SARS-CoV-2 cases reported from long-term residential facilities (care homes) in South Africa: a retrospective cohort study – BMC Public Health

As of July 31, 2021, 2,324 SARS-CoV-2 cases were reported from 45 LTCFs in eight of South Africa’s nine provinces. Psychiatric institutions reported the most cases (918, 39.5%), followed by retirement homes (420, 18.1%), retirement homes (405, 17.4%), substance abuse shelters (391, 16.8%) and vulnerable health care institutions (190 , 8.2%.

Psychiatric institutions reported cases in 657/1504 (43.8%) of residents and 261/820 1504 (31.8%) of staff; retirement homes reported 269/1504 (17.9%) residents and 151/820 (18.4%) employees infected, substance abuse shelters 241/1504 (16.0%) residents and 150/820 (18.3%) employees infected , retirement homes 214/1504 (14.2%) residents and 191/820 (23.3%) employees infected; and vulnerable care centers 123/1504 (8.2%) residents and 67/820 (8.2%) employees infected (Fig. 1 a).

figure 1

a. Share of SARS-CoV-2 Infected LTCF Residents and Staff by Facility Type, South Africa, March 5, 2020 – July 31, 2021, n= 2324. b. Share of LTCF’s Residents and Staff Infected with SARS-CoV-2 March 5, 2020 – July 31, 2021

Of all SARS-CoV-2 cases of sentinel LTCFs, 1259 (54.2%) were reported during the first wave, 362 (15.6%) during the second wave and 299 (12.9%) during the third wave (Fig. 2

Figure 2
Figure 2

Number of SARS-CoV-2 cases in care homes by epidemiological week, March 5, 2020 – July 31, 2021, South Africa, n= 2324

Transient trend in LTCF SARS-CoV-2 cases in LTCFs

The proportion of cases in the staff decreased during the surveillance period (Fig. 1 b).

Pattern of outbreaks in LTCFs

There were different outbreak patterns among LTCFs: six (13.3%) reported no outbreaks (sporadic cases only), 10 (22.2%) reported one outbreak, and 29 (64.5%) reported more than one outbreak (additional table 1† The six (13.3%) LTCFs reporting sporadic SARS-CoV-2 positive cases included four retirement homes and two retirement homes (Supplementary figure a† 48 (66.7%) minor outbreaks and 24 (33.3%) major outbreaks were reported (Supplementary figure b† The 24 (61.5%) LTCFs reporting major SARS-CoV-2 outbreaks included 8 (33.3%) retirement homes, 6 (25.0%) psychiatric facilities, 5 (20.8%) retirement homes, 4 (16.7%) recovery from drug abuse centers and 1 (4.0%) vulnerable care center (Supplementary figure c† 30 outbreaks were reported in wave 1, 21 in wave 2 and 15 in wave 3, while 6 outbreaks were reported between waves.

Demographic and Clinical Characteristics of SARS-CoV-2 Cases Among LTCF Residents

The median age of COVID-19 cases among residents was 56 years (IQR 38-73) and 812/1504 (54.0%) were male (Table 1† Of the 1,501 (99.8%) residents of whom the race was known, 734 (49.0%) were Black African, 610 (40.6%) White, 101 (6.7%) Colored, and 56 (3.6%) 7%) Indian. Of the 1,473 (97.9%) residents for whom data on comorbidities were available, 274 (18.6%) had comorbidities. Of these, 191 (69.7%) had one comorbid condition, 60 (21.9%) had two comorbid conditions, and 23 (8.3%) had three or more comorbid conditions. The most common comorbid conditions among residents were hypertension (194, 15.2%), diabetes mellitus (64, 4.5%) and chronic heart disease (48, 3.4%). Of the 1,504 SARS-CoV-2 positive residents with outcomes, 1308 (87.0%) recovered, 59 (3.9%) were active cases, and 137 (9.1%) had died, representing a case fatality ratio ( CFR) of 9.1%. The CFR excluding active cases among residents was 137/1445 (9.5%).

Table 1 Characteristics of SARS-CoV-2 Cases Among Residents and Staff in LTCFs, March 5, 2020 – July 31, 2021 (n= 2324)

Demographic and Clinical Characteristics of SARS-CoV-2 Cases Among LTCF Personnel

The median age of staff COVID-19 admissions was 42 years (IQR 35–51) and 705/820 (86.0%) were female (Table 1† Of the 767 (93.5%) employees whose race was known, 640 (83.4%) were Black African, 79 (10.3%) Colored, 8 (1.0%) Indian and 40 (5 .2%) white. Of the 793 (96.7%) employees for whom data on comorbidities was available, 104 (13.1%) had comorbidities. Of these, 82 (78.8%) had one comorbidity, 20 (18.2%) had two, and three (2.9%) had three or more comorbid conditions. The most common comorbid conditions among staff were hypertension 69 (8.7%), diabetes mellitus 28 (3.5%), HIV 15 (1.9%) and asthma 14 (1.8%). Of the 820 SARS-CoV-2 positive employees with outcomes, 762 (92.9%) cases recovered, 54 (6.6%) were active cases, and 4 (0.5%) had died, representing a case fatality ratio. (CFR) of 0.5%. The CFR excluding active cases among staff was 4/766 (0.5%).

Transient trend in SARS-CoV-2 deaths in LTCFs

The number of SARS-CoV-2 deaths and CFR among residents in the different epidemic periods was 22/115 (19.1%) in pre-wave 1; 72/793 (9.1%) during wave 1; 5/60 (8.3%) during post-wave 1; 23/241 (9.5%) during wave 2, 4/18 (22.2%) during post-wave 2 and 16/218 (7.3%) during wave 3. (Fig. 3

Fig. 3
figure 3

Numbers of COVID-19 deaths reported per week among residents and staff, by epidemiological week, South Africa, March 5, 2020 – July 31, 2021, (n= 142)

The SARS-CoV-2 deaths and CFR among staff in the different pandemic periods was 1/91 (1.1%) during pre-wave 1; 2/438 (0.5%) during wave 1; and 1/112 (0.9%). During post-wave 1, post-wave 2 and wave 3, there were no staff deaths.

Among residents, the CFR was 46/252 (18.3%) in retirement homes, 15/112 (13.4%) in vulnerable care centers; 21/389 (10.5%) in villages for the elderly; 47/649 (7.2%) in psychiatric institutions; and 9/232 (3.9%) in substance abuse recovery centers.

Of the four staff members (0.5%) who died, two were female and male. The median age was 48.5 years (IQR 44.5-57.0). One woman had hypertension and diabetes mellitus. The remaining three individuals who died had no reported co-morbidities. Each of the four deaths occurred at a retirement home, a psychiatric facility, a retirement home, and a substance abuse recovery center.

Factors Associated with SARS-CoV-2 Death in Residents

On multivariable analysis, factors associated with SARS-CoV-2 mortality among LTCF residents were age 40-59 years (aOR 2.4, 95% CI 1.0-5.5), 60-79 years (aOR 7.6, 95% CI 3.6-16.5) and ≥ 80 years (aOR 18.2, 95% CI 8.1–41.2) compared to < 40 years; and are residents of an LTCF in the Free State (aOR 4.2, 95% CI 1.4-12.8) or Northern Cape (aOR 3.8, 95% CI 1.2-12.6) compared to Western Cape Cape (table 2† Compared to pre-wave 1, there was a reduced risk of death in wave 1 (aOR 0.3, 95% CI 0.1-0.9), post-wave 1 (aOR 0.2, 95% CI 0.05-0 .8), wave 2 (aOR 0.3, 95% CI 0.1–1.0), post-wave 2 (aOR 0.1, 95% CI 0.02-0.9), and wave 3 (aOR 0.2, 95% CI 0.006–0.6).

Table 2 Multivariable Analysis of Factors Associated with SARS-CoV-2 Mortality Among LTCF Residents, South Africa, March 5, 2020 – July 31, 2021 (n= 1504)

Table 2 Multivariable Analysis of Factors Associated with SARS-CoV-2 Mortality Among LTCF Residents, South Africa, March 5, 2020 – July 31, 2021 (n= 1504).

#SARSCoV2 #cases #reported #longterm #residential #facilities #care #homes #South #Africa #retrospective #cohort #study #BMC #Public #Health

Leave a Comment

Your email address will not be published. Required fields are marked *