Original Study
A Longitudinal, Clinical, and Spatial Epidemiologic Analysis of a Large COVID-19 Long-Term Care Home Outbreak

https://doi.org/10.1016/j.jamda.2021.07.021Get rights and content

Abstract

Objectives

COVID-19 has had devastating effects on long-term care homes across much of the world, and especially within Canada, with more than 50% of the mortality from COVID-19 in 2020 in these homes. Understanding the way in which the virus spreads within these homes is critical to preventing further outbreaks.

Design

Retrospective chart review.

Settings and Participants

Long-term care home residents and staff in Ontario, Canada.

Methods

We conducted a longitudinal study of a large long-term care home COVID-19 outbreak in Ontario, Canada, using electronic medical records, public health records, staff assignments, and resident room locations to spatially map the outbreak through the facility.

Results

By analyzing the outbreak longitudinally, we were able to draw 3 important conclusions: (1) 84.5% had typical COVID-19 symptoms and only 15.5% of residents had asymptomatic infection; (2) there was a high attack rate of 85.8%, which appeared to be explained by a high degree of interconnectedness within the home exacerbated by staffing shortages; and (3) clustering of infections within multibedded rooms was common.

Conclusion and Implications

Low rates of asymptomatic infection suggest that symptom-based screening in residents remains very important for detecting outbreaks, a high degree of interconnectedness explains the high attack rate, and there is a need for improved guidance for homes with multibedded rooms on optimizing resident room movement to mitigate spread of COVID-19 in long-term care homes.

Keywords

COVID-19
SARS-CoV-2
nursing home
long-term care

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