Abstract
More than 40% of the deaths recorded in the first wave of the SARS-CoV-2 pandemic were linked to nursing homes. Not only are the residents of long-term care facilities (LTCFs) typically older and more susceptible to endemic infections, the facilities’ high degree of connection to wider communities makes them especially vulnerable to local COVID-19 outbreaks. In 2008, in the wake of the SARS-CoV-1 and MERS epidemics and anticipating an influenza pandemic, we created a stochastic compartmental model to evaluate the deployment of non-pharmaceutical interventions (NPIs) in LTCFs during influenza epidemics. In that model, the most effective NPI by far was a staff schedule consisting of 5-day duty periods with onsite residence, followed by an 4-to-5 day off-duty period with a 3-day quarantine period just prior to the return to work. Unlike influenza, COVID-19 appears to have significant rates of pre-symptomatic transmission. In this study, we modified our prior modeling framework to include new parameters and a set of NPIs to identify and control the degree of pre-symptomatic transmission. We found that infections, deaths, hospitalizations, and ICU utilization were projected to be high and largely irreducible, even with rigorous application of all defined NPIs, unless pre-symptomatic carriers can be identified and isolated at high rates. We found that increasingly rigorous application of NPIs is likely to significantly decrease the peak of infections; but even with complete isolation of symptomatic persons, and a 50% reduction in silent transmission, the attack rate is projected to be nearly 95%.
Highlights
Despite being less than 1% of the population of the United States, 8% of all confirmed cases and more than 41% of recorded COVID-19 deaths during the first wave of infections in US were linked to nursing homes and other long-term care facilities (LTCFs)
When the pre-symptomatic isolation rate was 0%, the four non-pharmaceutical interventions (NPIs) scenarios were indistinguishable in terms of the total infections, hospitalizations, ICU admissions, and deaths (Supplementary Figure S3, and Supplementary Table S2)
These results are consistent with empirical reports from facilities in high-risk areas, in which the absence of control measures and most merely identifying and isolating only symptomatic cases, a COVID-19 outbreak will likely spread rapidly within all long term care facilities [8,33,36,37]
Summary
Despite being less than 1% of the population of the United States, 8% of all confirmed cases and more than 41% of recorded COVID-19 deaths during the first wave of infections in US were linked to nursing homes and other long-term care facilities (LTCFs). Nursing homes and residential care communities staffed by more than 1 million nurses, aides, and social workers are home to more than 2.2 million residents, most of advanced age [5], and at a higher risk of infection and mortality from COVID-19 [6,7,8]. In 2018, the World Health Organization (WHO) released the Global Influenza Strategy 2019–2030 with the goals of reducing the burden of seasonal influenza, minimizing the risk of zoonotic influenza, and mitigating the effects of pandemic influenza These efforts, have provided limited guidance on the implementation of nonpharmaceutical interventions (NPIs) for controlling the spread of pandemic infection [18]. Controlling exposure pathways through social distancing measures, personal protection measures, and community-based interventions is critically important, uniquely so during the period of time between pandemic pathogen emergence and the development and distribution of therapeutics and vaccines, and during periods of uncertainty when a new variant with breakthrough potential emerges
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