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

Source avec lien : medRxiv, (Prépublication), 8/1/2020. 10.1101/2020.06.09.20125237

Nous présentons les résultats d’un examen systématique vivant comprenant des études identifiées par des recherches dans les bases de données jusqu’au 26 juin 2020. Nous avons effectué des recherches dans sept bases de données afin d’identifier toutes les études présentant des données primaires sur la mortalité et l’incidence des maladies liées à la COVID-19 chez les utilisateurs et le personnel des établissements de SLD. Nous avons exclu les études qui ne portaient pas sur les SLD. Les études incluses ont fait l’objet d’une évaluation critique et les résultats concernant le nombre de décès et les taux de mortalité liés à la COVID-19, les taux de létalité et les décès excédentaires (résultats coprimaires), ainsi que l’incidence de la maladie, les hospitalisations et les admissions en soins intensifs ont été synthétisés de manière narrative.

We report findings of a living systematic review including studies identified through database searches up to 26 June 2020. We searched seven databases 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. 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. 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.

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