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Abstract

Background

Late outbreak identification is a common risk factor mentioned in case reports of large respiratory infection outbreaks in long-term care (LTC) homes.

Aim

To systematically measure the association between late SARS-CoV-2 outbreak identification and secondary SARS-CoV-2 infection and mortality in residents of LTC homes.

Methods

We studied SARS-CoV-2 outbreaks across LTC homes in Ontario, Canada from March to November 2020, before the COVID-19 vaccine rollout. Our exposure (late outbreak identification) was based on cumulative infection pressure (the number of infectious resident-days) on the outbreak identification date (early: ≤ 2 infectious resident-days, late: ≥ 3 infectious resident-days), where the infectious window was −2 to +8 days around onset. Our outcome consisted of 30-day incidence of secondary infection and mortality, based on the proportion of at-risk residents with a laboratory-confirmed SARS-CoV-2 infection with onset within 30 days of the outbreak identification date.

Results

We identified 632 SARS-CoV-2 outbreaks across 623 LTC homes. Of these, 36.4% (230/632) outbreaks were identified late. Outbreaks identified late had more secondary infections (10.3%; 4,437/42,953) and higher mortality (3.2%; 1,374/42,953) compared with outbreaks identified early (infections: 3.3%; 2,015/61,714; p < 0.001, mortality: 0.9%; 579/61,714; p < 0.001). After adjustment for 12 LTC home covariates, the incidence of secondary infections in outbreaks identified late was 2.90-fold larger than that of outbreaks identified early (OR: 2.90; 95% CI: 2.04–4.13).

Conclusions

The timeliness of outbreak identification could be used to predict the trajectory of an outbreak, plan outbreak measures and retrospectively provide feedback for quality improvement, with the objective of reducing the impacts of respiratory infections in LTC home residents.

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2024-10-10
2024-11-21
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.41.2300719
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Association between delayed outbreak identification and SARS-CoV-2 infection and mortality among long-term care home residents, Ontario, Canada, March to November 2020: a cohort study
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Kevin+A+Brown&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brown Kevin A</a>, <a href="/search?value1=Sarah+A+Buchan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Buchan Sarah A</a>, <a href="/search?value1=Adrienne+K+Chan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Chan Adrienne K</a>, <a href="/search?value1=Andrew+Costa&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Costa Andrew</a>, <a href="/search?value1=Nick+Daneman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Daneman Nick</a>, <a href="/search?value1=Gary+Garber&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Garber Gary</a>, <a href="/search?value1=Michael+Hillmer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hillmer Michael</a>, <a href="/search?value1=Aaron+Jones&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jones Aaron</a>, <a href="/search?value1=James+M+Johnson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Johnson James M</a>, <a href="/search?value1=Dylan+Kain&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kain Dylan</a>, <a href="/search?value1=Kamil+Malikov&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Malikov Kamil</a>, <a href="/search?value1=Richard+G+Mather&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mather Richard G</a>, <a href="/search?value1=Allison+McGeer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">McGeer Allison</a>, <a href="/search?value1=Kevin+L+Schwartz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schwartz Kevin L</a>, <a href="/search?value1=Nathan+M+Stall&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stall Nathan M</a>, <a href="/search?value1=Jennie+Johnstone&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Johnstone Jennie</a></span>. Association between delayed outbreak identification and SARS-CoV-2 infection and mortality among long-term care home residents, Ontario, Canada, March to November 2020: a cohort study. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(41):pii=2300719. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.41.2300719" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.41.2300719</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 14 Dec 2023;&nbsp;&nbsp; <span class="generated">Accepted</span>: 03 Jun 2024 </span> </p>
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