Brazilian Journal of Infectious Diseases (May 2024)

Analysis of the fight against the COVID-19 pandemic in long-term care facilities in the pre-vaccination period

  • Jáder Freitas Maciel Garcia de Carvalho,
  • Rodrigo Ribeiro dos Santos,
  • Alcimar Marcelo do Couto,
  • Juliana Santos Neves,
  • Flávia Lanna de Moraes,
  • Cristiana Ceotto Deslandes,
  • Viviane Rodrigues Jardim,
  • Thiara Joanna Peçanha da Cruz Tavares,
  • Raquel Souza Azevedo,
  • Edgar Nunes de Moraes

Journal volume & issue
Vol. 28, no. 3
p. 103748

Abstract

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Introduction: The COVID-19 pandemic has disproportionately affected individuals residing in Long-Term Care Facilities (LTCFs), necessitating tailored strategies to manage outbreaks. This study examines the outcomes of the ILPI BH project, a collaborative effort between the Municipal Health Department and the Hospital das Clínicas of the Federal University of Minas Gerais, designed to mitigate COVID-19 spread within LTCFs. Methods: Prospective cohort of secondary data: 1,794 old residents in 99 long-term care facilities of Belo Horizonte, Brazil, were followed from May 2020 to January 2021. The study analyzed the prevention strategies, residents’ clinical data, and the characteristics of the long-term care facilities, correlating these variables with the number of infections, hospitalizations, and deaths from COVID-19. It checked absolute numbers and rates of incidence, hospitalization, mortality, and lethality. Results: There have been 58 COVID-19 outbreaks in long-term care facilities. There were 399 cases among residents, 96 hospitalizations for COVID-19 and 48 deaths from COVID-19 (2.7 % of the cohort), with a case fatality rate of 12 %. After multivariate analysis, the intrinsic variables to residents associated with higher mortality risk were higher degree of frailty (OR=1.08; p = 0.004) and the fact of living in a long-term care facility with a considerable proportion of residents’ coverage by health plans (OR = 1.01; p = 0.028). Early geriatric follow-up showed an association with a reduction in the number of hospitalizations due to COVID-19. Conclusion: The correct classification of the degree of frailty of institutionalized older people seems to have been relevant for predicting mortality from COVID-19. The extensive assistance by private health plans, contrary to what is supposed, did not result in better health protection. Early geriatric follow-up was beneficial and may be an attractive strategy in the face of health emergencies that affect long-term care facilities to reduce hospital admissions.

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