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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
2024-10-11
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.41.2300719
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References

  1. Panagiotou OA, Kosar CM, White EM, Bantis LE, Yang X, Santostefano CM, et al. Risk factors associated with all-cause 30-day mortality in nursing home residents with COVID-19. JAMA Intern Med. 2021;181(4):439-48.  https://doi.org/10.1001/jamainternmed.2020.7968  PMID: 33394006 
  2. Hashan MR, Smoll N, King C, Ockenden-Muldoon H, Walker J, Wattiaux A, et al. Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis. EClinicalMedicine. 2021;33:100771.  https://doi.org/10.1016/j.eclinm.2021.100771  PMID: 33681730 
  3. Canadian Institute for Health Information (CIHI). Pandemic experience in the long-term care sector: how does Canada compare with other countries? Ottawa: CIHI; 2020. Available from: https://www.cihi.ca/sites/default/files/document/covid-19-rapid-response-long-term-care-snapshot-en.pdf
  4. Fisman DN, Bogoch I, Lapointe-Shaw L, McCready J, Tuite AR. Risk factors associated with mortality among residents with coronavirus disease 2019 (COVID-19) in long-term care facilities in Ontario, Canada. JAMA Netw Open. 2020;3(7):e2015957.  https://doi.org/10.1001/jamanetworkopen.2020.15957  PMID: 32697325 
  5. Danis K, Fonteneau L, Georges S, Daniau C, Bernard-Stoecklin S, Domegan L, et al. , ECDC Public Health Emergency Team. High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020. Euro Surveill. 2020;25(22):2000956. PMID: 32524949 
  6. Malikov K, Huang Q, Shi S, Stall NM, Tuite AR, Hillmer MP. Temporal associations between community incidence of COVID-19 and nursing home outbreaks in Ontario, Canada. J Am Med Dir Assoc. 2021;22(2):260-2.  https://doi.org/10.1016/j.jamda.2020.12.011  PMID: 33476568 
  7. Stall NM, Jones A, Brown KA, Rochon PA, Costa AP. For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths. CMAJ. 2020;192(33):E946-55.  https://doi.org/10.1503/cmaj.201197  PMID: 32699006 
  8. Bui DP, See I, Hesse EM, Varela K, Harvey RR, August EM, et al. Association between CMS quality ratings and COVID-19 outbreaks in nursing homes - West Virginia, March 17-June 11, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(37):1300-4.  https://doi.org/10.15585/mmwr.mm6937a5  PMID: 32941409 
  9. Brown KA, Jones A, Daneman N, Chan AK, Schwartz KL, Garber GE, et al. Association between nursing home crowding and COVID-19 infection and mortality in Ontario, Canada. JAMA Intern Med. 2021;181(2):229-36.  https://doi.org/10.1001/jamainternmed.2020.6466  PMID: 33165560 
  10. Paul LA, Daneman N, Brown KA, Johnson J, van Ingen T, Joh E, et al. Characteristics associated with household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Ontario, Canada: A Cohort Study. Clin Infect Dis. 2021;73(10):1840-8.  https://doi.org/10.1093/cid/ciab186  PMID: 33751026 
  11. Tang S, Sanchez Perez M, Saavedra-Campos M, Paranthaman K, Myers R, Fok J, et al. Mass testing after a single suspected or confirmed case of COVID-19 in London care homes, April-May 2020: implications for policy and practice. Age Ageing. 2021;50(3):649-56.  https://doi.org/10.1093/ageing/afab054  PMID: 33620453 
  12. Kain D, Stall N, Brown K, McCreight L, Rea E, Kamal M, et al. A longitudinal, clinical, and spatial epidemiologic analysis of a large COVID-19 long-term care home outbreak. J Am Med Dir Assoc. 2021;22(10):2003-2008.e2.  https://doi.org/10.1016/j.jamda.2021.07.021  PMID: 34425097 
  13. Kain D, Stall NM, Allen V, Evans GA, Hopkins J, Kouyoumdjian FG, et al. Routine asymptomatic SARS-CoV-2 screen testing of Ontario long-term care staff after COVID-19 Vaccination. Ontario COVID-19 Science Advisory Table; 2021. Available from: https://covid19-sciencetable.ca/sciencebrief/routine-asymptomatic-sars-cov-2-screen-testing-of-ontario-long-term-care-staff-after-covid-19-vaccination
  14. Brown KA, Stall NM, Vanniyasingam T, Buchan SA, Daneman N, Hillmer MP, et al. Early impact of Ontario’s COVID-19 vaccine rollout on long-term care home residents and health care workers. Ontario COVID-19 Science Advisory Table; 2021. Available from: https://www.doi.org/10.47326/ocsat.2021.02.13.1.0
  15. Mor V. A comprehensive clinical assessment tool to inform policy and practice: applications of the minimum data set. Med Care. 2004;42(4) Suppl;III50-9.  https://doi.org/10.1097/01.mlr.0000120104.01232.5e  PMID: 15026672 
  16. Ottawa Public Health. COVID-19 outbreak definitions in Ottawa over time. Ottawa: Ottawa Public Health; 2022. Available from: https://www.ottawapublichealth.ca/en/reports-research-and-statistics/resources/Documents/covid-19/outbreak_definitions_2022-02_EN.pdf
  17. Ajao AO, Harris AD, Roghmann M-C, Johnson JK, Zhan M, McGregor JC, et al. Systematic review of measurement and adjustment for colonization pressure in studies of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and clostridium difficile acquisition. Infect Control Hosp Epidemiol. 2011;32(5):481-9.  https://doi.org/10.1086/659403  PMID: 21515979 
  18. Lockwood JL, Cassey P, Blackburn T. The role of propagule pressure in explaining species invasions. Trends Ecol Evol. 2005;20(5):223-8.  https://doi.org/10.1016/j.tree.2005.02.004  PMID: 16701373 
  19. Wood SN. Generalized Additive Models: An Introduction with R. 2nd ed. Chapman and Hall/CRC, 2017. Available from:  https://doi.org/10.1201/9781315370279  https://doi.org/10.1201/9781315370279 
  20. Douma JC, Weedon JT. Analysing continuous proportions in ecology and evolution: A practical introduction to beta and Dirichlet regression. Methods Ecol Evol. 2019;10(9):1412-30.  https://doi.org/10.1111/2041-210X.13234 
  21. Manuel DG, Rosella LC, Hennessy D, Sanmartin C, Wilson K. Predictive risk algorithms in a population setting: an overview. J Epidemiol Community Health. 2012;66(10):859-65.  https://doi.org/10.1136/jech-2012-200971  PMID: 22859516 
  22. Murti M, Goetz M, Saunders A, Sunil V, Guthrie JL, Eshaghi A, et al. Investigation of a severe SARS-CoV-2 outbreak in a long-term care home early in the pandemic. CMAJ. 2021;193(19):E681-8.  https://doi.org/10.1503/cmaj.202485  PMID: 33972221 
  23. Telford CT, Onwubiko U, Holland DP, Turner K, Prieto J, Smith S, et al. Preventing COVID-19 outbreaks in long-term care facilities through preemptive testing of residents and staff members - Fulton County, Georgia, March-May 2020. MMWR Morb Mortal Wkly Rep. 2020;69(37):1296-9.  https://doi.org/10.15585/mmwr.mm6937a4  PMID: 32941413 
  24. Holmdahl I, Kahn R, Hay JA, Buckee CO, Mina MJ. Estimation of transmission of COVID-19 in simulated nursing homes with frequent testing and immunity-based staffing. JAMA Netw Open. 2021;4(5):e2110071.  https://doi.org/10.1001/jamanetworkopen.2021.10071  PMID: 33988707 
  25. McGarry BE, SteelFisher GK, Grabowski DC, Barnett ML. COVID-19 test result turnaround time for residents and staff in US nursing homes. JAMA Intern Med. 2021;181(4):556-9.  https://doi.org/10.1001/jamainternmed.2020.7330  PMID: 33125044 
  26. Thompson A, Stall NM, Born KB, Gibson JL, Allen U, Hopkins J, et al. Benefits of paid sick leave during the COVID-19 pandemic. Ontario COVID-19 Science Advisory Table. 2021. Available from: https://covid19-sciencetable.ca/sciencebrief/benefits-of-paid-sick-leave-during-the-covid-19-pandemic
  27. Gussin GM, Singh RD, Tjoa TT, Saavedra R, Kaplan SH, Huang SS. Evaluating barriers and potential solutions to speaking up about coronavirus disease 2019 (COVID-19) symptoms: A survey among nursing home workers. Infect Control Hosp Epidemiol. 2023;44(11):1834-9.  https://doi.org/10.1017/ice.2023.51  PMID: 37990904 
  28. McGarry BE, Gandhi AD, Barnett ML. Covid-19 surveillance testing and resident outcomes in nursing homes. N Engl J Med. 2023;388(12):1101-10.  https://doi.org/10.1056/NEJMoa2210063  PMID: 36947467 
  29. Larremore DB, Wilder B, Lester E, Shehata S, Burke JM, Hay JA, et al. Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening. Sci Adv. 2021;7(1):eabd5393.  https://doi.org/10.1126/sciadv.abd5393  PMID: 33219112 
  30. Bochner AF, Makumbi I, Aderinola O, Abayneh A, Jetoh R, Yemanaberhan RL, et al. Implementation of the 7-1-7 target for detection, notification, and response to public health threats in five countries: a retrospective, observational study. Lancet Glob Health. 2023;11(6):e871-9.  https://doi.org/10.1016/S2214-109X(23)00133-X  PMID: 37060911 
  31. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD000259. Available from: https://doi.wiley.com/10.1002/14651858.CD000259.pub3
  32. Comondore VR, Devereaux PJ, Zhou Q, Stone SB, Busse JW, Ravindran NC, et al. Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis. BMJ. 2009;339(aug04 2):b2732-2732.  https://doi.org/10.1136/bmj.b2732  PMID: 19654184 
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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