The Epidemiological Analysis of COVID-19 Outbreaks in Nursing Homes during the Period of Omicron Variant Predominance

Jeffrey Che-Hung Tsai; Ying-Ying Chang; Chiann-Yi Hsu; Hui-Ju Chen; Feng-Tse Chan; Zhi-Yuan Shi

doi:10.3390/healthcare11212868

The Epidemiological Analysis of COVID-19 Outbreaks in Nursing Homes during the Period of Omicron Variant Predominance

Healthcare (Basel). 2023 Oct 31;11(21):2868. doi: 10.3390/healthcare11212868.

Authors

Jeffrey Che-Hung Tsai^{1

2

3}, Ying-Ying Chang⁴, Chiann-Yi Hsu⁵, Hui-Ju Chen⁶, Feng-Tse Chan⁴, Zhi-Yuan Shi^{2

3

7

8}

Affiliations

¹ Department of Emergency Medicine, Taichung Veterans General Hospital, Puli Branch, Nantou 545402, Taiwan.
² School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan.
³ College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan.
⁴ Nursing Department, Taichung Veterans General Hospital, Puli Branch, Nantou 545402, Taiwan.
⁵ Biostatistics Group, Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
⁶ Infection Control Team, Taichung Veterans General Hospital, Puli Branch, Nantou 545402, Taiwan.
⁷ Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
⁸ Department of Industrial Engineering & Enterprise Information, Tunghai University, Taichung 407224, Taiwan.

Abstract

Background: The main purpose of this study was to evaluate the epidemic trend and risk factors associated with COVID-19 outbreaks in nursing homes during the period of Omicron variant predominance.

Methods: The study analyzed the risk factors associated with SARS-CoV-2 infection and death among the 327 residents and 129 healthcare workers (HCWs) in three hospital-affiliated nursing homes through a multivariate Cox regression model.

Results: The rates of receiving a COVID-19 booster dose were 70.3% for the residents and 93.0% for the healthcare workers (HCWs), respectively. A number of asymptomatic individuals, including 54 (16.5%) residents and 15 (11.6%) HCWs, were detected through mass screening surveillance tests. The COVID-19 infection rates during the outbreaks were 41.6% among residents and 48.1% among HCWs, respectively. The case fatality rate among residents was 10.3%. None of the HCWs were hospitalized or died. The multivariate Cox regression model showed that the risk of COVID-19 infection increased in males (HR 2.46; 95% CI 1.47-4.11; p = 0.001), Barthel index ≥ 61 (HR 1.93; 95% CI 1.18-3.17; p = 0.009), and dementia (HR 1.61; 95% CI 1.14-2.27; p = 0.007). The risk of COVID-19 death increased with pneumonia (HR 11.03; 95% CI 3.02-40.31; p < 0.001), hospitalization (HR 7.18; 95% CI 1.97-26.25; p = 0.003), and admission to an intensive care unit (HR 8.67; 95% CI 2.79-26.89; p < 0.001).

Conclusions: This study highlighted the high infection rates with a substantial proportion of asymptomatic infections for both residents and HCWs, as well as a high case fatality rate for the residents among nursing homes during the Omicron epidemic period. We suggest implementing mass screening through regular surveillance testing as an effective strategy for early detection of COVID-19 and for preventing transmission during an epidemic period. Pneumonia is the primary risk associated with COVID-19 death. Early detection and prompt treatment of pneumonia for vulnerable residents in nursing homes are crucial to protect them from potential mortality.

Keywords: Barthel index; COVID-19; Omicron; nursing home; outbreak; risk factors.

Grants and funding

PL-2020001/Taichung Veterans General Hospital, Puli Branch