Maximilian Salcher-Konrad ¹, Arnoupe Jhass,^2,3 Huseyin Naci,⁴ Marselia Tan,¹ Yousef El-Tawil,⁴ Adelina Comas-Herrera ¹

^{1 Care Policy and Evaluation Centre (CPEC), Department of Health Policy, London School of Economics and Political Science, 2 Research Department of Primary Care & Population Health, University College London, 3 Institute of Health Informatics, University College London, 4 Department of Health Policy, London School of Economics and Political Science}

On 9 June 2020, we published the first report of a living systematic review of emerging evidence on COVID-19 related mortality and spread of disease in long-term care, summarising evidence published up until 29 May. In an updated report, published on medRxiv, we included four new studies identified through database searches conducted on 5 June and excluded one previously included study which had been withdrawn by the author in the meantime, for a total of 30 unique primary studies included in the review.[1] While the overall findings of our review have not changed, newly added studies provided some complementary information, as summarised below:

• One of the newly included studies reported on the successful containment of a potential outbreak at two long-term care facilities at Hong Kong.[2] After a nurse was confirmed as a case, all residents were placed under quarantine for 28 days, and repeat testing of residents and all staff showed no further infections during that period.
• A different picture was provided by another outbreak report from the US, where over 50% of all residents at a skilled nursing facility tested positive.[3]
• Another newly included study is the first we identified that did not exclusively focus on institutional care settings. In this study, a US organisation providing support to people with intellectual and developmental disability in various settings (including family homes, foster care, small group homes, and intermediate care facilities) reports on their experience during the first 100 days of the COVID-19 pandemic.[4] Among a total population of 11,540 individuals, there were 66 confirmed cases, and only 1.3% of all sites supported by the organisation recorded a case. However, only symptomatic people were tested, and the true number of cases is therefore likely to be higher.
• In the institutional care setting, systematic testing in care homes in the Spanish region of Galicia showed a prevalence of 3.4% among all residents and staff, and 263 of 306 care homes in this region did not have a single case.[5]  

• In addition to the primary studies described above, the systematic review report was updated with official mortality figures from five new countries, showing wide international variation in the number of COVID-19 related deaths among care home residents.

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References:

[1] Salcher-Konrad M, Jhass A, Naci H, Tan M, El-Tawil Y, Comas-Herrera A. COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence. medRxiv. 2020. doi:10.1101/2020.06.09.20125237.

[2] Shea Y-F, Lam HY, Yuen JKY, et al. Maintaining zero COVID-19 infection among long term care facility residents in Hong Kong. J Am Med Dir Assoc. 2020. doi:10.1016/j.jamda.2020.05.042

[3] Goldberg SA, Pu CT, Thompson RW, Mark E, Sequist TD, Grabowski DC. Asymptomatic Spread of COVID-19 in 97 Patients at a Skilled Nursing Facility. J Am Med Dir Assoc. 2020. doi:10.1016/j.jamda.2020.05.040

[4] Mills WR, Sender S, Lichtefeld J, et al. Supporting individuals with intellectual and developmental disability during the first 100 days of the COVID-19 outbreak in the USA. J Intellect Disabil Res. 2020. doi:10.1111/jir.12740

[5] Cabrera JJ, Rey S, Perez S, et al. Pooling for SARS-CoV-2 control in care institutions. medRxiv. 2020. doi:10.1101/2020.05.30.20108597.