Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK.
Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK.
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DOI：
10.1016/s2666-7568(20)30012-x
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发表时间：
2020-10
期刊：
影响因子：
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通讯作者：
Guthrie B
中科院分区：
文献类型：
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作者：
Burton JK;Bayne G;Evans C;Garbe F;Gorman D;Honhold N;McCormick D;Othieno R;Stevenson JE;Swietlik S;Templeton KE;Tranter M;Willocks L;Guthrie B
COVID-19在国际上影响了护理院的居民，但有关疫情的详细信息很少。我们的目的是描述苏格兰一个大型卫生区的所有养老院中COVID-19疫情的演变。我们对英国国家卫生服务（NHS）洛锡安卫生区的护理院的检测，病例和死亡进行了人口分析。我们获得了COVID-19检测（鼻咽拭子的严重急性呼吸系统综合征冠状病毒2型[SARS-CoV-2] PCR检测）和死亡（COVID-19相关和非COVID-19相关）的数据，我们通过几个变量分析了数据，包括养老院类型，床位数量和地点。结果指标包括爆发时间、护理院居民中确诊的COVID-19病例数、与爆发相关的护理院特征以及护理院和医院居民的死亡人数。我们计算了超额死亡人数（包括COVID-19相关和非COVID-19相关），我们将其定义为过去5年同期超过历史平均水平的死亡人数总和。2020年3月10日至8月2日期间，189家养老院（5843张床位）的居民在出现症状时接受了COVID-19检测。69家（37%）护理院确认爆发COVID-19疫情，其中66家（96%）为老年人护理院。老年人护理院的规模与COVID-19爆发密切相关（每增加20张床位的比值比为3.35，95%CI为1.99 - 5.63）。在研究期间，记录了907例SARS-CoV-2感染确诊病例，432例COVID-19相关死亡。189家护理院中有5家（3%）发生了229例（25%）COVID-19相关病例和99例（24%）COVID相关死亡，13家（7%）护理院发生了441例（49%）病例和207例（50%）死亡。411例（95%）与COVID-19相关的死亡发生在69家确诊COVID-19爆发的护理院中，19例（4%）死亡发生在医院，2例（<1%）死亡发生在120家未确诊COVID-19爆发的护理院中的一家。在69家确诊COVID-19爆发的护理院中，报告了74例非COVID-19相关死亡病例，而在120家未确诊COVID-19爆发的护理院中观察到10例非COVID-19相关死亡病例。住院护理院居民报告的非COVID-19相关死亡人数比预期少32人。COVID-19对护理院的影响是巨大的，但集中在已知爆发疫情的护理院。我们的研究结果的一个关键含义是，如果COVID-19的社区发病率再次增加，许多养老院居民将受到影响。保护护理院居民免受SARS-CoV-2感染的潜在来源，并确保在感染发生时迅速采取行动以最大限度地减少疫情规模，对于任何第二波都很重要。没有。
COVID-19 has affected care home residents internationally, but detailed information on outbreaks is scarce. We aimed to describe the evolution of outbreaks of COVID-19 in all care homes in one large health region in Scotland. We did a population analysis of testing, cases, and deaths in care homes in the National Health Service (NHS) Lothian health region of the UK. We obtained data for COVID-19 testing (PCR testing of nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) and deaths (COVID-19-related and non-COVID-19-related), and we analysed data by several variables including type of care home, number of beds, and locality. Outcome measures were timing of outbreaks, number of confirmed cases of COVID-19 in care home residents, care home characteristics associated with the presence of an outbreak, and deaths of residents in both care homes and hospitals. We calculated excess deaths (both COVID-19-related and non-COVID-19-related), which we defined as the sum of deaths over and above the historical average in the same period over the past 5 years. Between March 10 and Aug 2, 2020, residents at 189 care homes (5843 beds) were tested for COVID-19 when symptomatic. A COVID-19 outbreak was confirmed at 69 (37%) care homes, of which 66 (96%) were care homes for older people. The size of care homes for older people was strongly associated with a COVID-19 outbreak (odds ratio per 20-bed increase 3·35, 95% CI 1·99–5·63). 907 confirmed cases of SARS-CoV-2 infection were recorded during the study period, and 432 COVID-19-related deaths. 229 (25%) COVID-19-related cases and 99 (24%) COVID-related deaths occurred in five (3%) of 189 care homes, and 441 (49%) cases and 207 (50%) deaths were in 13 (7%) care homes. 411 (95%) COVID-19-related deaths occurred in the 69 care homes with a confirmed COVID-19 outbreak, 19 (4%) deaths were in hospital, and two (<1%) were in one of the 120 care homes without a confirmed COVID-19 outbreak. At the 69 care homes with a confirmed COVID-19 outbreak, 74 excess non-COVID-19-related deaths were reported, whereas ten non-COVID-19-related excess deaths were observed in the 120 care homes without a confirmed COVID-19 outbreak. 32 fewer non-COVID-19-related deaths than expected were reported among care home residents in hospital. The effect of COVID-19 on care homes has been substantial but concentrated in care homes with known outbreaks. A key implication from our findings is that, if community incidence of COVID-19 increases again, many care home residents will be susceptible. Shielding care home residents from potential sources of SARS-CoV-2 infection, and ensuring rapid action to minimise outbreak size if infection is introduced, will be important for any second wave. None.