LTCcovid Country Profiles

Responses to 2.02. Deaths attributed to COVID-19 among people using long-term care

Australia

As of the 18th March 2022 there were 360 active outbreaks in residential aged care in Australia, with 1,613 residents and 1,542 staff affected.

As of 18th March 2022, there have been 20,154 confirmed cases of COVID-19 among subsidized residents in aged care facilities. There have been 1,879 deaths so far. Among people who use government-subsidized home care, there have been 192 confirmed cases of COVID-19 and 13 deaths. As of 18th March 2022 there have been 5,736 deaths among the whole population suggesting that 32.8% of all COVID-19 deaths in Australia have been among care home residents. These figures are based on people who have tested positive for COVID-19 and are for the place of residence, not place of death, so may include residents who died in hospital. In 2020, there were approximately 208,500 people living in aged care residential accommodation in Australia. Therefore, the numbers of care home COVID-19 deaths would amount to 0.90% of this population (source: AIHW).

A weekly report publishes data on the number of outbreaks and staff infected in care homes. As of 18th March 2022, there have been 24,216 cases of staff with COVID-19 infections.

About the data:

The Australian Department of Health first published deaths linked to COVID-19 in care homes and among users of home care services on April 15, 2020.

Last updated: March 23rd, 2022   Contributors: Erica Breuer  |  

Austria

During the earlier part of the pandemic, Austria was among those countries that had reported fewer deaths in care homes. During the second wave of the COVID-19 pandemic, Austria experienced very high rates of infections, reflected in a steep rise in infections and deaths due to COVID-19 in care homes (Source: https://ltccovid.org/2020/11/27/the-second-wave-has-hit-austria-harder-also-in-care-homes/). Through the spring and summer months infection rates fell but as of November 2021, infection growth rates are increasing again.

As of November 1st 2021, there are 69,730 residents in care homes (including all ages) Of this population, 3,953 have died. Compared to the 11,369 total deaths linked to COVID-19 in Austria on the same date, deaths of care home residents would represent 35% of all deaths.

According to data from September 17, 2020, only 0.4% of care home residents had died after the first wave. By November 2021, this number has risen to 5.7%. This is based on there being 69,730 residents in care homes in Austria (BM für Arbeit, Soziales, Gesundheit und Konsumentenschutz (2019) Pflegevorsorgebericht 2018. Vienna, BMASGK).

Last updated: December 4th, 2021   Contributors: Andrea E. SCHMIDT  |  Disha Patel  |  

Belgium

Belgium first reported official estimates of the number of deaths in care homes on April 11, 2020. The data is collected by Sciensano, a public research institution, which publishes very detailed epidemiological daily reports on COVID-19, including data on the number of deaths in care homes (“maisons de repos”). As of April 15, 2020, reports have also included the number of tests done within care homes. For deaths outside hospitals, Belgium reports both “confirmed” cases (through a test or, since April 1, a chest scan), and “suspected” cases where the patient had not been tested but a doctor confirmed that their symptoms were consistent with COVID-19. Deaths in nursing homes are notified by the regional authorities with a 2 day delay, and are classified according to the date of death.

As of April 22nd, 2022, there have been 31,319 deaths linked to COVID-19 in Belgium. Of these 14,216 were residents in care homes and 10,261 occurred in the institutions themselves (source: Sciensano).  Belgium has an estimated 125,000 people aged 65 and over living in care homes. The number of deaths in care homes linked to COVID-19 so far would represent 11.37% of this population (source: KCE).

Last updated: May 3rd, 2022   Contributors: Daisy Pharoah  |  Disha Patel  |  

Brazil

There is no official data on the number of cases and mortality related to COVID-19 across Brazilian care homes. A report published in September 2020, found that there had been over 4,015 confirmed cases and 937 deaths in Brazilian care homes, which represents a case fatality rate of 23.33%. This was based on data collated informally by the researchers.

An article published in December 2021 describing morbidity and mortality in long term care facilities in the state of Bahia, Brazil, found COVID-19 incidence of 30.71% in residents of a 175 facility sample from April 2020 to June 2021. According to this data 19.97% cases in older residents required hospitalisation and there was an 11.63% case fatality rate, which the authors noted to be lower than expected. (Source: COVID-19 morbimortality in long-term care facilities in the state of Bahia, Brazil)

Last updated: January 2nd, 2022   Contributors: Disha Patel  |  William Byrd  |  

Canada

The National Institute on Ageing Long-Term COVID-19 Tracker Open Data Working Group collects information on confirmed and presumptive positive, resident and staff cases and death in long-term care settings in Canada from multiple sources including public health units, government reports, media,  information posted bu homes publicly and shared with their staff, residents and family. Given this, all cases reported cannot be guaranteed to be laboratory confirmed. This data is updated twice a week.

In Wave 1 (up to September, 2020) NIA data shows there were 7,310 deaths, across 1,171 LTC facilities with outbreaks, making up 74% of total deaths from COVID-19 in Canada for that wave. In Wave 2 (still ongoing at the publishing of this data on February 15, 2021) there were a further 7,016 deaths across, 1,389 LTC facilities with outbreaks. At this time resident deaths across both waves represented 67% of total deaths from COVID-19 in Canada.

As of April 25, 2022, there have been 16,780 COVID-attributed deaths in care home residents. As of the 2016 census Canada had 425,755 residents living across 6029 LTC facilities. Thus, the number of COVID-19 related deaths of LTC residents represents 3.94% of the estimated population in care homes.

Last updated: May 3rd, 2022   Contributors: Disha Patel  |  

Chile

There are no official publicly available estimates of the total number of people who use care who have died with COVID-19 infections. The lack of data on the impact of the pandemic is particularly problematic in the unregulated sector (Browne et al., 2020).

References:

Browne J, Fasce G, Pineda I, Villalobos P (2020) Policy responses to COVID-19 in Long-Term Care facilities in Chile. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 24 July 2020.

Last updated: December 22nd, 2021

Denmark

Data on cases and deaths within nursing homes are published weekly every Tuesday by Statens Serum Insititut under the Danish Department of Health. Deaths among confirmed residents are defined as deaths among residents who died within 30 days of a positive covid-19 PCR test (from the data first tested). In other words, these are not deaths which can positively be attributed to COVID-19 and the cause of death may be another.

As of September 9, 2022, there have been 2,439 deaths of care home residents. Therefore, with  6,068 deaths from COVID-19 in the whole population, the share of confirmed deaths among nursing home residents is 40% (Source: https://covid19.ssi.dk/overvagningsdata/ugentlige-opgorelser-med-overvaagningsdata). There are 38.863 nursing home residents in Denmark, which means that 6.28% of this population have died with confirmed COVID-19.

The research center VIVE has on commission from the Ministry of Health conducted a systematic analysis and evaluation of the spread of COVID-19 in the population and the LTC sector, and the following refers to the findings from this evaluation:

The daily number of infected in nursing homes grew in particular from March to April 2020, thereafter it fell and rose again at the end of the year. However, the testing strategy changed in this period and only the residents who needed to be admitted to hospital were tested in the spring. The factual number of persons infected and having died from COVID-19 would therefore be higher. In the winter 2020/21 a more systematic testing strategy was rolled out at the nursing homes and the daily number of persons infected climaxed at 80 persons, with 15-20 daily deaths in nursing homes (Hirani et al, 2022).

An excess mortality among nursing home residents can be observed in the winter of 2020/21, mainly driven by high mortality in the capital area, which was three times as high as in other regions. This was also the region where most persons were tested and found to be positive. The excess mortality was, however, only slightly higher than in comparable periods of previous flu epidemics (where there were no lockdowns) (Kjellberg et al, 2022b).

Community infection seems to be the main cause of the spread into the nursing homes (the analysis looks at the period Jan 2020-April 2021). In 36% of cases, the cause of infection is unknown, in 40% a member of staff had tested positive 14 days before, and in 8% a relative. In 17% there was both infection among staff and relatives. However, it should be noted that the testing strategy was different among staff and relatives with staff being tested regularly. Also that relatives did not have access to the nursing homes in the period March-April 2020. An analysis of the source of infection at the end of the year – where also many more test were distributed – shows fewer unknown sources and more often it is both staff and relatives who may have been the source (Hirani et al., 2022; Topholm and Kjellberg, 2022).

A separate analysis of older people living outside nursing homes shows that there are fewer persons who died in this period than during previous periods with flu epidemics. Again, there is regional variation, with proportionally more deaths in the capital and Sealand regions (Hirani et al, 2022).

Overall, the analysis shows that the increase in infection among those not living in a nursing home follow the same pattern: a small increase in March/April 2020 and then a larger increase at end of the year (Hirani et al, 2022).

A sub-analysis shows that among those older persons with home care there were approx. 70 daily cases and approx. 10 daily deaths, and 300 daily cases among older persons not receiving home care with approx. 20 daily deaths (Hirani et al, 2022).

The VIVE evaluation conclude that the nursing homes and the home care sector were “totally unprepared” when the pandemic started spreading (Jan- April 2020). There were no routines in place for disease prevention and management of disease outbreaks. There was only limited access to guidance and PPE and the test strategy only included persons who were admitted to hospital (Kjellberg et al, 2022a).

In the second phase (May-Oct 2020) the number of infections fell, and PPE and test equipment became more available, so that also relatives could be tested, but no preventive test were administered (Hirani et al, 2022.)

In the third phase, the infection rate rose in the nursing homes and more and more nursing homes introduced lockdowns. There were increasing concerns that the government’s response to the pandemic such as the lockdowns was inflexible and not tailored to individuals’ circumstances (rather, it was based on ‘one size fits all’ rules). Combined with the late ease of restrictions, it had a negative long-term impact on older people’s mental and physical health and concerns were raised that the government should have done more to respect basic individuals’ freedoms (Source: https://www.djoef.dk/presse). Over Christmas, the visiting ban was lifted, and it was also allowed to gather up to 50 residents for celebration, the latter which receives criticism from the interviewed experts in the VIVE evaluation – who are also in general agreement that the national lockdown came too late in order to protect the nursing home sector (Kjellberg, 2022b).

References:

Hirani, J.C.; Mikkelsen, M, and Kjellberg, J. (2022) Test, smitte og covid-19-relateret dødelighed under covid-19-epidemien 2020 – 2021. Delrapport 2. https://www.vive.dk/da/udgivelser/test-smitte-og-covid-19-relateret-doedelighed-under-covid-19-epidemien-2020-2021-delrapport-2-17873/

Kjellberg, J.; Hirani, J.C.; Mikkelsen, M. Juel, K. (2022a) Dødelighed under covid-19-epidemien januar 2020 – april 2021 Delrapport 1. En sammenligning med tidligere epidemier og andre lande. København: VIVE. https://www.vive.dk/da/udgivelser/doedelighed-under-covid-19-epidemien-januar-2020-april-2021-delrapport-1-en-sammenligning-med-tidligere-epidemier-og-andre-lande-17871/

Kjellberg, P.K., Kjellberg, J.; Hirani, J.C., Mikkelsen, M.; Juel, K.; Christensen, J.; Lauritzen, H.H.; Thøstesen, A.; Topholm, E.H.E.; Martin, H.M.; Navne, L.E.; Johansen, M.B. & Bech, M.  (2022b) Baggrunden for covid-19-udbrud og -dødsfald på plejecentre og i hjemmeplejen i Danmark i perioden januar 2020 – april 2021. Tværgående analyse og besvarelse af opdraget. København: VIVE. https://www.vive.dk/da/udgivelser/baggrunden-for-covid-19-udbrud-og-doedsfald-paa-plejecentre-og-i-hjemmeplejen-i-danmark-i-perioden-januar-2020-april-2021-17878/

Rostgaard T (2020) The COVID-19 Long-Term Care situation in Denmark. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 25 May 2020.

Topholm, E.H-E. and Kjellberg, p.K. (2022) Decentrale beretninger fra hjemmeplejen og plejecentre under covid-19-epidemien. Delrapport 4. København: VIVE. https://www.vive.dk/media/pure/17876/6978327

Last updated: May 25th, 2023   Contributors: William Byrd  |  Disha Patel  |  Joanna Marczak  |  

Finland

As of April 8, 2021, 80,842 people have tested positive for COVID-19 and 866 people have died. Of those, 29% (approximately 251) died in social care 24-hour units (Source: https://thl.fi/en/web/infectious-diseases-and-vaccinations/what-s-new/coronavirus-covid-19-latest-updates/situation-update-on-coronavirus#Coronavirus_situation). In 2018, there were 50,298 residents in social care 24-hour units (Source: https://thl.fi/fi/tilastot-ja-data/tilastot-aiheittain/ikaantyneet/sosiaalihuollon-laitos-ja-asumispalvelut). Therefore, the number of COVID-19 related deaths in these units represents 0.50% of this population.

Last updated: August 2nd, 2021

France

France first published official death estimates for people in care homes on March 31, 2020. Deaths from COVID-19 are recorded where either the death of a confirmed case or a death attributed to COVID-19 by the physician in the medical certificate of death.

Numbers published by the Ministry of Health on April 1, 2021 (Wave 1 & Wave 2), reported a total of 95,264 COVID-19 related deaths, of which 36,889 (39%) were residents in care homes. Of these, 26,044 (71%) died in the care homes and, particularly in the earlier part of the pandemic, were mostly “probable cases” (people who were not tested but a doctor confirmed that the symptoms were associated with COVID-19). The remaining 10,845 died in hospital and were confirmed through testing. As of April 1, 2021, there have been 201,766 confirmed infections among care home residents, and 105,980 among care home staff.

As of January 26th 2022, further data published by the Ministry of Health reported a total of 129,747 COVID-19 related deaths, of which 44,253 (34.1%) were care home residents. Of these, 27,403 died within a care home setting. There are an estimated 605,061 care home beds in France. Therefore, the number of deaths of care home residents linked to COVID-19 would represent 7.31% of all the available beds (Source: https://www.insee.fr/fr/statistiques/3676717?sommaire=3696937).

A 2021 study of the impact of COVID-19 in care homes found that, over the year 2020, 75% of residential and nursing homes had at least one resident infected by COVID-19. 20% of care and nursing homes experienced a critical episode in which at least 10 residents or 10% of the total number of residents died. Over 2020, 38% of care home residents were infected by COVID-19 of which 5% died, amounting to 29,300 deaths. The study finds that care/nursing homes with 24-hour nursing staff were better able to treat serious cases. The study also suggests that for-profit care homes had a slightly greater probability of having a more severe outbreak of COVID-19 compared to homes in the public or not-for-profit sector. Other determining factors include infection rates in the wider community and the size of the care home (source).  

Last updated: October 22nd, 2024   Contributors: William Byrd  |  Disha Patel  |  Alis Sopadzhiyan  |  

Germany

About the data:

Germany’s Robert Koch-Institute published the first official number of infections and deaths in different care settings on April 22, 2020. People in care and nursing homes are covered under §36 of the Protection Against Infection Law (IfSG). §36 also includes people living in facilities for those with disabilities or other care needs, homeless shelters, community facilities for asylum-seekers, repatriates, and refugees, and so the data is not directly comparable with the data on care homes presented for the other countries.

Data recorded here only includes confirmed cases following a laboratory diagnosis independent of clinical assessment. In addition, the Robert Koch Institute advises that information on care setting is missing in 37% of cases, which means that the number of people affected represents the minimum number of cases in specific care settings. A report estimated that, based on a survey of care homes, the share of deaths of care home residents attributed to COVID-19 by May 2020 was 49% of all COVID-19 deaths, which is higher than the rate that would result from the Robert Koch Institute data at the time (36%).

Deaths linked to COVID-19 in residential care

According to Germany’s Robert Koch-Institute, 25,789 residents of residential long-term care facilities (aged 60 and above) died in association with a SARS-CoV-2 infection during the course of the pandemic until week 4 of 2022 (Robert Koch Institut, 2022a). This figure may include a small proportion of staff and visitors in addition to residents, as attribution is not always clear. Thus, out of 118,504 death associated with the Covid pandemic in total, deaths associated with care homes constitute 21.76 % (Robert Koch Institut, 2022b).

The total number of people living in care and nursing homes in Germany in 2017 was 818,000, and assuming that there were a similar number in 2020 and that all the deaths in communal establishment were residents, 3.15% of all care home residents would have died due to COVID-19 (Source: Statista).

Deaths linked to COVID-19 among people who use care in the community

The number of users of community care or persons who are being cared for without the assistance of professional services in the community is unclear. The last data on this group was published on 16 July 2021 when the number of deaths was reported as 195 persons (Robert Koch Institut, 2021). However, the validity of this figure is questionable as data collection does not account for persons in need of care in a standardizes way.

References

Robert Koch Institut (2021) Täglicher Lagebericht des RKI zur Coronavirus-Krankheit-2019 (COVID-19) 16.07.2021 – AKTUALISIERTER STAND FÜR DEUTSCHLAND. Available at: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/Jul_2021/2021-07-16-de.pdf?__blob=publicationFile (Accessed 5 February).

Robert Koch Institut (2022a) Wöchentlicher Lagebericht des RKI zur Coronavirus-Krankheit-2019 (COVID-19) 03.02.2022 – AKTUALISIERTER STAND FÜR DEUTSCHLAND. Available at: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/Wochenbericht/Wochenbericht_2022-02-03.pdf?__blob=publicationFile (Accessed 5 February 2022).

Robert Koch Institut (2022b) Coronavirus Disease 2019 (COVID-19) Daily Situation Report by the Robert Koch Institute 04/02/2022- CURRENT STATUS FOR GERMANY. Available at: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/Feb_2022/2022-02-04-en.pdf?__blob=publicationFile (Accessed 5 February 2022).

Last updated: February 12th, 2022   Contributors: Klara Lorenz-Dant  |  Thomas Fischer  |  Kerstin Hämel  |  

Greece

As of January 31, 2021 there were 1,512 cases of COVID-19 amongst nursing home residents and 228 deaths, accounting for 4% of COVID-19 related deaths according to The National Public Health Organisation and The European Centre for Disease Prevention and Control. This corresponds to 2.1 COVID-19-related deaths per 100 nursing home beds in Greece.

Last updated: December 6th, 2021   Contributors: Disha Patel  |  

Hong Kong (China)

Data availability

There is no regularly published official data on the number of deaths of care home residents in Hong Kong, so this section reports data from credible media sources.

Early part of the pandemic

In Hong Kong, until 2022, the strategy of zero-COVID was successful in limiting infections in care homes. As of December 2020, there had been 20 care homes with outbreaks. This resulted in 124 residents and 29 staff members testing positive for COVID-19. Of these 124 residents, 32 had died, accounting for 19% of all COVID-19 related deaths in Hong Kong.

Omicron wave

The situation has been very different since the arrival of the Omicron wave. Since March 2022 there have been major outbreaks in care homes and large number of deaths. The media reported, on March 23 2022, that, of the just over 6000 deaths in the whole population to that date, 60% were care home residents. In addition, a total of 33,758 care home residents (45% of the total) were infected at that time in 776 care homes.

This high impact of the Omicron variant has been attributed to low vaccination rates among older people and lack of isolating facilities within care homes.

Size of care home population

In June 2020 there were 76,091 care home places in Hong Kong. Therefore, the number of deaths of care home residents linked to COVID-19 so far would represent 2.3% of this population.

Last updated: April 11th, 2022   Contributors: Cheng Shi  |  

Hungary

As of August 27, 2020, there have been 142 COVID-19 related deaths in care homes, accounting for 23% of all deaths (142 of 614). These COVID-19 related deaths only account for people who have tested positive and died (Source: https://koronavirus.gov.hu/cikkek/idosotthonok-142-koronavirussal-fertozott-gondozott-hunyt-el-kozuluk-55-en-pesti-uton).

Because less than 3% of the population aged over 65 lives in care homes in Hungary, it is expected that the share of deaths in care homes in Hungary will be lower than in other countries. In 2018, the total number of residents of care homes was 55,170, of which 50,589 were aged 65 or more. Assuming the number of residents hasn’t changed, then the share of care home residents who have died as of August 27, 2020, would be 0.3%.

Last updated: August 2nd, 2021

Ireland

Ireland has a centralised system to collect epidemiological information in relation to cases of COVID-19 infections (Source: https://ltccovid.org/wp-content/uploads/2020/04/Ireland-COVID-LTC-report-updated-28-April-2020.pdf). All deaths, in all care settings and dwellings, related to COVID-19 that are notified to the Health Prevention Surveillance Centre are included in the official count of deaths. A weekly report detailing mortality by place of death and as linked to outbreaks is published by the HSPC.

A report by the Department of Health and the Health Prevention Surveillance Centre published in December 2020, estimated that up to December 13, 2020, there had been 1,112 deaths linked to COVID-19 in nursing homes. On that date, there had been 2,110 deaths attributed to COVID-19 in Ireland. Therefore, deaths of nursing home residents represented 51% of all deaths linked to COVID-19, but this figure has changed during the pandemic, suggesting lessons from the first wave may have improved the capacity of nursing homes to fight the pandemic. Based on the data in the same report, during what was the first wave in Ireland (up to early August 2020), the proportion of COVID-19 deaths attributed to nursing home residents was 54%, but in the second wave (August to October 2020) it was 38%, and between November and mid-December the share was 34%.

As of April 16th 2022, there have been a total of 6,964 deaths due to COVID-19 in Ireland, of which, 2,543 are linked to outbreaks in nursing homes and 2,240 occurred within residential institutions (including community hospital/long stay unit, homeless facility, mental health facility and nursing homes) themselves. Thus deaths linked to nursing home outbreaks represent 36.5% of all deaths from COVID-19. There are an estimated 30,000 people living in nursing homes. Therefore, 8.47% of all nursing home care residents would have died because of COVID-19 as of April 2022.

Last updated: May 3rd, 2022   Contributors: Disha Patel  |  William Byrd  |  

Israel

The first outbreak in a long-term care facility in Israel began in mid-March 2020, sixteen days after the first patient was diagnosed in Israel. Only a month after the initial outbreak, and following massive public criticism and a call for help from the managers of long-term care facilities, the Israeli government appointed a national-level team to manage the COVID-19 outbreaks in long-term care facilities. As of October 12, 2020, there have been 704 COVID-19 related deaths in long-term care facilities, which accounts for 39% of the total deaths in the population. There were 45,000 people in long-term care facilities in Israel. Therefore, the number of COVID-19 related deaths in these facilities represents 1.56% of this population . Furthermore, according to a survey, 50% of all COVID-19 related deaths occurred in residential care settings, while the overall share of people infected in care homes only amounts to 8.5%. Although the Israel Ministry of Health provides ongoing statistics concerning COVID-19 deaths, place of residence does not appear on their dashboard, even though age is used as a descriptor.

Sources:

Tsadok-Rosenbluth, S., Hovav, B., Horowitz, G. and Brammli-Greenberg, S., 2021. Centralized Management of the Covid-19 Pandemic in Long-Term Care Facilities in Israel. Journal of Long-Term Care, (2021), pp.92–99. DOI: http://doi.org/10.31389/jltc.75

Last updated: December 5th, 2021   Contributors: Shoshana Lauter  |  LIAT AYALON  |  

Italy

For the first wave of the pandemic in Italy, the only data available on the virus outbreak in LTC services are for nursing homes, thanks to the results from a survey carried out by the National Health Institute (Istituto Superiore di Sanità), which was sent to 3,292 nursing homes out of the 3,417 NHs for people living with dementia. These data cover the period between February 1^st and May 5^th and were published on June 17, 2020. By May 5, 2020, 1,356 nursing homes had responded. The total mortality rate during that time was 9,1% (considering all deaths). The COVID-19 related mortality rate (tests and suspected) was 3,1%.

In September, 2021 the National Health Institute published a new report on the results of the surveillance of COVID–19 cases from October 5^th 2020 to September 19^th 2021 for a sample of Long-Term Care Facilities (LTCFs) representing 31,178 beds. Overall, 341 out of the 852 facilities were nursing homes for older adults, counting 15,031 beds. Indicators show an increase in both COVID-19 cases and deaths in the months of October and November 2020, in line with the second epidemic wave in Italy. However, in contrast with the national data, there was a progressive reduction of COVID-19 cases, hospitalizations of SARS-CoV-2 positive residents and deaths in LTCFs in the period from February to April 2021. This trend is associated with the start of the vaccination campaign, which prioritised nursing home residents and severely vulnerable people, as well as LTCFs staff.

In the months of July, August and September 2021, there was slight increase in COVID-19 cases, both in residents and among the staff. This relates to the increase in the number of new cases in the general population in the same period. However, despite the increase in new cases and outbreaks in the monitored facilities, the number of deaths from COVID-19 occurring in LTCFs remained very low (< 0.01% per week), and this is probably due to the protective effect of the SARS-CoV-2 vaccination against the most severe forms of COVID-19.

Although the surveillance showed a significant decrease in new SARS-CoV-2 positive cases in LTCFs during the period May-June 2021, a slight increase of positive cases has been observed during summer, in the period July-September 2021. Yet, the Institute claims that this trend shall not be overlooked: rather, it suggests the opportunity to strengthen the immune protection through an additional dose of vaccine, as already provided for by the Ministry of Health. 

At present, these reports are the only official data on deaths related to the pandemic in LTCFs, urging for a comprehensive revision of monitoring systems in the LTC sector.

Sources:

Berloto, S., Notarnicola, E., Perobelli, E., Rotolo, A. (2020) Italy: Estimates of mortality of nursing home residents linked to the COVID-19 pandemic. LTCcovid, International Long Term Care Policy Network, CPEC-LSE, 25 June 2020.

National Health Institute (2021). Surveillance of COVID–19 at Long–Term Care Facilities. Italian National Report. Time course of the COVID–19 epidemic. October 5th 2020 – September 19th 2021

Ministry of Health (2021). Circular no. 43604 of September 27th

Last updated: November 8th, 2021   Contributors: Eleonora Perobelli  |  Elisabetta Notarnicola  |  

Japan

There is no publicly available official data on the numbers of people who use or provide care who have had COVID-19 infections or whose deaths are attributed to COVID-19. It was reported that 14% of all COVID-19 was the result of infections in care homes in early May 2020.

Last updated: August 3rd, 2021

Lithuania

As of January 24, 2022, there have been 7,782  COVID-19 related deaths (defined as the number of deaths for which COVID-19 was identified as the primary cause of death by physicians on the death certificate), of which 415 were wards of social care institutions (5.3%) (Source: Ministry of Social Security and Labor of the Republic of Lithuania and the European Centre for Disease Prevention and Control). There are 13,100 residents in social care institutions in Lithuania. Therefore, the total number of COVID-19 related deaths in social care institutions represents 3.17% of all residents.

Last updated: February 7th, 2022   Contributors: William Byrd  |  Disha Patel  |  

Netherlands

During the first wave, the National Institute for Public Health and the Environment (RIVM) estimated that about 40% of nursing homes had experienced outbreaks. By May 15, 2020, about 7% of residents in nursing homes had been infected and 2% had died. A report published in November 2020 noted that approximately 50% of all COVID-19 related deaths during the second wave were residents of nursing homes.

As of March 6, 2021, there had been 8,446 COVID-19 related deaths of care home residents. Accounting for 51% of the total COVID-19 deaths in the Netherlands. These numbers are an underestimation of the actual COVID-19 deaths because not all those who died due to COVID-19 will have been tested (especially at the beginning of the pandemic). Only people over 70 years of age are included in these statistics.

As of April 25, 2022, there are 10,867 COVID-19 related deaths of care home residents and 22,227 deaths in the Netherlands overall (Source:https://coronadashboard.rijksoverheid.nl/landelijk). Thus care home residents account for 48.8% of the total COVID-19 deaths. The Netherlands has approximately 125,000 care home residents, so the deaths represent 8.7% of residents.

Statistics Netherlands (CBS), a governmental organisation, provides weekly updates on observed mortality. They distinguish the mortality figures by long-term care users and age. They also provide expected figures based on the previous 5 years to estimate excess mortality. These figures show that there has been 9.9% excess mortality (observed-expected/expected) among long-term care users since the start of the pandemic to the end of January, 2022, compared to 8.5% excess mortality among the wider population (outside long-term care).

Last updated: May 3rd, 2022   Contributors: Adelina Comas-Herrera  |  Disha Patel  |  

New Zealand

As of March 25, 2021, there have been 16 COVID-19 related deaths in Aged Residential Care facilities, accounting for 57% of all COVID-19 related fatalities (Source: https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-current-situation/covid-19-current-cases#summary). The Aged Residential Care sector comprises 38,000 beds in over 650 facilities throughout the country. Therefore, the number of deaths in aged care facilities represents 0.04% of all beds.

Last updated: August 2nd, 2021

Poland

Data illustrated that by 12 November 2021, there were overall 78 555 deaths attributed to Covid 19. People aged 65 years or more constituted about 80% of all Covid-19 deaths and people aged 80 years or more about 44%. Moreover, an early report showed that in June 2020 about 9% of COVID-19 cases were related to infections in long-term care facilitates in Poland: 3% in nursing and care homes and 6% in social welfare homes.

Expert highlighted that the situation in Poland in terms of absolute numbers of deaths among the elderly in LTC facilities is not as dramatic as in other countries because care is provided mainly in families rather than through formal services, e.g. less than two percent of the elderly reside in LTC facilities whilst provision of home care is also low (sources: Alert Zdrowotny 2; Ageing policies-access to services in different EU Member States).

Sources:

Raport zakazen koronawirusem (SARS-CoV-2) -Portal Gov.pl (www.gov.pl)

Sowa-Kofta, A. Responding to the Covid19 in residential long-term care in Poland

Alert Zdrowotny 2

Ageing policies – access to services in different EU Member States.

Last updated: November 24th, 2021   Contributors: Joanna Marczak  |  Agnieszka Sowa-Kofta  |  

Portugal

Although no official reports have been published, the Government of Portugal released the number of deaths in nursing homes to the media. According to data published in the media, as of January 10, 2021, 2,254 people have died in nursing homes, corresponding to 2.27% of all the 99,000 residents in legal care homes in Portugal. On the same date, 7,803 deaths attributed to COVID-19 had been reported in Portugal. Therefore, the deaths of care home residents as a share of total deaths would be 28.9% (Source: https://covid19.min-saude.pt/wp-content/uploads/2021/01/314_DGS_boletim_20210110.pdf).

Last updated: August 3rd, 2021

Republic of Korea

Data on the numbers of deaths linked to COVID-19  is reported in a regular briefing document provided by the Central Disease Control Headquarters. While the report is released daily, specific data on deaths of people who use Long-Term Care is reported sporadically. The most recent data is from 23rd October 2021.

Of the 2,745 COVID-19 deaths in the whole population by 23rd October 2021, 465 (16.9%) have been attributed to those in long-term care hospitals, while 253 (9.2%) have been attributed to long-term care facilities, or nursing homes. Another 97 (3.5%) deaths were attributed to other community-based LTC providers such as adult day care centres and senior welfare centres.

As for place of death, vast majority of deaths (92.2%) occurred in the hospital inpatient setting. The remaining 4% occurred in the ER, 3.2% at home, and 0.6% other (overseas, in transport, etc.)

In 2019, according to OECD data, there were 210,284. Therefore, 0.12% of this population are estimated to have died from COVID-19. There were 483,433 patients hospitalized in the 1,560 long-term care hospitals in 2018. Therefore, 0.1% of this population would have died from COVID-19.

Last updated: February 20th, 2022   Contributors: Hongsoo Kim  |  

Singapore

In August 2021 there had only been 42 COVID-19 related deaths in Singapore, with a small share of those in care homes. When there was a smaller number of deaths and individual reporting of cases, it was possible to identify deaths of people who lived in care homes. However, since Singapore pivoted to an endemic COVID-19 strategy, once a high (over 80%) vaccination rate had been achieved, the number of deaths has increased rapidly, with many outbreaks in care homes. No separate data is published for care homes (Feng Tan and Feng Tan, 2021).

The Ministry of Health’s dashboard reports that there have been 882 deaths linked to COVID-19 on 11th February 2022.

References:

Feng Tan L. and Feng Tan M. (2021) Pandemic to endemic: New strategies needed to limit the impact of COVID-19 in long-term care facilities. Journal of the American Geriatrics Society.  70(1): 72-73. https://doi.org/10.1111/jgs.17556

Last updated: February 11th, 2022

Slovenia

As of October 31, 2021, there have been 5,149 deaths in total, and 2,997 among the care home population, representing 58% of all deaths (Source: National Institute of Public Health). In 2017, there were 22,904 people living in long-term care institutions in Slovenia. Therefore, the share of residents who would have died linked to COVID-19 would be 13.09% (Source: https://www.stat.si/StatWeb/en/News/Index/8579).

Last updated: December 5th, 2021   Contributors: William Byrd  |  Disha Patel  |  

Spain

The Spanish National Institute of Older People and Social Services (IMSERSO) publishes weekly reports  on deaths linked to COVID-19 in care homes, collecting data from all regions and including care homes for younger people. The data is collected in line with The European Surveillance System (TESSy) of the European Centre for Disease Prevention and Control (ECDC).

Cumulative estimated number of deaths linked to COVID-19 among care home residents:

So far, the total number of deaths linked to COVID-19 among care home residents (until the 6^th of February 2022) is 32,639. The total number of deaths in the whole population (confirmed through testing) is 95,163 up to 9^th February, 2022. Adding the suspected cases among care home residents in the first wave (10,546, see above) would bring this to 105,531. The estimated share of all deaths (confirmed and suspected) linked to COVID-19 who were care home residents in the whole period would be 30.9%. Comparing the number of deaths with the estimated number of residents in 2019, 333,920 (estimate by Envejecimiento en Red) suggests that the number of deaths linked to COVID so far represents 9.77% of the number of care home residents at the beginning of the pandemic.

First wave: difficulties estimating the number of deaths linked to COVID-19

Due to lack of testing at the beginning of the pandemic, there is some uncertainly about the number of people who had a COVID-19 infection and died in that period. IMSERSO estimates that, until 22^nd June 2020, there were 27,411 deaths from all causes among care home residents. Of these, 9,753 had COVID infections confirmed through testing, and 10,546 had symptoms compatible with COVID. So the total number of care home residents who died with either a COVID-19 infection or compatible symptoms (suspected COVID) were 20,299. In the total population, official data shows that, during the same period, the total number of people who died with confirmed COVID infections was 29,692, there is no national estimate of the numbers of people who died with suspected COVID in the population. To estimate the total number of people who died linked to COVID in Spain during the first wave (up to 22^nd June) we can add the number of suspected COVID deaths among care home residents to the total number of official deaths in the population, resulting in an estimate of 40,238 COVID-related deaths. Based on this, the share of COVID deaths that would have been care home residents would be 50.4% in the first wave.

2020: Estimated number of deaths linked to COVID-19 among care home residents

In total in the year 2020 there were 26,335 deaths among care home residents linked to COVID-19 (confirmed and suspected).

2021: Estimated number of deaths linked to COVID-19 among care home residents

During 2021 there were 5,205 deaths of care home residents who had tested positive for COVID-19, of these, 3,686 took place before the 1^st of March, the date when the initial COVID-19 vaccination of care home residents was completed. There were 1,519 deaths in the period post-vaccination until the end of year.

2022 so far: Estimated number of deaths linked to COVID-19 among care home residents

As of the 6^th February there have been 1,099 deaths of care home residents who had tested positive for COVID-19.

Excess mortality among people registered with the public LTC system:

IMSERSO also publishes a monthly report on excess mortality among people registered with the Spanish System for Autonomy and Dependency Support (SAAD). Between March 2020 and December 2021 there 71,539 excess deaths (compared to average in previous five years) among people in the SAAD register (19.7% more than expected), affecting 3.77% of people registered with the system. 78.9% of those whose death is counted as “in excess” were aged 80 and over (56,411 people).

Excess mortality was much higher among people who receive their SAAD benefits through residential care, amounting to 29,435 (11.8% of all recipients), among those receiving benefits for community or home-based care there were 44,977 excess deaths, representing 5.2% of recipients.

Last updated: February 14th, 2022

Sweden

The National Board of Health and Welfare has reported statistics about mortality by COVID-19 as recorded as the underlying cause of death on the death certificates for users of long-term care over the age of 70 since the beginning of 2020. Mortality and cases are reported separately for users of residential facilities and home care, and numbers remain provisional as death certificates are submitted within 3 weeks of the date of death. These figures may underestimate total mortality as they exclude individuals aged 69 and below.

As of April 11, 2022, there have been 16,396 deaths in Sweden from COVID-19. Of these 6,546 (40%) have occurred in residents of care homes. On October 31, 2019, there were 82,217 care home residents in Sweden. Therefore, the total number of COVID-19 related deaths in care home residents represents 7.96% of this population.

As of April 5, 2021, there were 12,598 deaths in Sweden where COVID-19 was mentioned on the death certificate, of which 5,446 (43%) were among care home residents, and 3,277 among people who use care services in their own home (26%). Of the deaths of care home residents, 4,887 happened in the care home (90%). The regional differences at this time were strong in Sweden. In the Stockholm region, 7 % of care home residents had died, while there were hardly any COVID-19 deaths in care homes in several other regions (Sources: https://aldrecentrum.se/wp-content/uploads/2021/02/Johansson-L.-Sch%C3%B6n-P.-2021.-Governmental-response-to-the-COVID-19-pandemic-in-Long-Term-Care-residences.pdf; https://ltccovid.org/wp-content/uploads/2020/07/The-COVID-19-Long-Term-Care-situation-in-Sweden-22-July-2020-1.pdf).

Last updated: May 3rd, 2022   Contributors: William Byrd  |  Disha Patel  |  

Switzerland

Data on COVID-19-related mortality among people living in care homes is only available for a few cantons. In the canton of Geneva where these data are published regularly, and as of January 27, 2021, there have been 674 COVID- related deaths, of which 511 (76%) were care home residents, and 110 of people who received domiciliary care. An estimated 46% (310) of all COVID-19 related deaths happened in care homes, suggesting that 39% of all care home residents who died from COVID-19 did so in hospital. There are an estimated 4,125 care home beds in Geneva. Therefore, the number of COVID-19 related deaths in care homes represents 12.4% of this population (Source: https://www.bfs.admin.ch/bfs/fr/home/statistiques/sante/etat-sante/personnes-agees.assetdetail.15724050.html).

Last updated: October 27th, 2021

Turkey

On September 30, 2020, the Minister of Heath announced that the official figures of COVID-19 refer to the number of COVID-19 ‘patients’ (who have received treatment), whereas COVID-19 ‘cases’ (who tested positive but do not show any symptoms) have not been included in the published data since July 29, 2020. As of October 2, 2020, the total number of patients was 321,512 and 8,325 COVID-19 related deaths have been recorded (Source: https://covid19.saglik.gov.tr/?_Dil=2).

No recent official data on deaths of care home residents has been released by the Ministry. Based on public statements of government officials provided on different platforms, as of May 7, 2020, there have been 1,030 diagnosed COVID-19 cases in care institutions where the resident had been admitted to a hospital and 150 deaths of care home patients. The deaths in nursing homes accounted for 4% of all COVID-19 deaths in Turkey (Source: https://ltccovid.org/wp-content/uploads/2020/06/The-COVID-19-Long-Term-Care-situation-in-Turkey.pdf).

Last updated: August 3rd, 2021

England (UK)

COVID-attributed deaths among care home residents

The Office for National Statistics (ONS) provide weekly updates of deaths registered in England, which include any death where COVID-19 was mentioned on death certificates.

In wave 1 (up to September 2020), ONS  data shows that there were 19,783 registered deaths attributed to COVID-19 among care home residents in England, and 20,388 in wave 2 (from 12 September 2020 to 2 April 2021). Due to constraints in testing during the first wave, the ONS data shows that during wave 1 there around 26,087 more deaths in the period of the first wave compared to the average number of deaths observed on the same dates in the previous five years. In contrast, during the second wave, when care homes had much better access to testing, excess deaths amounted to 1,145. It is important, as ONS point out, to interpret excess deaths with caution, particularly in wave 2, as occupation rates in care homes were lower and the population that survived wave 1 is likely to be younger and healthier.

Between 3rd April 2021 and 14th April 2022, based on data from the ONS, we calculate that there were 4,658 COVID-attributed deaths registered among care home residents in England. This brings the cumulative number of deaths of care home residents registered as attributed to COVID since the beginning of the pandemic to 44,829. This figure does not include deaths that may have been due to COVID but not identified as such (particularly at the beginning of the pandemic when care homes had little access to tests). The total number of registered deaths attributed to COVID-19 in England IS 176,004 (Source: ONS).

According to ONS estimates, between 2019 and 2020 there were 391,027 people living in care homes in England. Therefore, the number of COVID-19 related deaths of care home residents represents 11.25% of the population in care homes when the pandemic started.

In July 2021, the Care Quality Commission published care home level data on deaths notifications involving COVID-19 for the period from April 10, 2020, to March 31, 2021. In total, the Care Quality Commission had been notified of 39,017 deaths in that period that took place in 6,765 care homes.

COVID-attributed deaths among people who use home care

Data on people who use home care is available through the ONS for the period up to 2nd April, by then the deaths of 2,226 people who used home care had been linked to COVID-19.

Deaths linked to COVID-19 among people living with intellectual disabilities

Multiple studies using data sources have reported higher COVID-19 mortality rates among adults with intellectual disabilities in England. An analysis of notifications of deaths of people with intellectual disabilities to the LeDeR programme up to 5 June 2020 reported an estimated COVID-19 mortality rate of 3.6 for adults with intellectual disabilities compared to the general population. The ONS linked primary care record data to death certificate data from 24 January to 20 November 2020, reporting age-standardised mortality hazard ratios for COVID-19 of 3.5 for men with intellectual disabilities and 4.0 for women with intellectual disabilities aged 30+. Controlling for residence type (private household, care home and other communal establishments) reduced these COVID-19 mortality hazard ratios to 2.1 for men and 2.2 for women. A further analysis linking primary care record data (using a less expansive set of codes for intellectual disability than the ONS analysis) to death certifications reported a COVID-19 mortality hazard ratio of 8.2 for adults with intellectual disabilities aged 16+ between 1 March and 31 August 2020; and 7.4 between 1 September 2020 and 8 February 2021 (Williamson et al., 2021).

Deaths linked to COVID-19 among people living with dementia

According to ONS estimates, around half of all COVID-19-attributed deaths among care-home residents in England and Wales between March 2020 and April 2021 (waves 1 and 2), were people who were known to have with dementia.

References:

Williamson, et al, (2021). OpenSAFELY: Risks of COVID-19 hospital admission and death for people with learning disabilities – a cohort study. BMJ doi: https://doi.org/10.1101/2021.03.08.21253112 

Last updated: May 3rd, 2022   Contributors: William Byrd  |  Disha Patel  |  

Northern Ireland (UK)

The Northern Ireland Statistics and Research Agency publish data on deaths, including those where COVID-19 (suspected or confirmed) is mentioned on the death certificate.

As of March 5, 2021, there had been 2,839 COVID-19 related deaths, with 762 of these occurring in care homes (27%). Furthermore, there had been 997 COVID-19 related deaths of care home residents. Therefore as of Wave 2 care home residents accounted for 35% of all COVID-19 related deaths in Northern Ireland.

As of April 15, 2022, there have been 4,519 deaths COVID-19 related deaths of which 1,270 (28%) were care home residents. 968 deaths have occurred within care homes. There are 14,935 care home residents in Northern Ireland. Therefore, the number of COVID-19 related deaths of care home residents represents 8.5% of this population.

Last updated: May 3rd, 2022   Contributors: William Byrd  |  Disha Patel  |  

Scotland (UK)

Since May 25, 2020, the Care Inspectorate Scotland (CIS) has reported weekly data on notifications of deaths of care home residents. Care homes are required to note whether COVID-19 was noted as confirmed or suspected on the death certificate.

As of April 24, 2022, the Scottish Government has reported 14,332 deaths where COVID-19 was mentioned on the death certificate. As of the same date, CIS has reported 4,726 deaths of care residents of suspected or probable COVID-19, accounting for 33% of total deaths. 4,151 deaths were reported to have occurred within care homes. Assuming that the number of adult care home residents has remained stable since 2017 (based on Care Home Census for Scotland, 35,898 adults receiving care in care homes in March 2017) the number of COVID-19 related deaths of care home residents represents 13.17% of this population.

At present, the authors are not aware of any publicly available data to identify if any care home staff died because of COVID-19.

With respect to social care provided at home, the authors are not aware of any data to identify if those receiving or providing care at home have died because of COVID-19.

Deaths linked to COVID-19 among people with learning disabilities:

A nationwide data linkage study in Scotland comparing all COVID-19 confirmed deaths of people with learning disabilities from 24 January to 15 August 2020 with a 5% sample of adults without learning disabilities reported a Standardised Mortality Ratio (SMR) of 3.20. SMRs were particularly high for people with learning disabilities aged 18-54 (SMR 6.62) and 55-64 (SMR 16.16) (Henderson A. et al. 2021).

References: 

Henderson, A. et al. (2021) COVID-19 infection and outcomes in a population-based cohort of 17,173 adults with intellectual disabilities compared with the general population. BMJ doi: https://doi.org/10.1101/2021.02.08.21250525

Last updated: May 3rd, 2022   Contributors: Chris Hatton  |  Disha Patel  |  Jenni Burton  |  David Bell  |  Elizabeth Lemmon  |  David Henderson  |  

Wales (UK)

The Welsh Government publishes data collated by the Care Inspectorate Wales (CIW) at the Local Authority level of the number of notifications of deaths of adult care home residents by cause and location of death.

As of April 8, 2022, data published by the UK Health Security Agency there have been 10,797 deaths with COVID-19 on the death certificate. As of the same date, the CIW reported 2,163 Covid-19 related deaths (both confirmed and suspected) of care home residents in Wales. Therefore, care home resident deaths account for 25.6% of COVID-19 related deaths in Wales. Of these care home resident deaths, 1,477 (68%) occurred within care homes. There are 24,178 care home residents in Wales. Therefore, the number of COVID-19 related deaths of care home residents represents 8.95% of this population.

Data published by the Office of National Statistics showed that as of March 12, 2021, there had been 7,717 COVID-19 related deaths, with 1,650 of these occurring in care homes (21%). As of the same date, according to CIW data, there had been 1,911 COVID-19 related deaths of care home residents. Therefore, care home residents accounted for 25% of all COVID-19 related deaths in Wales at this point during Wave 2. (Source: https://gov.wales/notifications-care-inspectorate-wales).

A nationwide study in Wales compared certified COVID-19 deaths of people with learning disabilities identified through inpatient services and all Welsh resident COVID-19 deaths, from 1 March to 19 November 2020. This reported a Standardised Mortality Ratio (SMR) of 4.60 for people with learning disabilities compared to all Welsh residents; this was particularly high for people aged under 60 (SMR 12.7) (Watkins, 2021).

References:

Watkins, A. (2021). COVID-19-related deaths in Wales amongst People with Learning Disabilities from 1st March to 19th November 2020.  Improvement Cymru

Last updated: May 3rd, 2022   Contributors: William Byrd  |  Chris Hatton  |  Adelina Comas-Herrera  |  Disha Patel  |  

United States

This covers cumulative deaths in US care homes (nursing facilities, assisted living facilities, and other long-term care facilities) from January 1, 2020, through to March 29, 2021. Information about deaths in care homes comes from three sources: the Center for Medicare and Medicaid Services (CMS), the Kaiser Family Foundation (KFF), and the COVID Tracking Project (CTP) produced by The Atlantic Magazine. As of March 7, 2021, COVID Tracking Project has stopped collecting data. We derived COVID-19 mortality estimates by starting with state-level figures, which were reported directly by each of the sources (Sources: https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/; https://www.kff.org/coronavirus-covid-19/issue-brief/state-covid-19-data-and-policy-actions/#long-term-care-cases-deaths; https://covidtracking.com/). We started with state-level figures to address inconsistencies between the three data systems in the number of recorded COVID-19 deaths. Because the sources draw from different sources, their state totals differ. By starting at the state level, we were able to pick the ‘best’ estimate of care home COVID-19 deaths from each state from among the three data systems. To obtain the ‘best’ estimate of care home COVID-19 deaths, we selected the highest number of deaths recorded for each state from among the three sources. The ‘best’ estimate was a cumulative number of 185,269 COVID-19 related deaths in care homes. Based on this data, care home COVID-19 related deaths account for 34% of all COVID-19 related deaths.

The number of residents in care homes was approximated by adding the residents in nursing facilities from the Center for Medicare and Medicaid Services data and the number of residents in assisted living facilities taken from a report by the National Center for Assisted Living, to get 1,937,345. Therefore, the total number of COVID-19 related deaths in care homes represents 9.56% of this population.

Last updated: August 2nd, 2021

Vietnam

There is no publicly available information that provides a breakdown of COVID-19 deaths by population group. We know that the first cases of COVID-19 deaths in Vietnam were elderly members of the population: the first was a 70-year-old man, and the second was a 63-year-old man.  Although there have been relatively few deaths as a result of the pandemic (although the number spiked in late 2021), it could be assumed that the elderly faced higher risks of fatality as compared to other population age groups (Susilowati et al., 2020).

Last updated: January 3rd, 2022   Contributors: Daisy Pharoah  |