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Risk and Mortality Among Residents With COVID-19 in Long-Term Care Facilities
Quick Takes
- There was rapid spread of COVID-19 through Ontario’s long-term care (LTC) system, with a marked increase in risk of death among older residents with frailty during the pandemic.
- Overall, the incidence of mortality was more than 13 times greater among LTC residents than that seen in community-living adults >69 years during a similar period.
- There is a need for improved infection control measures, widespread testing, better access to PPE, and additional support to protect the at-risk LTC population.
Study Questions:
What are the trends and risk factors associated with coronavirus disease 2019 (COVID-19) death in long-term care (LTC) facilities in Ontario, Canada?
Methods:
The investigators conducted a cohort study of 627 LTC facilities and included 269 total individuals who died of COVID-19 in Ontario to April 11, 2020, and 83 individuals who died of COVID-19 in Ontario LTC facilities to April 7, 2020. Because population denominators were not available for LTC residents, they were approximated as the total number of LTC facility beds in Ontario (79,498), assuming complete occupancy. Data on confirmed or suspected COVID-19 outbreaks, confirmed COVID-19 infection among residents and staff, diagnosed by real-time polymerase chain reaction testing were collected. COVID-19–specific mortality incidence rate ratios (IRRs) for LTC residents were calculated with community-living Ontarians aged >69 years as the comparator group. Count-based regression methods were used to model temporal trends and to identify associations of infection risk among staff and residents with subsequent LTC resident death. Model-derived IRRs for COVID-19–specific mortality were generated through bootstrap resampling (1,000 replicates) to generate median and 95% credible intervals for IRR over time.
Results:
Of 627 LTC facilities, 272 (43.4%) reported COVID-19 infection in residents or staff. Of 1,731,315 total individuals aged >69 years living in Ontario during the study period, 229 (<0.1%) died; of 79,498 potential residents in LTC facilities, 83 (0.1%) died. The IRR for COVID-19–related death in LTC residents was 13.1 (95% confidence interval [CI], 9.9-17.3) compared with community-living adults aged >69 years. The IRR increased sharply over time and was 87.3 (95% credible interval, 6.4-769.8) by April 11, 2020. Infection among LTC staff was associated with death among residents with a 6-day lag (e.g., adjusted IRR for death per infected staff member, 1.17; 95% CI, 1.11-1.26).
Conclusions:
The authors concluded that in this cohort study of COVID-19–related deaths during the pandemic in Ontario, Canada, mortality risk was concentrated in LTC residents and increased during a short period.
Perspective:
This cohort study documents the rapid spread of COVID-19 through Ontario’s LTC system, with a marked increase in risk of death among older residents with frailty during the pandemic. Issues such as crowding, use of communal space, low staffing ratios, and high care needs with high density of physical contact between residents and staff likely contributed to the increased susceptibility and outbreak in the LTC facility setting. Overall, the incidence of mortality was more than 13 times greater among LTC residents than that seen in community-living adults aged >69 years during a similar period. These data underscore the need for improved infection control measures, widespread testing, better access to personal protective equipment (PPE), and additional support to protect this at-risk population.
Clinical Topics: COVID-19 Hub, Geriatric Cardiology, Prevention
Keywords: Coronavirus, COVID-19, Frail Elderly, Geriatrics, Infection Control, Long-Term Care, Personal Protective Equipment, Primary Prevention, Real-Time Polymerase Chain Reaction, Risk Factors, severe acute respiratory syndrome coronavirus 2
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