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COVID-19 in Nursing Homes

The numbers of positive cases and deaths in nursing homes from COVID-19 continue to rise in residential facilities across the world.


Nursing Homes and COVID-19 (Spain)

  • At least 10,719 people have died (as of 16 April) with Covid-19 or similar symptoms in nursing homes throughout Spain, representing 50% of total death toll.
  • Precariousness of nursing homes: lack of protective equipment, lack of testing, lack of training.
  • Community of Madrid – Within 1 month period, 5000 older people died in nursing homes (confirmed or suspected Covid-19), compared to 900 deaths in the same period of 2019.

Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility (US)

  • 23 days after first positive test result, 64% of the residents tested positive (57/89).
  • 56% of these were still asymtomatic (27/48), most of them developed symptoms in the next 4 days.
  • From 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit), and 15 had died (mortality, 26%).

Global Spread of COVID-19 (29.04.2020)

Long-Term Care Facilities and the COVID-19 pandemic – WHO

Prevention:

  • Training of staff, implementing rules for hand hygiene and respiratory etiquette, physical distancing, regulating visitors.

Response:

  • Early recognition: assess health status and vital signs (twice daily). Immediate report of cases. Monitor staff (i.e. daily temperature check).
  • Isolation: whenever possible, restrict sharing devices, clean and disinfect.
  • Care: refer to clinical management guidelines for the elderly.
  • Source control: Ensure COVID-19 testing, notify public health authorities, appropriate use of personal protective equipment. Environmental cleaning and disinfection, follow laundry indications.



Key Recommendations - British Geriatric Society


Key recommendations - British Geriatrics Society

  • Standard operating procedures for individual residents with suspected and confirmed COVID-19 infection.
  • Training of staff: measuring vitals, early recognition of symptoms and atypical presentations.
  • Consider whether it is feasible to manage residents entirely within their rooms during the COVID-19 pandemic - safe staffing.
  • Care homes should work with General Practitioners, community healthcare staff and community geriatricians.
  • Care homes should be aware that escalation decisions to hospital will be taken in discussion with paramedics, general practitioners, and other healthcare support staff.

Important

  • Early identification of affected individuals and how to respond – Isolation and using personal protective equipment.
  • Advanced care planning and escalation to hospital.
  • Supporting residents and staff.