Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis

Mohammad Rashidul Hashan; Nicolas Smoll; Catherine King; Hannah Ockenden-Muldoon; Jacina Walker; Andre Wattiaux; Julieanne Graham; Robert Booy; Gulam Khandaker

doi:10.1016/j.eclinm.2021.100771

Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis

EClinicalMedicine. 2021 Mar:33:100771. doi: 10.1016/j.eclinm.2021.100771. Epub 2021 Mar 1.

Authors

Mohammad Rashidul Hashan^{1

2}, Nicolas Smoll², Catherine King^{3

4}, Hannah Ockenden-Muldoon², Jacina Walker², Andre Wattiaux⁵, Julieanne Graham⁶, Robert Booy^{3

4}, Gulam Khandaker^{1

2

4}

Affiliations

¹ Central Queensland University, Rockhampton, Australia.
² Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia.
³ National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia.
⁴ The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁵ Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Gold Coast, Australia.
⁶ Medical Services Team, Central Queensland Hospital and Health Service, Rockhampton, Australia.

Abstract

Background: COVID-19 outbreaks in aged care facilities (ACFs) often have devastating consequences. However, epidemiologically these outbreaks are not well defined. We aimed to define such outbreaks in ACFs by systematically reviewing literature published during the current COVID-19 pandemic.

Methods: We searched 11 bibliographic databases for literature published on COVID-19 in ACFs between December 2019 and September 2020. Original studies reporting extractable epidemiological data as part of outbreak investigations or non-outbreak surveillance of ACFs were included in this systematic review and meta-analysis. PROSPERO registration: CRD42020211424.

Findings: We identified 5,148 publications and selected 49 studies from four continents reporting data on 214,380 residents in 8,502 ACFs with 25,567 confirmed cases of COVID-19. Aged care residents form a distinct vulnerable population with single-facility attack rates of 45% [95% CI 32-58%] and case fatality rates of 23% [95% CI 18-28%]. Of the cases, 31% [95% CI 28-34%] were asymptomatic. The rate of hospitalization amongst residents was 37% [95% CI 35-39%]. Data from 21 outbreaks identified a resident as the index case in 58% of outbreaks and a staff member in 42%. Findings from the included studies were heterogeneous and of low to moderate quality in risk of bias assessment.

Interpretation: The clinical presentation of COVID-19 varies widely in ACFs residents, from asymptomatic to highly serious cases. Preventing the introduction of COVID-19 into ACFs is key, and both residents and staff are a priority group for COVID-19 vaccination. Rapid diagnosis, identification of primary and secondary cases and close contacts plus their isolation and quarantine are of paramount importance.

Funding: Queensland Advancing Clinical Research Fellowship awarded to Prof. Gulam Khandaker by Queensland Health's Health Innovation, Investment and Research Office (HIRO), Office of the Director-General.

Keywords: Aged care facility; Clinical features; Coronavirus disease 2019; Covid-19; Epidemiology; Nursing homes; Outbreak; SARS-CoV-2.