Kai Leichsenring, Andrea Schmidt, Heidemarie Staflinger

While Austria was among those countries that had reported less infections per 100,000 inhabitants, and less deaths in care homes during spring 2020 (BMSGPK, 2020), the second wave of the COVID-19 pandemic has revealed a different pattern. Austria has now become one of the countries with the highest rates of infections per 100,000 inhabitants, and this is also reflected in a steep rise of infections in care homes.

The table below shows a comparison of data in June and November 2020, with cumulated numbers of cases in care homes as against in the total population. Data for 18 November (based on reporting of the nine Austrian regions) show that 5,118 residents in care homes (including all ages) tested positive for SARS-CoV-2 and of these, 728 had died with COVID-19. Compared to the 2,018 total deaths linked to COVID-19 in Austria on the same date, deaths of care home residents would continue to represent approximately 36% of all deaths due to COVID-19. In general, this situation confirms the association between mortality levels due to COVID-19 in the general population with mortality levels in care homes due to COVID-19, which has been observed in many countries worldwide (Comas-Herrera et al., 2020).

It is important to note that a rise in SARS-Cov-2 cases (and deaths due to COVID-19) in care homes mainly took place during the month of October when the pandemic spread to all regions and in particular among staff – until 18 November, 3,190 care workers in care homes tested positive, but as of to date no deaths among staff have been reported. Given the number of about 70,000 residents in care homes in Austria (BMASGK, 2019), the death rate due to COVID-19 is at 1.04% in 2020. At that date there were also 672 SARS-CoV-2 positive cases in homes for people with disabilities, of which 12 persons had died by 18 November 2020 from COVID-19. There were 832 SARS-CoV-2 positive cases among staff in homes for people with disabilities, and no deaths due to COVID-19. No data are available for staff nor for clients in community care. It is likely that still a high number of care home residents are hospitalised, including in intensive care so that data on excess deaths will have to be observed over the next few weeks.

Table 1: Number of COVID-19 cases in care homes and in the entire population in Austria, cumulated by June and November 2020

Sources: BMI, BMSGPK; AGES. Abbreviations: BMI – Ministry of the Interior; EMS – epidemiological reporting system. Notes: (1) EMS data are based on official register data from counties and laboratories, while BMI data are gathered from the regional governments via daily videoconferences; Austria has about 8.9 mio. inhabitants.

There had been several hotspots, also in care homes, over the summer, but only from mid- September onwards a massive rise in the numbers of infections in the general population started, resulting in an eventual ‘world-record’ of new infections per million inhabitants per day by mid-November (https://ourworldindata.org/coronavirus). At that time, the second lockdown that had been initiated by 3 November in a ‘light’ version (with bars and restaurants closed, curfew from 8 p.m. to 6 a.m., but shops still open), started to show first signs of levelling, though still at a high level. Therefore, by 17 November also shops were closed and the curfew was extended, with exceptions for work, care of others and individual sports activities such as jogging or walking.

Regional differences in measures to protect care homes

In line with the rise of infections in the entire population, also positive cases in care homes increased, together with the rise of deaths. The original aim, to prepare for the second wave and to shield in particular vulnerable older people in care homes, was apparently and unfortunately not fully reached across Austria. Still, there are significant differences between regions due to different policies by regional governments that are responsible for care homes. For instance, in Vienna, the share of deaths during October in total deaths was only 43%, while the same share was 91% and 82% in Lower and Upper Austria respectively. In Vienna, screenings and the restriction of visits only to public spaces of care homes seem to have been possibly more successful than the specific ‘Corona traffic lights’ system in Lower Austria, with graded measures according to the level of infections in the local context. Upper Austria restricted the possibilities for visits by October to two visitors per resident per day, and in care homes with positively tested staff and residents to those in palliative care only. One caveat might have been the long waiting times for test results as care homes were originally not prioritised in testing procedures. By November 2020, restrictions in care homes were intensified, still with regional distinctions. For instance, in Upper Austria only residents in critical status and/or palliative care could be visited. All staff had to wear FFP2 masks throughout their work with residents. However, residents were allowed to leave the care home, e.g. for visiting family.[1]

New measures less stringent than during the first wave

In the meantime, there are federal regulations for care homes stipulating massive visiting restrictions, however these are less severe than those in Spring 2020. Residents may now receive visitors once a week, if visitors show a negative test result and wear FFP2 masks. Individual regions have added restrictions, regional health authorities impose complete closures of those care homes with SARS-CoV-2 cases. Moreover, staff in care homes are now subject to compulsory testing at least once per week (funded by federal budgets). There is some skepticism about the regulation that staff with a positive test may still work with a FFP2 mask if they do not show symptoms and their Ct value is above 30. This means that there are a number of professional carers still working, rather than being in quarantine.

With care homes remaining partly accessible, and staff moving in and out, staff, visitors and residents continue to be subject to risk of SARS-CoV-2 infection. It is likely that even weekly tests cannot guarantee virus-free staff. Up to now, residents were scarcely tested, and test results were partly communicated too late. Also, it is difficult to explain hygiene rules to residents with cognitive impairments (cf. Suarez-Gonzalez et al., 2020). While during Spring 2020 care homes stopped accepting new residents, such stringent measures were not applied in Autumn. Also, hospitals now discharge COVID-19 patients to care homes sooner. Yet, complete isolation is hardly possible in care homes, also because some care homes still have double rooms for residents. Avoidance of further SARS-CoV-2 clusters in care homes has, in general, become an important policy goal. Therefore, for instance in Upper Austria, hygiene specialists from hospitals are being sent to care homes for monitoring hygiene standards and assisting in improving them. At the time of writing, it seems that these interventions together with the general lockdown have resulted in stable infection rates at a still high level.

Recently published results of the “work climate index” (a panel survey among more than 20,000 Austrian employees) from May 2020 showed that 46% of care professionals assess their job as mentally stressful (as against 11% in other jobs). Although they are generally satisfied with their job, only 38% think that they will be able to reach pension age in care (61% in other professions).[2] The additional burden perceived during the pandemic is certainly also due to the additional lack of personnel due to colleagues in quarantine or in sickness leave – one third of care professionals reports stress due to time pressure and changing labour processes. Also, the second wave of COVID-19 shows that already difficult working conditions in long-term care are getting more and more burdensome. The only silver lining is currently the start of the vaccination campaign by January 2021 that will privilege residents and staff in long-term care.[3]

Key points:

• There is an on-going public debate in Austria about the fact that the country moved from one of the least hit countries to one of the world champions of new infections.
• Mortality due to COVID-19 in care homes over time confirms the association that exist with mortality levels due to COVID-19 in the general population, which has been observed in many countries worldwide.
• Austrian care homes were hit strongly during the second wave of the COVID-19 pandemic, in particular in some regions where also the general rates of infection were high.
• More restrictive measures in the context of the second lockdown during November seem to show first signs of a flattened curve of infections.
• There is hope that the vaccination campaign can start in January 2021, beginning with residents and staff in long-term care settings.

Links:

14 November 2020, https://www.vienna.at/verschaerfte-corona-massnahmen-in-alters-und-pflegeheimen-uebersicht-nach-bundeslaendern/6782466

14 November 2020, https://www.derstandard.at/story/2000121710636/oesterreich-aktuell-mit-hoechster-neuinfektionsrate-weltweit

20 November 2020, https://www.tt.com/artikel/30763596/covid-todesfaelle-in-tiroler-heimen-wir-wussten-dass-einige-sterben

17 October 2020, https://www.sn.at/panorama/oesterreich/hoechste-zahl-an-taeglichen-neuinfektionen-in-oesterreich-94335931

References:

BM für Arbeit, Soziales, Gesundheit und Konsumentenschutz (2019) Pflegevorsorgebericht 2018. Vienna, BMASGK.

BM für Soziales, Gesundheit, Pflege und Konsumentenschutz (2020) COVID-19 in Alten- und Pflegeheimen. Stand: Juli 2020. Vienna, BMSGPK.

Comas-Herrera A, Zalakaín J, Lemmon E, Henderson D, Litwin C, Hsu AT, Schmidt AE, Arling G and Fernández J-L (2020) Mortality associated with COVID-19 in care homes: international evidence. Article in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 14 October.

Suárez-González A, Livingston G, Low LF, Cahill S, Hennelly N, Dawson WD, Weidner W, Bocchetta M, Ferri CP, Matias-Guiu JA, Alladi S, Musyimi CW, Comas-Herrera A. (2020) Impact and mortality of COVID-19 on people living with dementia: cross-country report. LTCcovid.org, International Long-Term Care Policy Network, CPECLSE, 19 August 2020.

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[1] https://www.land-oberoesterreich.gv.at/Mediendateien/Formulare/Dokumente_BH_VB/LGBLA_OB_20201109_104.pdfsig.pdf

[2] www.arbeitsklima.at

[3] https://www.sozialministerium.at/Informationen-zum-Coronavirus/Coronavirus—Fachinformationen.html

Author affiliations:

Kai Leichsenring: European Centre for Social Welfare Policy and Research, www.euro.centre.org

Andrea E. Schmidt: Austrian National Institute of Public Health, www.goeg.at

Heidemarie Staflinger, Chamber of Labour for Upper Austria.