COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence

  1. Maximilian Salcher-Konrad
  2. Arnoupe Jhass
  3. Huseyin Naci
  4. Marselia Tan
  5. Yousef El-Tawil
  6. Adelina Comas-Herrera

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Abstract

Background

Policy responses to mitigate the impact of the COVID-19 pandemic on long-term care (LTC) require robust and timely evidence on mortality and spread of the disease in these settings. The aim of this living systematic review is to synthesise early international evidence on mortality rates and incidence of COVID-19 among people who use and provide LTC.

Methods

We report findings of a living systematic review (CRD42020183557), including studies identified through database searches up to 26 June 2020. We searched seven databases (MEDLINE; Embase; CINAHL Plus; Web of Science; Global Health; WHO COVID-19 Research Database; medRxiv) to identify all studies reporting primary data on COVID-19 related mortality and incidence of disease among LTC users and staff. We excluded studies not focusing on LTC. Included studies were critically appraised and results on number of deaths and COVID-19 related mortality rates, case fatality rates, and excess deaths (co-primary outcomes), as well as incidence of disease, hospitalisations, and ICU admissions were synthesised narratively.

Findings

A total of 54 study reports for 49 unique primary studies or outbreak reports were included. Outbreak investigations in LTC facilities found COVID-19 incidence rates of between 0.0% and 71.7% among residents and between 0.4% and 64.0% among staff at affected facilities. Mortality rates varied from 0.0% to 17.1% of all residents at outbreak facilities, with case fatality rates between 0.0% and 33.7%. In included studies of outbreaks, no LTC staff members had died.

Studies of wider LTC populations found that between 0.4% and 40.8% of users, and between 4.0% and 23.8% of staff were infected, although the generalisability of these studies is limited.

There was limited information on the impact of COVID-19 on LTC in the community.

Interpretation

Long-term care users have been particularly vulnerable to the COVID-19 pandemic. However, we found wide variation in spread of disease and mortality rates between outbreaks at individual LTC facilities. Further research into the factors determining successful prevention and containment of COVID-19 outbreaks is needed to protect long-term care users and staff.

Funding

This work was partially conducted as part of the “Strengthening responses to dementia in developing countries” (STRiDE) project, supported by the UK Research and Innovation’s Global Challenges Research Fund (ES/P010938/1). The funders had no role in the design and execution of this study, interpretation of its results, and decision to submit this work to be published.

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  1. Version published to 10.1101/2020.06.09.20125237v3 on medRxiv
  2. Version published to 10.1101/2020.06.09.20125237v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.06.09.20125237: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    13 Search Strategy & Selection Criteria: Potentially eligible studies were identified through systematic searches of seven electronic databases (MEDLINE, Embase, CINAHL plus, Web of Science, Global Health, the World Health Organization’s
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    These limitations highlight the need to establish minimum reporting standards for future studies evaluating COVID-19 related mortality and spread of disease in LTC settings. Limitations: This living review had some limitations. First, we extracted the number of people who contracted COVID-19 as defined by study authors when there was no specific confirmatory diagnostic test mentioned in the study, which may have overestimated the number of people with confirmed COVID-19. Second, we also relied on the definitions used by study authors for deaths due to COVID-19. These sometimes relied on official mortality figures, which share the limitations of the underlying data sources. Third, we report the proportion of long-term care users who were hospitalised due to COVID-19 but this is not necessarily an indicator for severity of disease, as it is likely to partially reflect differences in policies for transferring patients to acute care hospitals. Fourth, we deviated from our protocol due to the unanticipated large volume of research identified in this area. Instead of completing all review steps in double, one reviewer was responsible for study inclusion and data extraction. However, we implemented broad eligibility criteria in order to ensure no relevant studies were missed, and all studies deemed eligible for inclusion were reviewed by the same reviewer to ensure consistency. Conclusions: Long-term care users are particularly vulnerable during the COVID-19 pandemic, facing substan...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • No funding statement was detected.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.06.09.20125237v1 on medRxiv