Covid-19: Nursing-home outbreaks linked to high local infection rates

Nursing homes were more likely to suffer a coronavirus outbreak if infections increased locally or if other care homes were located nearby, according to fresh analysis.

A report from the Republic’s health regulator, the Health Information and Quality Authority (Hiqa) and the HSE’s Health Protection Surveillance Centre, found that that residents of nursing homes and other long-term care facilities were “disproportionately” affected by higher death rates from the virus.

The congregated settings and the “high-contact” environment means nursing homes are more vulnerable to residents contracting the disease.

"Older people, particularly those who are frail or medically compromised, are at a higher risk of poor outcomes from Covid-19," said Hiqa's chief scientist Conor Teljeur.

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“Those living in nursing homes have been severely impacted with a disproportionate number of deaths during the early stages of the pandemic,” said Dr Teljeur.

The analysis revealed that the probability of an outbreak in a nursing home increases with rising community incidence around the home, the number of beds within the home and other nursing homes being in close proximity.

Public and private homes were affected the same.

“A high density of homes in an area may point towards a higher level of movement of people between homes, such as visitors, or use of the same companies for services such as cleaning,” the report noted.

Epidemiological analysis found that to the end of June 2020, 14.5 per cent of nursing home residents aged over 65 were infected compared with 0.4 per cent in the general population.

Reported deaths in nursing homes accounted for 56 per cent of all coronavirus-related deaths in the State at that point, compared with 46 per cent of all Covid-19 deaths across 21 countries.

The proportion of residents affected by an outbreak reduced with an increasing number of beds. But the probability of an outbreak was higher in larger nursing homes which had more beds.

Limited analysis

There was a reduced likelihood of an outbreak occurring during the second wave, from August to November, than in the first, from March to August. Outbreaks were smaller in the second. The report does not cover the period of the third wave from December to February.

The report said that analysis was limited “due to the lack of reliable and consistent data across nursing homes”. Reliable data was also unavailable to assess the impact of transfers to and from hospitals, occupancy levels and movement within nursing homes.

Sarah Lennon, executive director of Sage Advocacy, which represents residents, said she was concerned that the report would create a "simplistic interpretation" that outbreaks were caused by high community incidence rates when other factors could not be reliably assessed.

“It is not simple – and we know it is not simple – and we cannot just draw a line that says high community incidence leads to outbreaks in nursing homes,” she said.

“I would be very worried that people took that away from this report and that these other issues aren’t a factor. There are other reasons but we are not able to rely on the data to explain it.”