COVID-19 In Long-term Care Facilities Research Articles

An Emergency Strategy for Intersectoral Local Government Responses to COVID-19 in Long-term Care Facilities in Western Cape Province, South Africa

An Emergency Strategy for Intersectoral Local Government Responses to COVID-19 in Long-term Care Facilities in Western Cape Province, South Africa

Long term care facilities in England during the COVID-19 pandemic—a scoping review of guidelines, policy and recommendations

BackgroundThe disproportionate effect of COVID-19 on long term care facility (LTCF) residents has highlighted the need for clear, consistent guidance on the management of pandemics in such settings. As research exploring the experiences of LTCFs during the pandemic and the implications of mass hospital discharge, restricting staff movement, and limiting visitation from relatives are emerging, an in-depth review of policies, guidance and recommendations issued during this time could facilitate wider understanding in this area.AimsTo identify policies, guidance, and recommendations related to LTCF staff and residents, in England issued by the government during the COVID-19 pandemic, developing a timeline of key events and synthesizing the policy aims, recommendations, implementation and intended outcomes.MethodA scoping review of publicly available policy documents, guidance, and recommendations related to COVID-19 in LTCFs in England, identified using systematic searches of UK government websites. The main aims, recommendations, implementation and intended outcomes reported in included documents were extracted. Data was analysed using thematic synthesis following a three-stage approach: coding the text, grouping codes into descriptive themes, and development of analytical themes.ResultsThirty-three key policy documents were included in the review. Six areas of recommendations were identified: infection prevention and control, hospital discharge, testing and vaccination, staffing, visitation and continuing routine care. Seven areas of implementation were identified: funding, collaborative working, monitoring and data collection, reducing workload, decision making and leadership, training and technology, and communication.DiscussionLTCFs remain complex settings, and it is imperative that lessons are learned from the experiences during COVID-19 to ensure that future pandemics are managed appropriately. This review has synthesized the policies issued during this time, however, the extent to which such guidance was communicated to LTCFs, and subsequently implemented, in addition to being effective, requires further research. In particular, understanding the secondary effects of such policies and how they can be introduced within the existing challenges inherent to adult social care, need addressing.

Changing genomic epidemiology of COVID-19 in long-term care facilities during the 2020–2022 pandemic, Washington State

BackgroundLong-term care facilities (LTCFs) are vulnerable to disease outbreaks. Here, we jointly analyze SARS-CoV-2 genomic and paired epidemiologic data from LTCFs and surrounding communities in Washington state (WA) to assess transmission patterns during 2020–2022, in a setting of changing policy. We describe sequencing efforts and genomic epidemiologic findings across LTCFs and perform in-depth analysis in a single county.MethodsWe assessed genomic data representativeness, built phylogenetic trees, and conducted discrete trait analysis to estimate introduction sizes over time, and explored selected outbreaks to further characterize transmission events.ResultsWe found that transmission dynamics among cases associated with LTCFs in WA changed over the course of the COVID-19 pandemic, with variable introduction rates into LTCFs, but decreasing amplification within LTCFs. SARS-CoV-2 lineages circulating in LTCFs were similar to those circulating in communities at the same time. Transmission between staff and residents was bi-directional.ConclusionsUnderstanding transmission dynamics within and between LTCFs using genomic epidemiology on a broad scale can assist in targeting policies and prevention efforts. Tracking facility-level outbreaks can help differentiate intra-facility outbreaks from high community transmission with repeated introduction events. Based on our study findings, methods for routine tree building and overlay of epidemiologic data for hypothesis generation by public health practitioners are recommended. Discrete trait analysis added valuable insight and can be considered when representative sequencing is performed. Cluster detection tools, especially those that rely on distance thresholds, may be of more limited use given current data capture and timeliness. Importantly, we noted a decrease in data capture from LTCFs over time. Depending on goals for use of genomic data, sentinel surveillance should be increased or targeted surveillance implemented to ensure available data for analysis.

Learning from the covid-19 outbreaks in long-term care facilities: a systematic review

BackgroundThe COVID-19 pandemic has devastatingly affected Long-Term Care Facilities (LTCF), exposing aging people, staff members, and visitors. The world has learned through the pandemic and lessons can be taken to adopt effective measures to deal with COVID-19 outbreaks in LTCF. We aimed to systematically review the available evidence on the effect of measures to minimize the risk of transmission of COVID-19 in LTCs during outbreaks since 2021.MethodsThe search method was guided by the preferred reporting items for systematic reviews (PRISMA) and the reporting guideline synthesis without meta-analysis (SWiM) in systematic reviews. The search was performed in April 2023. Observational and interventional studies from the databases of PubMed, Web of Science, Scopus, Cochrane Systematic Reviews, CINAHL, and Academic Search were systematically reviewed. We included studies conducted in the LTCF with outbreaks that quantitatively assess the effect of non-pharmacological measures on cases of COVID-19. Two review authors independently reviewed titles for inclusion, extracted data, and undertook the risk of bias according to pre-specified criteria. The quality of studies was analyzed using the Joanna Briggs Institute Critical Appraisal.ResultsThirteen studies were included, with 8442 LTCF experiencing COVID-19 outbreaks and 598 thousand participants (residents and staff members). Prevention and control of COVID-19 infection interventions were grouped into three themes: strategic, tactical, and operational measures. The strategic measures reveal the importance of COVID-19 prevention and control as LTCF structural characteristics, namely the LTCF size, new admissions, infection control surveillance, and architectural structure. At the tactical level, the lack of personal and long staff shifts is related to COVID-19's spread. Operational measures with a favorable effect on preventing COVID-19 transmission are sufficient. Personal protective equipment stock, correct mask use, signaling, social distancing, and resident cohorting.ConclusionsOperational, tactical, and strategic approaches may have a favorable effect on preventing the spread of COVID-19 in LTCFs experiencing outbreaks. Given the heterogeneous nature of the measures, performing a meta-analysis was not possible. Future research should use more robust study designs to explore similar infection control measures in LTCFs during endemic situations with comparable outbreaks.Trial registrationThe protocol of this systematic review was registered in PROSPERO (CRD42020214566).

Overview of the Epidemiological Situation and Risk Factors for Severe COVID-19 in Long-Term Care Facilities in the World and Russia

Background: Residents of long-term care facilities are at higher risk of the severe course and outcomes of COVID-19. Objective: To describe the epidemiological situation and risk factors for severe COVID-19 in nursing homes in the world and Russia. Materials and methods: We reviewed Russian and English-language papers published in March 2020 to October 2022 and found in such resources as eLIBRARY.ru, Web of Science, PubMed, Google Academy, and Scopus using the following keywords: long-term care facilities, nursing homes, COVID-19 morbidity in nursing homes, COVID-19 mortality in nursing homes, and COVID-19 risk factors in nursing homes. Availability of information on morbidity and mortality among residents and employees of long-term care facilities in Russia, Europe and the USA and about the risk factors for severe course and adverse outcomes of COVID-19 was the inclusion criterion. Of 1,013 articles initially identified, 40 publications were included in the review. Results: The analysis of the worldwide epidemiological situation has shown that COVID-19 incidence and mortality rates in nursing homes fluctuate, and, as of October 2022, cases of the disease among residents, including multiple cases within a facility, were still registered. In most countries, the highest incidence of COVID-19 in long-term care facilities was observed in January – March 2022, while the lowest was noted in May – July 2021. The number of deaths has decreased significantly over time and remains low. Risk factors for a severe course and death from the novel coronavirus disease include age, male sex, and concomitant diseases. We established, however, that disease severity was also affected by the staff-to-resident ratio, availability of paid sick leave of the personnel, patient isolation opportunities, division of the working area, type of ownership (private), and COVID-19 incidence rates in the local community. Conclusion: We have analyzed the epidemiological situation and risk factors for severe COVID-19 in long-term care facilities at the national and global levels. As of October 2022, the novel coronavirus disease remains a challenge for nursing facilities. The severity of the infection is influenced by personal characteristics of patients and external factors related to the residential care facility.

National Weekly SARS-CoV-2 RT-PCR Screening of All Workers in Long-Term Care Facilities Associated with Decrease in Resident Mortality Rate

Introduction: Outbreaks of COVID-19 in long-term care facilities (LTCFs) have resulted mainly from disease transmission by asymptomatic health care workers. This study examines whether routine screening tests carried out on health care workers can help in reducing COVID-19 outbreaks, morbidity, and mortality of LTCF residents. Methods: The study followed a weekly, nationwide, government-funded screening program of LTCF personnel for SARS-CoV-2, by using reverse transcription polymerase chain reaction as the main testing technology. It included all residents and employees in Israeli LTCFs who were screened weekly during the second wave of COVID-19, during the period of time between July 13, 2020, and November 21, 2020. Results: During the study period, 1,107 LTCFs were screened on a weekly basis, including 62,159 HCWs and 100,046 residents. The program screened a median of 55,282 (range 16,249, min 45,910, max 62,159) employees per week, 0.05–1.5% of which were positive for SARS-CoV-2. LTCF mortality in the first wave accounted for 45.3% of all COVID-19 deaths recorded nationally (252 of 556), and in the second wave, this ratio was reduced to 30.3% (709 of 2,337) representing a reduction of 33.8% in expected mortality (p < 0.001). A significant reduction was detected also in hospitalization rate (13.59 vs. 11.41%, p < 0.001) and elder (≥75 years old) mortality rate (52.89 vs. 41.42%, p < 0.001). 214 outbreaks in the second wave were avoided by early identification of SARS-CoV-2 positive HCWs and successful prevention of subsequent infections in the facility. Conclusion: Routine weekly SARS-CoV-2 RT-PCR testing of LTCF employees was associated with reduced national LTCF residents’ hospitalizations and mortality rate.

Strategies to combat COVID-19 in long -term care facilities for older people.

To describe the strategies to combat COVID-19 in Long-Term Care Facilities for older people in Bahia state. This is a qualitative study based on documentary analysis of the collection produced by the Intersectoral Committee on Monitoring Long-Term Care for older people in the state of Bahia, from April 2020 to June 2021. Data analysis was based on Bardin's content analysis. The commission produced seven documents in the period analyzed. Two thematic categories emerged: Intersectoral Networks and Telemonitoring of Long-Term Care Facilities for the Elderly. The coordination in an intersector network and the telemonitoring carried out by the Intersector Committee on Monitoring Long-Term Care Facilities were the main strategies to fight COVID-19 in these institutions. The need to implement effective public policies to support long-term care facilities for older people is highlighted.

COVID-19 in Long-Term Care Facilities: A Rapid Review of Infection Correlates and Impacts on Mental Health and Behaviors.

Long-term care facilities (LTCFs) with compact, group-living arrangements have become COVID-19 hot spots during the pandemic. Systematic research is needed to understand factors associated with COVID-19 infections in LTCFs and the inadvertent effects of preventive measures adopted by LTCFs. This rapid review identifies factors associated with LTCF residents' COVID-19 infections and the impacts of the pandemic and the corresponding preventive measures on residents' mental health and behavioral problems. Following the preferred reporting items for systematic reviews and meta-analyses guidelines, we identified and reviewed relevant literature in Medline, PsycINFO, and AgeLine. Thirty-seven articles were identified and reviewed, including 30 reporting factors associated with COVID-19 infections in LTCFs and seven reporting the impact of the pandemic and corresponding prevention measures on LTCF residents. Results revealed four domains of factors associated with COVID-19 infections: facility physical environments, resident characteristics, facility management and testing, and community factors. The pandemic and infection control measures increased residents' depression, anxiety, loneliness, and behavioral problems (e.g., agitation, hallucinations). Residents without cognitive impairments were more vulnerable to these adverse effects. LTCF managers/policymakers and healthcare designers can help mitigate COVID-19 infections by (1) providing additional resources to vulnerable LTCFs; (2) enhancing the training of personal protective equipment use and guideline compliance; and (3) investing in amenities, such as sinks, quarantine rooms, and outdoor spaces. Digital activities and accessible green spaces can mitigate mental health and behavior issues. Future LTCF design can benefit from flexible spaces, natural ventilation, and reducing crowding.

Long-Term Care Facilities (LTCFs) During the COVID-19 Pandemic-Lessons From the Asian Approach: A Narrative Review.

ObjectivesThe COVID-19 pandemic put into question the organizational skills of LTCF. The containment measures implemented in several Asian countries avoided heavy death tolls in LTCF in contrast to other countries across the globe. The aim of this review is therefore to investigate and illustrate the measures that were undertaken in Asia to contain and prevent the spread of the COVID-19 pandemic in LTCF.DesignNarrative review.Setting and ParticipantsAsian older subjects institutionalized in LTCF.MethodsBroad literature research from July 2020–April 2021. The following search terms were used: “COVID-19 Nursing homes” AND the country of interest or “contact tracing.” Eligible categories for inclusion comprise editorials, reviews, government guidelines, letters to the editor, and perspectives. The COVID-19 measures were then subdivided into different sections and compiled into an evidence table.ResultsPrompt measures were put into action since the beginning of the pandemic that avoided the spread of COVID-19 in LTCF. Examples range from simple acts of proper hand hygiene and environmental disinfection, swab testing, social distancing, preventive measures on health care workers, organizational measures such as quarantine, outbreak control, visitor restrictions, relationship with acute hospitals, and admission policy. Technology also played a fundamental role in promoting social distancing by using specific robots and in managing contact tracing.Conclusions and ImplicationsThe Asian preventive control guidelines are similar to those recommended elsewhere. Difference in timing and past experience with prior outbreaks such as SARS and MERS might have favored the Asian response. Furthermore, sociocultural values toward older persons by protecting and making sure that LTCF are part of the health care system could have also played a role.

Psychological and Functional Impact of COVID-19 in Long-Term Care Facilities: The COVID-A Study

ObjectiveTo analyze the psychological and functional sequelae of the COVID-19 pandemic among older adults living in long term care facilities (LTCFs). DesignCohort longitudinal study Setting ant participantsA total of 215 residents ≥ 65 years without moderate-to-severe cognitive impairment, living in five LTCFs in Albacete (Spain). MeasurementsBaseline on-site data were collected between March - June 2020 and three-month follow-up between June to September 2020. Symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), and sleep disturbances were measured as psychological variables. Disability in basic activities of daily living (BADL), ambulation and frailty were assessed as functional variables. Differences were analyzed in relation to level of comorbidity and test positivity for COVID-19. ResultsAt baseline, residents with COVID-19 presented worse functionality, higher frailty levels and malnutrition risk compared to non-COVID-19 residents. At three-month follow-up, higher rates of clinically significant depressive symptoms (57.7%), anxiety symptoms (29.3%), PTSD symptoms (19.1%) and sleep disturbances (93.0%) were found among residents regardless of COVID status. Thus, among 215 residents, 101 (47%) experienced a decline in BADL from baseline to the 3-month follow-up (median functional loss = 5 points in Barthel Index). In multivariate analyses, COVID-19 status did not explain either the functional or the ambulation loss. By contrast, residents with low comorbidity and COVID-19 presented higher PTSD symptoms (effect 2.58; 95% CI 0.93 to 4.23) and anxiety symptoms (effect 2.10; 95% CI 0.48 to 3.73) compared to the low comorbidity/non-COVID19 group. ConclusionCOVID-19 pandemic was associated, after three-months, with high psychological impact in older adults in LTCFs., specifically with higher post-traumatic stress and anxiety symptoms. Functional decline did not differ in relation to COVID-19 status but could be related to isolation strategies used for pandemic control.

Protection against COVID-19 in long-term care facilities and political and technical foundations for operation in Brazil

Objective: that aimed to highlight and discuss the contributions of public policies and resolutions to the protection of older people in the qualification of Long Term Care Facilities in Brazil in the face of COVID-19. Method: This is a qualitative document analysis study. Data were collected between August and September 2021 from government websites and the Virtual Health Library database. Results: We analyzed resolutions 216/2004 up to the most recently published resolutions 502/2021, technical notes, and public policies for the older population published between 1994 and 2021, including people residing in long-term care facilities in Brazil. Our analysis indicated that, in order to operate the apparatus of protection and care, councils and Society need to fulfill their roles, aiming at the dignity and quality of life of residents of long-term care facilities. The discussion was conducted in light of the political framework and technical foundations that guide the operation of these facilities. Conclusion: This study highlights the relevance, value, and quality of the area of gerontology, specifically for reflecting on public policies and resolutions so that we have the necessary guidelines for elaborating policies for the long-term care and protection of the health of older adults, which includes a wide discussion on collective housing/lon-term care institutions.

COVID-19 in Long-Term Care Facilities With Advanced Practice Registered Nurses

The purpose of our report is to give our analytical description of COVID-19 response. The study placed two APRNs in each of five participating nursing facilities (NF), 5-7 days/week for up to two years with the purpose of quantifying if employment of a full-time, salaried APRN, as part of the NF care team, improved the quality of care for the NF residents. Secondarily, we studied policies that influenced ability to provide APRN care in the NF. Resident data collected and evaluated to determine if this model of care reduced the rates of adverse events among NF residents. Data included re-hospitalizations, inappropriate prescribing (antipsychotics, antibiotics, opioids and polypharmacy), observational data, and clinical outcomes negatively affecting the quality of life for NF residents (such as falls and pressure injuries). Factors influencing APRN employment in the NF setting were NF mission, environmental aesthetics, resources, NF administrator interactions, state law, and medical director support.

Meeting the Challenges of COVID-19 in Long-Term Care: Lessons Learned From an International Perspective

The outbreak of COVID-19 is a major challenge for health care systems all over the world. Older residents of long-term-care facilities (LTCF) such as nursing homes (NH) are among those at highest risk for COVID-19 and comprise a population with dramatically higher rates of morbidity and mortality than the general community. NH staff are also affected by the pandemic as they are challenged by increased workloads, emotional burden caused by the loss of resident life, and the fear of becoming infecting themselves or infecting family members. Finally, the pandemic places emotional and practical demands upon informal carers who are involved in the life of the NH resident. Therefore, research should investigate different perspectives on LTCF during the pandemic and discuss major challenges and possible support structures and strategies. Such an understanding is necessary to optimize care, support post-pandemic recovery, and prepare for future public health challenges. This international symposium will therefore provide four presentations to address these issues. The first presentation will report on global mortality data associated with COVID-19 in LTCF. The second presentation reports on the situation in German NHs addressing the complex situation of morbidity, care dependency, and social isolation. The third presentation will describe the effects of the pandemic upon NH staff in Poland. The final presentation examines the impact and guidelines of allowing visitors in NHs in the Netherlands for residents, family caregivers and staff. Our discussant, Marie Boltz, will synthesize the research findings and lead a discussion of future directions for policy and practice.

What are the effects of contact regulation and transmission-reducing measures on COVID-19 in long-term care facilities (LTCFs)?

What are the effects of contact regulation and transmission-reducing measures on COVID-19 in long-term care facilities (LTCFs)?

COVID-19 Incidence and Mortality Among Long-Term Care Facility Residents and Staff in South Carolina

ObjectivesThis study explored differences in COVID-19 incidence, mortality, and timing among long-term care facility (LTCF) residents and staff with those living in the community in South Carolina (SC). DesignLongitudinal secondary data analysis. Setting and ParticipantsAdults age ≥18 in SC with confirmed COVID-19 diagnosis from 3/15/2020 and 1/2/2021 (n = 307,891). MethodsCOVID-19 data came from the SC Department of Health and Environmental Control (SCDHEC). We included all COVID-19 cases, hospitalizations, and deaths among adult residents. Residence and employment in LTCF were confirmed by SCDHEC. Descriptive statistics and trends for cases, hospitalizations, and deaths were calculated. We used Cox proportional hazards to compare COVID-19 mortality in LTCF residents and staff to community dwelling older adults and adults not employed in LTCF, respectively, controlling for age, gender, race, and pre-existing chronic health conditions. ResultsLTC residents experienced greater incidence of cases throughout the study period until the week ending on 1/2/21. LTCF residents with COVID-19 were more likely to be hospitalized compared to older adults in the community and 74% more likely to die (HR: 1.74, 95% CI: 1.59-1.90), after adjusting. LTC staff experienced greater incidence of cases compared to adults not employed in LTCF until the week ending on 12/26/2020, while experiencing similar incidence of death compared to the similar community members. After adjusting, LTC staff had 0.58 (HR = 0.58; CI: 0.39-0.88) times lower hazard of death compared to community members that did not work in a LTCF. Conclusions and ImplicationsNarrowing of the gap between LTCF and community-wide infection and mortality rates over the study period suggests that early detection of COVID-19 in LTCFs could serve as a first indicator of disease spread in the greater community. Results also indicate that policies and regulations addressing staff testing and protection may help to slow or prevent spread within facilities.

Excess Mortality After COVID-19 in Swedish Long-Term Care Facilities

ObjectiveTo compare 30-day mortality in long-term care facility (LTCF) residents with and without COVID-19 and to investigate the impact of 31 potential risk factors for mortality in COVID-19 cases. DesignRetrospective cohort study. Setting and ParticipantsAll residents of LTCFs registered in Senior Alert, a Swedish national database of health examinations in older adults, during 2019-2020. MethodsWe selected residents with confirmed COVID-19 until September 15, 2020, along with time-dependent propensity score–matched controls without COVID-19. Exposures were COVID-19, age, sex, comorbidities, medications, and other patient characteristics. The outcome was all-cause 30-day mortality. ResultsA total of 3731 residents (median age 87 years, 64.5% female) with COVID-19 were matched to 3731 controls without COVID-19. Thirty-day mortality was 39.9% in COVID-19 cases and 5.7% in controls [relative risk 7.05, 95% confidence interval (CI) 6.10-8.14]. In COVID-19 cases, the odds ratio (OR) for 30-day mortality was 2.44 (95% CI 1.57-3.81) in cases aged 80-84 years, 2.99 (95% CI 1.93-4.65) in cases aged 85-89 years, and 3.28 (95% CI 2.11-5.10) in cases aged ≥90 years, as compared with cases aged <70 years. Other risk factors for mortality among COVID-19 cases included male sex (OR, 2.60, 95% CI 2.22-3.05), neuropsychological conditions (OR, 2.18; 95% CI 1.76-2.71), impaired walking ability (OR, 1.45, 95% CI 1.17-1.78), urinary and bowel incontinence (OR 1.51, 95% CI 1.22-1.85), diabetes (OR 1.36, 95% CI 1.14-1.62), chronic kidney disease (OR 1.37, 95% CI 1.11-1.68) and previous pneumonia (OR 1.57, 95% CI 1.32-1.85). Nutritional factors, cardiovascular diseases, and antihypertensive medications were not significantly associated with mortality. Conclusions and ImplicationsIn Swedish LTCFs, COVID-19 was associated with a large excess in mortality after controlling for an extensive number of risk factors. Beyond older age and male sex, several prevalent clinical risk factors independently contributed to higher mortality. These findings suggest that reducing transmission of COVID-19 in LTCFs will likely prevent a considerable number of deaths.

COVID-19 susceptibility in long-term care facilities

Disease outbreaks in long-term care facilities (LTCFs) have been a large driver of morbidity and mortality during the COVID-19 pandemic. This susceptibility to outbreaks in LTCFs is likely to be multifactorial, including frailty of residents, structural and environmental characteristics of buildings (eg, shared spaces, ventilation, and outdoor access), staffing policies and models, and the value society places on older people and LTCFs.1 Understanding of the true burden of COVID-19 in LTCFs has been limited by gaps in measurement and reporting.

An emergency strategy framework for managing COVID-19 in long-term care facilities in Brazil

This paper presents a novel policy framework to support government responses to COVID-19 in long-term care facilities (LTCFs) in low and middle-income countries. It focuses on issues that are of specific relevance to Brazilian policy-settings, including examples of its local implementation. The CIAT Framework combines and summarizes broad elements for an emergency strategy to address the potential effects of COVID-19. The 4 steps of the Framework entail policies to coordinate, identify, assess, and target support. Those policies can be applied immediately to mitigate the impact of the COVID-19 pandemic in LTCFs. It is, however, essential to situate these responses within a more comprehensive and permanent strategy. Intersectoral collaboration must evolve into a fully institutionalized system.

COVID-19 in long-term care facilities in Brazil: serological survey in a post-outbreak setting.

ABSTRACTThis cross-sectional seroepidemiological survey presents the seroprevalence of SARS-CoV-2 in a population living in 15 Long-Term Care Facilities (LTCFs), after two intra-institutional outbreaks of COVID-19 in the city of Botucatu, Sao Paulo State, Brazil. Residents were invited to participate in the serological survey performed in June and July 2020. Sociodemographic and clinical characterization of the participants as well as the LTCF profile were recorded. Blood samples were collected, processed and serum samples were tested using the rapid One Step COVID-19 immunochromatography test to detect IgM and IgG anti-SARS-CoV-2. Among 209 residents, the median of age was 81 years old, 135 (64.6%) were female and 171 (81.8%) self-referred as being white. An overall seroprevalence of 11.5% (95% CI: 7.5% – 16.6%) was found. The highest seroprevalences of 100% and 76.9% were observed in LTCFs that had experienced COVID-19 outbreaks. Most residents with positive immunochromatography tests (70.8%) referred previous contact with a confirmed COVID-19 case. Although there was a relatively low seroprevalence of COVID-19 in the total number of elderly people, this population is highly vulnerable and LTCFs are environments at higher risk for COVID-19 dissemination. A well-established test for COVID-19 policies, the adequate characterization of the level of interaction between residents and the healthcare provider team and the level of complexity of care are crucial to monitor and control the transmission of SARS-CoV-2 in these institutions.

COVID-19 in long-term care facilities in Frankfurt am Main, Germany: incidence, case reports, and lessons learned.

: As of August 30, 2020, the World Health Organisation (WHO) reported 24,822,800 COVID-19 infections world wide. Severe disease and deaths occur especially in older people with chronic illnesses. Residents of nursing homes are considered to be the most vulnerable group. In this paper, the experiences with COVID-19 in nursing homes in Frankfurt will be presented and discussed.Materials and methods: Based on the data of the statutory reporting obligation, the reported COVID-19 cases are presented and incidences are calculated in different age groups and among residents of nursing homes. Outbreaks in various homes are described in detail based on the documentation from the public health department.Results: By August 28, 2020, 2,665 COVID-19 infections were reported in Frankfurt am Main (incidence 351/100,000 inhabitants), including 116 (4.3%) residents of nursing homes (2,416/100,000 residents). Almost half (39%) of all deaths in Frankfurt (n=69; incidence 9.1/100,000) were among nursing home residents (n=27; incidence 558/100,000 nursing home residents), with 22 of them in just one long-term care facility (LTCF). Compared to previous years, the mortality rate in nursing homes did not increase in the first half of 2020. In one home, 75% of residents tested positive for SARS-CoV-2 and 25% died; in two other homes, 6.7% and 14.1% of the residents became infected, and the mortality rate was 0.5% and 1%, resp. In the other 42 homes in the city (3,906 beds), the infection rate remained below 1% and the death rate was 0.1%.Discussion: In many countries, 30–70% of all deaths occur among nursing home residents, including Frankfurt (39%). An increase in overall mortality compared to previous years was not observed in Frankfurt as a whole or in the nursing homes in the city specifically. Due to the measures taken (monitoring of residents and staff, nursing care in protective clothing, prohibition or restriction of visits, physical distancing, isolation of infected people and quarantining of contact persons), only individual cases of COVID-19 illnesses occurred in nursing home residents in most homes and the outbreaks in the three homes could be stopped. We do not recommend regular nontargeted testing in nursing homes, but rather vigilance and the implementation of good hygiene as well as immediate targeted testing if COVID-19 is suspected in residents or staff. In order to mitigate the considerable negative effects of these measures on the residents, a good balance should be sought between infection prevention and the goal of ensuring self-determination and the residents’ quality of life.