Project Summary

This project aimed to synthesise published studies of mortality rates and incidence of COVID-19 among people who use and provide long-term care (LTC). Acknowledging the evolving nature of evidence during the pandemic, this project was set up in April 2020 as a living systematic review with continuously updated database searches and publication of key findings. A protocol was published on the PROSPERO database of systematic reviews (CRD42020183557). Initial findings were reported on medRxiv and fed into a WHO Policy Brief on the prevention and management of COVID-19 in LTC.

We developed search terms for seven databases (MEDLINE; Embase; CINAHL Plus; Web of Science; Global Health; WHO COVID-19 Research Database; medRxiv) to identify all studies reporting primary data on COVID-19 related mortality and incidence of disease among LTC users and staff. We exclude studies not focusing on LTC. Included studies are critically appraised using the Joanna Briggs Institute critical appraisal tool for prevalence studies. We extract information on the number of deaths, COVID-19 related mortality rates, case fatality rates, and excess deaths (co-primary outcomes), as well as incidence of disease, hospitalisations, and ICU admissions. Findings are initially synthesised narratively. Upon assessment of the heterogeneity of populations in included studies, we will quantitatively synthesise rates of mortality and infection.

In the last published report (1 August 2020), a total of 54 study reports for 49 unique primary studies or outbreak reports were included, which documented the severe impact that COVID-19 had on LTC. In badly affected care homes, more than two thirds of residents may be infected with COVID-19, and close to one fifth of all residents at care homes with outbreaks may die as a result.

• Three pre-prints (original review followed by two updates) of this ongoing living systematic review have been published on medRxiv from June to August 2020: https://www.medrxiv.org/content/10.1101/2020.06.09.20125237v3
• Early findings of the systematic review informed a WHO Policy Brief on the prevention and management of COVID-19 in LTC: https://www.who.int/publications/i/item/WHO-2019-nCoV-Policy_Brief-Long-term_Care-2020.1