Sean P. Kennelly1, Adam H. Dyer1, Claire Noonan1, Ruth Martin2, Siobhan M. Kennelly2, Alan Martin3, Desmond O’Neill1, Aoife Fallon1
1. Department of Age-Related Healthcare, Tallaght University Hospital, Dublin 24, Ireland
2. Department of Medicine for the Elderly, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
3. Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin 9, Ireland
Summary of this article:
Asymptomatic carriage rates and case-fatality of SARS-CoV-2 infection in residents and staff in Irish nursing homes. Sean P Kennelly, Adam H Dyer, Claire Noonan, Ruth Martin, Siobhan M Kennelly, Alan Martin, Desmond O’Neill, Aoife Fallon. Age and Ageing, https://doi.org/10.1093/ageing/afaa220
Published: 28 September 2020
The significant impact of COVID–19 on nursing homes has been recognised since its emergence in late 2019. Nursing home residents are among the most frail in society, with high infection and case-fatality rates reported in this group internationally. The first nursing home COVID-19 clusters in Ireland were reported on 16 March 2020. By May 2020, the incidence of COVID-19 in long-term-care residents was 133/1000, with 258 clusters accounting for 4,872 cases and 851 deaths. Over the course of the pandemic, emerging evidence on COVID-19 in the care home setting and the risks associated with asymptomatic infection has led to the implementation of systematic testing programmes in this setting. In Ireland, the Health Service Executive (HSE) implemented a National Ambulance Service-led testing protocol for nursing homes, followed by a national point-prevalence COVID-19 mass-testing programme of all nursing home residents and staff. As new nursing home COVID-19 cases were identified, systematic testing of residents and staff was completed at two-week intervals.
Our study included nursing homes across three Irish Community Health Organisations (CHOs) in Dublin/Eastern Ireland, regions that were impacted early in the course of the pandemic. It aimed to examine the characteristics of these nursing homes, the proportion with COVID-19 outbreaks, symptom profile for staff and residents, resident mortality rates and the impact of outbreak timing on outcomes.
Results:
Completed surveys were returned from twenty-eight nursing homes, representing 2,043 residents. Three-quarters (21/28) of these nursing homes had a COVID-19 outbreak.
COVID-19 in Nursing Home Residents:
- 40.8% of residents in nursing homes with COVID-19 outbreaks had laboratory-confirmed COVID-19 infection and an additional 3.1% had clinically suspected infection
- 27.2% of residents with laboratory-confirmed COVID-19 were asymptomatic
- Case-fatality rate was 27.6%
COVID-19 in Nursing Home Staff:
- Ten nursing homes with COVID-19 outbreaks returned information on total staffing levels
- 32.2% of staff in these nursing homes had laboratory-confirmed COVID-19.
- 24.6% of this group were asymptomatic
Impact of COVID-19-outbreak timing:
- Median time from the first confirmed COVID-19 case in Ireland to the first case in included nursing homes was used to distinguish between ‘early’ (<28 days) and ‘late’ (?28 days) outbreaks
- Similar proportions of residents developed COVID-19 in ‘early’ and ‘late’ (45.4% vs 42.1%) outbreak nursing homes but a higher proportion of those in the ‘early’ outbreak group remained in isolation at the end of the study period (32.9% vs 13.3%)
- A greater proportion of staff with laboratory-confirmed COVID-19 in nursing homes with ‘late’ outbreaks were asymptomatic (21.6% vs 28.9%)
Conclusion:
The proportion of residents and staff with asymptomatic COVID-19 infection supports the implementation of systematic testing programmes in this setting, allowing timely identification and management of cases to enable outbreak eradication and recovery.
It’s good to hear that in Ireland many are still called “nursing homes.” This terminology was phased out at least (possibly a good deal more) in Australia. more than 5 years ago. They are now all called “AGED CARE” homes, and it is rare for a nurse to work in any of them. 99% of staff do a 6 week TAFE (without any entry standards) certificate and they are called “carers”, who have NIL nursing backgrounds or skills, and mostly don’t really care about the people in them. At the same time there is a lot of gouging by private enterprise, asking for ENORMOUS sums of money for people to be admitted. These “Aged Care” come under the jurisdiction of The Australian Federal Government, which over the years has been exponentially been defunding these homes.
The woeful standard of care is obvious. They also take in some very young people as nursing homes are basically non-existent now, except for the VERY wealthy. It is little wonder that around 80-90% of people who have died from COVID-19 in Australia have been in these Aged Care homes.
I guess I’m writing this as a kind of cautionary tale: it is important not to allow that shift in terminology, which was originally touted as “simply” a name change, because it screens a significant paradigm shift. I note that some examples are called “Care Homes” in your case, but there is a slippery slide to be avoided at all costs.