 52 yr, range: 34–58, 29 males). Of these 31 COVID-19 deaths, four had taken two doses of the vaccine, seven had taken one dose and the rest 20 were unvaccinated. The incidence of COVID-19 deaths among the vaccinated with zero, one and two doses were 1.17, 0.21 and 0.06 per 1000 police personnel respectively. Compared to unvaccinated individuals, the relative risk of COVID-19 deaths among those receiving one and two doses were 0.18 (95% CI: 0.08-0.43) and 0.05 (95% CI: 0.02-0.15) respectively. The vaccine effectiveness in preventing COVID-19 deaths with one and two doses was 82 per cent (95% CI: 57 - 92%) and 95 per cent (95% CI: 85 – 98%) respectively (Table).Table: Vaccine effectiveness in preventing COVID-19 deaths, Tamil Nadu, IndiaThe published results of phase-3 clinical trial of Oxford AstraZeneca vaccine indicated efficacy of 97.5 per cent (lower bound of one-sided 97.5% CI: 72.2%) against hospitalization6. Observational studies conducted in different countries also indicated high effectiveness of the vaccine in preventing severe outcomes78. The interim results of BBV152 trial indicate high efficacy against preventing symptomatic disease9. A cohort study conducted among healthcare workers from a tertiary care hospital in Tamil Nadu indicated a strong protective effect of two doses of vaccines against hospitalization (77%, 95% CI: 68-84), the need for oxygen therapy (92%, 95% CI: 74-97) and need for ICU care (94%, 95% CI: 73-99)10. The results of our analyses are consistent with the published studies showing effectiveness against severe disease7810. The analysis, however, has certain limitations as potential confounders including age, comorbidities and previous exposure to COVID-19 infection could not be adjusted for, as the vaccination details were collected as aggregated numbers. Also the effectiveness could not be estimated separately for each vaccine. In conclusion, our analysis indicated COVID-19 vaccination, even with single dose, was effective in preventing deaths. It is necessary to increase coverage of COVID-19 vaccines, regardless of the type of vaccines, to reduce mortality in current as well as future waves of COVID-19 epidemic. Financial support & sponsorship: None. Conflicts of Interest: None. Acknowledgment: Authors thank the Tamil Nadu Police department, Government of Tamil Nadu, for sharing the data on police personnel for analysis in this study.

Disaggregated data on Asian ethnic groups are needed to identify health disparities among Asian people. We examined COVID-19 incidence, deaths, and vaccinations among Asian ethnic groups in Santa Clara County, California. We extracted data on SARS-CoV-2 infections and COVID-19 vaccinations from December 15, 2020, through August 6, 2021, from the California Reportable Diseases Information Exchange and the California Immunization Registry. We assigned Asian ethnic group based on name for missing self-reported information. We calculated age-adjusted rates and rate ratios of infections and deaths and percentages of vaccinations by race and ethnicity and Asian ethnic group. We conducted multivariable logistic regression to examine factors associated with COVID-19 deaths. Although Asian residents had the lowest rate of SARS-CoV-2 infections per 100 000 people (1801.9; 95% CI, 1771.5-1832.7) among all racial and ethnic groups, when disaggregated by Asian ethnicity, Filipino (3169.0; 95% CI, 3049.1-3292.4) and Vietnamese (3008.4; 95% CI, 2916.9-3102.1) residents had the highest age-adjusted rates. Asian (38.7; 95% CI, 33.7-44.3) and non-Hispanic White (42.3; 95% CI, 37.5-47.5) residents had the lowest rate of COVID-19 deaths compared with all other racial and ethnic groups; however, Filipino (67.6; 95% CI, 49.1-90.8) and Vietnamese (63.7; 97% CI, 48.9-81.6) residents had significantly higher rates than the aforementioned groups did. Among all racial and ethnic groups, Asian residents had the highest completion rate of primary COVID-19 vaccine series by August 6, 2021 (87.0%; 95% CI, 86.8%-87.3%). Within Asian ethnic groups, Filipino residents had the lowest vaccination rate (65.0%; 95% CI, 64.4%-65.6%). Differences in COVID-19 incidence, deaths, and vaccinations among Asian ethnic groups highlight the importance of data collection of ethnic groups as a standard practice.

Objectives: Involvement in activities is assumed to positively influence the quality of life of people with dementia, yet activity provision in long-term care remains limited. This study aims to provide more insight into the value of activity involvement for domains of the quality of life of long-term dementia care residents, taking resident characteristics and cognitive status into account.Method: Data were derived from 144 long-term care facilities participating in the second measurement (2010/2011) of the living arrangements for dementia study. Amongst 1144 residents, the relationship between time involved in activities (activity pursuit patterns; RAI-MDS) and quality of life (Qualidem) was studied using multilevel linear regression analyses. Analyses were adjusted for residents’ age, gender, neuropsychiatric symptoms, ADL dependency and cognition. To check for effect modification of cognition, interactions terms of the variables activity involvement and cognitive status were added to the analyses.Results: Despite resident's cognitive status, their activity involvement was significantly related to better scores on care relationship, positive affect, restless tense behaviour, social relations, and having something to do. A negative relationship existed between the activity involvement and positive self-image. The explained variance in the quality of life between residents caused by the activity involvement was small.Conclusion: Activity involvement seems to be a small yet important contributor to higher well-being in long-term care resident at all stages of dementia. Adjusting activities to individual preferences and capabilities might enlarge this relationship. Further research is needed to confirm this hypothesis, using measurement instruments less sensitive to recall bias and differentiating between the active and passive activity involvement.

Social Isolation of Older Adults in Long Term Care as a Result of COVID-19 Mitigation Measures During the COVID-19 Pandemic

Epidemiology, not geopolitics, should guide COVID-19 vaccine donations

Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine - United States, December 14-23, 2020.

Despite a lack of clinical data demonstrating the effectiveness of alcohol swab cleansing prior to vaccinations as a prophylactic measure to prevent skin infections, it is recommended for vaccine administration by the Canadian Immunization Guide. The objective of this study was to evaluate the risk of adverse events after omitting alcohol skin cleansing in long-term care (LTC) residents receiving vaccinations during the COVID-19 pandemic. Two medium-sized LTC homes participated in a cohort study, whereby one LTC used alcohol swab cleansing prior to resident vaccinations and the other did not. All residents received two doses of the BNT162b2 COVID-19 vaccine separated by an average (SD) 29.3 (8.5) days. The electronic chart records of participants were reviewed by researchers blinded to group allocation to assess for the presence of adverse events following immunization (AEFI), including reactogenicity, cellulitis, abscess, or systemic reactions. Log-binomial regression was used to compute risk ratios (with 95% confidence intervals) of an AEFI according to alcohol swab status. 189 residents were included, with a total of 56 AEFI between the two doses. The risk of reactogenicity (adjusted RR 0.54, 95% CI 0.17–1.73) or systemic reactions (adjusted RR 0.75, 95% CI 0.26–2.13) did not differ for the residents that received alcohol skin antisepsis compared to those that did not. There were no cases of cellulitis or abscess. This study did not demonstrate an elevated risk of AEFI in LTC residents receiving two doses of the BNT162b2 mRNA COVID vaccine without alcohol skin antisepsis.

Care Aides Working Multiple Jobs: Considerations for Staffing Policies in Long-Term Care Homes During and After the COVID-19 Pandemic

Using Digital Arts Engagement to Combat Loneliness Amongst Older Adults Living in Long-Term Care

The interplay between COVID-19 restrictions and vaccination

Vaccination