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Original article

Vol. 153 No. 3 (2023)

COVID-19 burden and influencing factors in Swiss long-term-care facilities: a cross-sectional analysis of a multicentre observational cohort

  • Giulia Scanferla
  • Delphine Héquet
  • Nicole Graf
  • Thomas Münzer
  • Simone Kessler
  • Philipp Kohler
  • Andres Nussbaumer
  • Christiane Petignat
  • Matthias Schlegel
  • Domenica Flury
DOI
https://doi.org/10.57187/smw.2023.40052
Cite this as:
Swiss Med Wkly. 2023;153:40052
Published
31.03.2023

Summary

OBJECTIVES: To describe the burden of COVID-19 in Swiss long-term care facilities in 2020, to identify its influencing factors, and to assess vaccination rates among residents and healthcare workers at the end of the vaccine campaign in Switzerland in May 2021.

DESIGN: Cross-sectional survey.

SETTING AND PARTICIPANTS: Long-term care facilities from two Swiss cantons (St. Gallen / Eastern Switzerland and Vaud / Western Switzerland).

METHODS: We collected numbers of COVID-19 cases and related deaths and all-cause mortality for 2020, potential risk factors at the institutional level (e.g. size, infection prevention and control measures, and resident characteristics), and vaccination rates among residents and healthcare workers. Univariate and multivariate analyses were used to identify factors associated with resident mortality in 2020.

RESULTS: We enrolled 59 long-term care facilities with a median of 46 (interquartile range [IQR]: 33–69) occupied beds. In 2020, the median COVID-19 incidence was 40.2 (IQR: 0–108.6) per 100 occupied beds, with higher rates in VD (49.9%) than in SG (32.5%; p = 0.037). Overall, 22.7% of COVID-19 cases died, of which 24.8% were COVID-19-related deaths. In the univariate analysis, higher resident mortality was associated with COVID-19 rates among residents (p < 0.001) and healthcare workers (p = 0.002) and age (p = 0.013). Lower resident mortality was associated with the proportion of single rooms (p = 0.012), isolation of residents with COVID-19 in single rooms (p = 0.003), symptom screening of healthcare workers (p = 0.031), limiting the number of visits per day (p = 0.004), and pre-scheduling visits (p = 0.037). In the multivariate analysis, higher resident mortality was only associated with age (p = 0.03) and the COVID-19 rate among residents (p = 0.013). Among 2936 residents, 2042 (69.9%) received ≥1 dose of the COVID-19 vaccine before 31 May 2021. Vaccine uptake among healthcare workers was 33.8%.

CONCLUSION AND IMPLICATIONS: COVID-19 burden was high but also highly variable in Swiss long-term care facilities. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers was a modifiable factor associated with increased resident mortality. Symptom screening of healthcare workers appeared to be an effective preventive strategy and should be included in routine infection prevention and control measures. Promoting COVID-19 vaccine uptake among healthcare workers should be a priority in Swiss long-term care facilities.

References

  1. Danis K , Fonteneau L , Georges S , Daniau C , Bernard-Stoecklin S , Domegan L , et al.; ECDC Public Health Emergency Team . High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020. Euro Surveill. 2020 Jun;25(22):2000956. https://doi.org/10.2807/1560-7917.ES.2020.25.22.2000956 DOI: https://doi.org/10.2807/1560-7917.ES.2020.25.22.2000956
  2. Comas-Herrera A , Zalakaín J , Lemmon E , et al. Mortality associated with COVID-19 in care homes: international evidence. Published online February 1, 2021. Available at: https://ltccovid.org/wp-content/uploads/2021/02/LTC_COVID_19_international_report_January-1-February-1-2.pdf
  3. European Centre for Disease Prevention and Control (ECDC) . COVID-19 clusters and outbreaks in occupational settings in the EU/EEA and the UK. Stockholm: ECDC, 2020. Available at: https://www.ecdc.europa.eu/en/publications-data/covid-19-clusters-and-outbreaks-occupational-settings-eueea-and-uk
  4. Bundesamt für Gesundheit BAG. Bericht Todesfälle Im Zusammenhang Mit Covid-19 in Der Schweiz Und Im Internationalen Vergleich.; 2021. Available at: https://www.bag.admin.ch/dam/bag/de/dokumente/mt/k-und-i/aktuelle-ausbrueche-pandemien/2019-nCoV/bericht-todesfaelle-februar-2021.pdf
  5. Robalo Nunes T , Lebowitz D , Fraccaro M , et al. Can long-term care facilities remain a coronavirus disease 2019 (COVID-19)-free bubble? An outbreak report. Infect Control Hosp Epidemiol. Published online January 11, 2021:1-2. doi:https://doi.org/10.1017/ice.2020.1432 DOI: https://doi.org/10.1017/ice.2020.1432
  6. Shallcross L , Burke D , Abbott O , Donaldson A , Hallatt G , Hayward A , et al. Factors associated with SARS-CoV-2 infection and outbreaks in long-term care facilities in England: a national cross-sectional survey. Lancet Healthy Longev. 2021 Mar;2(3):e129–42. https://doi.org/10.1016/S2666-7568(20)30065-9 DOI: https://doi.org/10.1016/S2666-7568(20)30065-9
  7. Bundesamt für Gesundheit BAG. Situationsbericht Zur Epidemiologischen Lage in Der Schweiz Und Im Fürstentum Liechtenstein - Woche 51 (14.12.-20.12.2020).; 2020. Available at: https://www.bag.admin.ch/bag/de/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/situation-schweiz-und-international.html
  8. REDCap . Accessed November 2, 2021. Available at: https://www.project-redcap.org
  9. Bundesamt für Gesundheit BAG. Kennzahlen der Schweizer Pflegeheime. Available at: https://www.bag.admin.ch/bag/de/home/zahlen-und-statistiken/zahlen-fakten-zu-pflegeheimen/pflegeheim-suchen.html. Accessed November 8, 2021.
  10. Locatelli I , Rousson V . A first analysis of excess mortality in Switzerland in 2020. Picone GA, ed. PLoS ONE. 2021;16(6):e0253505. doi:https://doi.org/10.1371/journal.pone.0253505 DOI: https://doi.org/10.1371/journal.pone.0253505
  11. Suñer C , Ouchi D , Mas MÀ , Lopez Alarcon R , Massot Mesquida M , Prat N , et al. A retrospective cohort study of risk factors for mortality among nursing homes exposed to COVID-19 in Spain. Nat Aging. 2021;1(7):579–84. https://doi.org/10.1038/s43587-021-00079-7 DOI: https://doi.org/10.1038/s43587-021-00079-7
  12. Sepulveda ER , Stall NM , Sinha SK . A Comparison of COVID-19 Mortality Rates Among Long-Term Care Residents in 12 OECD Countries. J Am Med Dir Assoc. 2020 Nov;21(11):1572–1574.e3. https://doi.org/10.1016/j.jamda.2020.08.039 DOI: https://doi.org/10.1016/j.jamda.2020.08.039
  13. Fisman DN , Bogoch I , Lapointe-Shaw L , McCready J , Tuite AR . Risk Factors Associated With Mortality Among Residents With Coronavirus Disease 2019 (COVID-19) in Long-term Care Facilities in Ontario, Canada. JAMA Netw Open. 2020 Jul;3(7):e2015957. https://doi.org/10.1001/jamanetworkopen.2020.15957 DOI: https://doi.org/10.1001/jamanetworkopen.2020.15957
  14. Arnedo-Pena A , Romeu-Garcia MA , Gascó-Laborda JC , Meseguer-Ferrer N , Safont-Adsuara L , Prades-Vila L , et al. Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes. Epidemiologia (Basel). 2022 Mar;3(2):179–90. https://doi.org/10.3390/epidemiologia3020014 DOI: https://doi.org/10.3390/epidemiologia3020014
  15. Wisniak A , Menon LK , Dumont R , Pullen N , Regard S , Dubos R , et al.; The SEROCoV-Work Study Group . Association between SARS-CoV-2 Seroprevalence in Nursing Home Staff and Resident COVID-19 Cases and Mortality: A Cross-Sectional Study. Viruses. 2021 Dec;14(1):43. https://doi.org/10.3390/v14010043 DOI: https://doi.org/10.3390/v14010043
  16. Abbas M , Robalo Nunes T , Martischang R , Zingg W , Iten A , Pittet D , et al. Nosocomial transmission and outbreaks of coronavirus disease 2019: the need to protect both patients and healthcare workers. Antimicrob Resist Infect Control. 2021 Jan;10(1):7. https://doi.org/10.1186/s13756-020-00875-7 DOI: https://doi.org/10.1186/s13756-020-00875-7
  17. Dykgraaf SH , Matenge S , Desborough J , Sturgiss E , Dut G , Roberts L , et al. Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence. J Am Med Dir Assoc. 2021 Oct;22(10):1969–88. https://doi.org/10.1016/j.jamda.2021.07.027 DOI: https://doi.org/10.1016/j.jamda.2021.07.027
  18. Arons MM , Hatfield KM , Reddy SC , Kimball A , James A , Jacobs JR , et al.; Public Health–Seattle and King County and CDC COVID-19 Investigation Team . Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility. N Engl J Med. 2020 May;382(22):2081–90. https://doi.org/10.1056/NEJMoa2008457 DOI: https://doi.org/10.1056/NEJMoa2008457
  19. Borras-Bermejo B , Martínez-Gómez X , San Miguel MG , Esperalba J , Antón A , Martin E , et al. Asymptomatic SARS-CoV-2 Infection in Nursing Homes, Barcelona, Spain, April 2020. Emerg Infect Dis. 2020 Sep;26(9):2281–3. https://doi.org/10.3201/eid2609.202603 DOI: https://doi.org/10.3201/eid2609.202603
  20. Kimball A , Hatfield KM , Arons M , James A , Taylor J , Spicer K , et al.; Public Health – Seattle & King County; CDC COVID-19 Investigation Team . Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr;69(13):377–81. https://doi.org/10.15585/mmwr.mm6913e1 DOI: https://doi.org/10.15585/mmwr.mm6913e1
  21. Patel MC , Chaisson LH , Borgetti S , Burdsall D , Chugh RK , Hoff CR , et al. Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility. Clin Infect Dis. 2020 Dec;71(11):2920–6. https://doi.org/10.1093/cid/ciaa763 DOI: https://doi.org/10.1093/cid/ciaa763
  22. Mossad SB , Deshpande A , Schramm S , Liu X , Rothberg MB . Working Despite Having Influenza-Like Illness: Results of An Anonymous Survey of Healthcare Providers Who Care for Transplant Recipients. Infect Control Hosp Epidemiol. 2017 Aug;38(8):966–9. https://doi.org/10.1017/ice.2017.91 DOI: https://doi.org/10.1017/ice.2017.91
  23. Tartari E , Saris K , Kenters N , et al. Not sick enough to worry? “Influenza-like” symptoms and work-related behavior among healthcare workers and other professionals: Results of a global survey. Katz M, ed. PLoS ONE. 2020;15(5):e0232168. doi:https://doi.org/10.1371/journal.pone.0232168 DOI: https://doi.org/10.1371/journal.pone.0232168
  24. Bergwerk M , Gonen T , Lustig Y , et al. Covid-19 Breakthrough Infections in Vaccinated Health Care Workers. N Engl J Med. Published online July 28, 2021:NEJMoa2109072. doi:https://doi.org/10.1056/NEJMoa2109072 DOI: https://doi.org/10.1056/NEJMoa2109072
  25. Hugelius K , Harada N , Marutani M . Consequences of visiting restrictions during the COVID-19 pandemic: an integrative review. Int J Nurs Stud. 2021 Sep;121:104000. https://doi.org/10.1016/j.ijnurstu.2021.104000 DOI: https://doi.org/10.1016/j.ijnurstu.2021.104000
  26. Verbeek H , Gerritsen DL , Backhaus R , de Boer BS , Koopmans RT , Hamers JP . Allowing Visitors Back in the Nursing Home During the COVID-19 Crisis: A Dutch National Study Into First Experiences and Impact on Well-Being. J Am Med Dir Assoc. 2020 Jul;21(7):900–4. https://doi.org/10.1016/j.jamda.2020.06.020 DOI: https://doi.org/10.1016/j.jamda.2020.06.020
  27. Brown KA , Jones A , Daneman N , Chan AK , Schwartz KL , Garber GE , et al. Association Between Nursing Home Crowding and COVID-19 Infection and Mortality in Ontario, Canada. JAMA Intern Med. 2021 Feb;181(2):229–36. https://doi.org/10.1001/jamainternmed.2020.6466 DOI: https://doi.org/10.1001/jamainternmed.2020.6466
  28. Zürcher K , Mugglin C , Egger M , Müller S , Fluri M , Bolick L , et al. Vaccination willingness for COVID-19 among healthcare workers: a cross-sectional survey in a Swiss canton. Swiss Med Wkly. 2021 Sep;151(37-38):w30061. https://doi.org/10.4414/SMW.2021.w30061 DOI: https://doi.org/10.4414/SMW.2021.w30061
  29. European Centre for Disease Prevention and Control (ECDC) . COVID-19 Vaccine Tracker. Available at: https://vaccinetracker.ecdc.europa.eu/public/extensions/COVID-19/vaccine-tracker.html#uptake-tab. Accessed November 3, 2021.
  30. Shrotri M , Krutikov M , Palmer T , Giddings R , Azmi B , Subbarao S , et al. Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of long-term care facilities in England (VIVALDI): a prospective cohort study. Lancet Infect Dis. 2021 Nov;21(11):1529–38. https://doi.org/10.1016/S1473-3099(21)00289-9 DOI: https://doi.org/10.1016/S1473-3099(21)00289-9
  31. Teran RA , Walblay KA , Shane EL , Xydis S , Gretsch S , Gagner A , et al. Postvaccination SARS-CoV-2 Infections Among Skilled Nursing Facility Residents and Staff Members - Chicago, Illinois, December 2020-March 2021. MMWR Morb Mortal Wkly Rep. 2021 Apr;70(17):632–8. https://doi.org/10.15585/mmwr.mm7017e1 DOI: https://doi.org/10.15585/mmwr.mm7017e1
  32. Lange B , Gerigk M , Tenenbaum T . Breakthrough Infections in BNT162b2-Vaccinated Health Care Workers. N Engl J Med. 2021 Sep;385(12):1145–6. https://doi.org/10.1056/NEJMc2108076 DOI: https://doi.org/10.1056/NEJMc2108076

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