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?:abstract
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BACKGROUND: SARS-CoV-2 has disproportionately affected nursing homes (NH). In Ireland, the first NH case COVID-19 occurred on 16/03/2020. A national point-prevalence testing program of all NH residents and staff took place (18/04/2020–05/05/2020). AIMS: To examine characteristics of NHs across three Irish Community Health Organisations (CHOs), proportions with COVID-19 outbreaks, staff and resident infection rates symptom-profile, and resident case-fatality. METHODS: Forty-five NHs surveyed requesting details on occupancy, size, COVID-19 outbreak, outbreak timing, total symptomatic/asymptomatic cases, and outcomes for residents from 29/02/2020–22/05/2020. RESULTS: Surveys were returned from 62.2% (28/45) of NHs (2043 residents, 2,303 beds). Three-quarters (21/28) had COVID-19 outbreaks (1741 residents, 1972 beds). Median time from first COVID-19 case in Ireland to first case in these NHs was 27.0 days. Resident incidence was 43.9% (764/1741): 40.8% (710/1741) laboratory-confirmed, with 27.2% (193/710) asymptomatic, and 3.1% (54/1741) clinically-suspected. Resident case-fatality was 27.6% (211/764) for combined laboratory-confirmed/clinically-suspected COVID-19. Similar proportions of residents in NHs with “early-stage” (<28 days) versus “later-stage” outbreaks developed COVID-19. Lower proportions of residents in “early” outbreak NHs had recovered compared to those with “late” outbreaks (37.4% vs 61.7%; χ(2) = 56.9, P < 0.001). Of 395 NH staff across twelve sites with confirmed COVID-19, 24.7% (99/398) were asymptomatic. There was a significant correlation between the proportion of staff with symptomatic COVID-19 and resident numbers with confirmed/suspected COVID-19 (Spearman’s rho = 0.81, P < 0.001). CONCLUSION: This study demonstrates the significant impact of COVID-19 on the NH sector. Systematic point-prevalence testing is necessary to reduce risk of transmission from asymptomatic carriers and manage outbreaks in this setting.
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