Maximilian Salcher-Konrad 1, Arnoupe Jhass,2,3 Huseyin Naci,4 Marselia Tan,1 Yousef El-Tawil,4 Adelina Comas-Herrera1
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
In an updated report of a living systematic review of evidence on COVID-19 related mortality and spread of disease in long-term care, we synthesised the findings of 49 unique studies. This follows the publication of the first report of this living review on medRxiv on 9 June 2020, and a first update on 29 June 2020.
Since the last update, we have included 21 new studies, which were published up until the 26 June 2020. New included studies add to the body of evidence on spread of disease and mortality in long-term care facilities with outbreaks, showing that more than two thirds of residents at badly affected care homes may contract COVID-19, and close to one fifth of all residents at care homes with outbreaks may die as a result.
In addition to reports of individual outbreaks, studies focusing on wider populations of long-term care users and staff are beginning to emerge. While these studies vary in terms of their samples and strategies used to identify people who contracted COVID-19, they provide insights into the impact of the pandemic on a highly vulnerable population. For example, a survey by the English Office for National Statistics (ONS) found that 10.7% of all residents and 4.0% of staff at English care homes for people living with dementia and older people were reported to have contracted COVID-19. However, these figures largely relate to a time before systematic testing at care homes was implemented and may therefore underestimate the true proportion of infected people in care home populations. Two other studies which were based on systematic testing found that 23.9% of residents at nursing homes in Barcelona (Spain) and 40.8% of residents at nursing homes in Dublin and Eastern Ireland had contracted COVID-19, although the Irish study only included nursing homes with active outbreaks. Yet other studies reported lower figures across long-term care populations in the Netherlands, Ontario (Canada), and the US,, but were again not based on systematic testing.
There is still only little evidence available on people receiving long-term care while living in the community (two studies from the US and one study with very limited information from Spain were included).
 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.
 Office for National Statistics. Impact of Coronavirus in Care Homes in England: 26 May to 19 June 2020.; 2020. Accessed July 20, 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/impactofcoronavirusincarehomesinenglandvivaldi/26mayto19june2020
 Borras-Bermejo B, Martinez-Gomez X, San Miguel MG, et al. Asymptomatic SARS-CoV-2 Infection in Nursing Homes, Barcelona, Spain, April 2020. Emerg Infect Dis. 2020;26(9). doi:10.3201/eid2609.202603
 Kennelly SP, Dyer AH, Martin R, et al. Asymptomatic carriage rates and case-fatality of SARS-CoV-2 infection in residents and staff in Irish nursing homes. medRxiv. Published online June 15, 2020. doi:10.1101/2020.06.11.20128199
 Verbeek H, Gerritsen DL, Backhaus R, De Boer BS, Koopmans RT, Hamers JP. Allowing visitors back in the nursing home during the COVID-19 crisis – A Dutch national study into first experiences and impact on well-being. J Am Med Dir Assoc. Published online 2020. doi:10.1016/j.jamda.2020.06.020
 Brown KA, Jones A, Daneman N, et al. Association Between Nursing Home Crowding and COVID-19 Infection and Mortality in Ontario, Canada. medRxiv. Published online June 26, 2020. doi:10.1101/2020.06.17.20133629
 Mills WR, Buccola JM, Sender S, et al. Home-Based Primary Care Led-Outbreak Mitigation in Assisted Living Facilities in the First One Hundred Days of COVID-19. J Am Med Dir Assoc. 2020;21(7):951-953. doi:10.1016/j.jamda.2020.06.014