Background and importance Older patients living in long term care facilities (LTCFs) were the most vulnerable population during the pandemic caused by SARS-CoV2. It has been estimated that as many as half of all deaths from COVID-19 in Europe occurred in care homes.
Aim and objectives To describe a coordinated programme in response to a COVID-19 outbreak in an LTCF, the clinical and epidemiological characteristics, and the mortality rate.
Material and methods The study was performed from 20 March to 30 June 2020 in a single 264 bed LTCF in Spain. In response to the COVID-19 outbreak, we created a multidisciplinary team to implement a coordinated programme to avoid high risk contagion with 12 interventions: (1) training on infection prevention and control, (2) screening of all staff members for symptoms, (3) communal activities and visit restrictions, (4) locating a clean room for equipment, (5) providing personal protective equipment, (6) resident cohorting, (7) assessment of all residents for symptoms and implementation of communication tools with families, (8) strengthening the workforce, (9) provision of equipment, materials and drugs s with a minimum of supplies, (10) establishment of a consultation circuit with the local hospital, (11) compliance of protocols and (12) laboratory testing.
Demographic, clinical and pharmacological data were retrospectively collected from residents with confirmed SARS-CoV-2 infection: comorbidities, signs and symptoms, outcome (recovery or death), therapy received for COVID-19 and concomitant antibiotic.
Results Of the 231 residents who lived in the LTCF when the first resident with confirmed COVID-19 was tested, 29.4% tested positive for SARS-CoV-2 during the study period, of whom 23.5% died. All cause mortality increased by 228.7% compared with the previous 3 years. Median Charlson comorbidity index, age adjusted was 6 (IQR 4.5–7). A few confirmed cases were hospitalised (26.5%) and most of these residents died in the local hospital (68.7%). Median duration of hospitalisation was 12.5 days (IQR 3.5–19). Most of the cases (72.1%) had symptoms, often typical symptoms (fever, cough or breathlessness). More than half received any experimental treatment for COVID-19 (58.8%). Antibiotics were prescribed in 52.9%, with an increase of 47.2% in consumption compared with the same period in 2019.
Conclusion and relevance We detected considerable mortality associated with COVID-19, highlighting the challenges of the implementation of a coordinated programme to control SARS-CoV2 outbreaks in LCTFs reducing hospital referral rates.
Conflict of interest No conflict of interest