The Impact of Non-Pharmaceutical Interventions on COVID-19 in Workers and Residents of Nursing Homes in Geneva: A Qualitative Study

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Abstract

To examine the impact of varying levels of non-pharmaceutical interventions (NPIs) on COVID-19 transmission in nursing homes during the first wave of the pandemic. Objective: The primary outcome involved exploring qualitative insights from staff and management regarding the implementation of NPIs. The secondary outcome was the cumulative incidence of PCR-confirmed COVID-19 cases among residents. Incident rate ratios (IRR) were calculated levels of NPI restrictiveness. Methods: We used a mixed-methodology to identify factors that might have affected COVID-19 expansion in nursing homes in the canton of Geneva, Switzerland. For the qualitative component, we interviewed the Attending Physicians and/or Director of each nursing home. In the quantitative component, we calculated incident rate ratios (IRR) for infection between the three levels of COVID-19-related measures taken in these nursing homes, and the cumulative incidence of PCR-confirmed COVID-19 cases in their resident population. The study was conducted in 12 nursing homes located in the canton of Geneva, Switzerland, between March 1, 2020, and June 1, 2020. Results: Most nursing homes mandated NPIs for their staff and residents during the first wave of COVID-19. We found an equal distribution of maximally (n=4), moderately (n=4), and minimally (n=4) restrictive NPIs for nursing home workers and residents. The extent of NPIs implemented did not show to be significantly associated with the cumulative incidence of COVID-19 cases among residents (maximally restrictive IRR = 3.90, 95%CI 0.82-45.54, p = 0.184; moderately restrictive IRR = 3.55, 95%CI 0.75-41.42, p = 0.212 ; minimally restrictive IRR = reference). Conclusion: Nursing homes in our study showed high variability in which NPIs, and to what extent, they implemented with no significant relationship between the restrictiveness of NPIs and COVID-19 incidence among nursing home residents. This suggests that other factors influence the transmission of COVID-19 in these settings. Future research should explore additional determinants and the balance between strict NPIs and the overall well-being of residents.

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