Impact of the COVID-19 pandemic and corresponding control measures on long-term care facilities : a systematic review and meta-analysis

Abstract

Background: Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks. Objective: To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staff. Method: We conducted a systematic search of six databases for articles published between December 2019 and 5 November 2021, and performed meta-analyses and subgroup analyses to identify the impact of COVID-19 on LTCFs and the association between control measures and infection rate. Results: We included 108 studies from 19 countries. These studies included 1,902,044 residents and 255,498 staff from 81,572 LTCFs, among whom 296,024 residents and 36,807 staff were confirmed SARS-CoV-2 positive. The pooled infection rate was 32.63% (95%CI: 30.29 ∼ 34.96%) for residents, whereas it was 10.33% (95%CI: 9.46 ∼ 11.21%) for staff. In LTCFs that cancelled visits, new patient admissions, communal dining and group activities, and vaccinations, infection rates in residents and staff were lower than the global rate. We reported the residents’ hospitalisation rate to be 29.09% (95%CI: 25.73 ∼ 32.46%), with a case-fatality rate of 22.71% (95%CI: 21.31 ∼ 24.11%) and mortality rate of 15.81% (95%CI: 14.32 ∼ 17.30%). Significant publication biases were observed in the residents’ case-fatality rate and the staff infection rate, but not in the infection, hospitalisation, or mortality rate of residents. Conclusion: SARS-CoV-2 infection rates would be very high among LTCF residents and staff without appropriate control measures. Cancelling visits, communal dining and group activities, restricting new admissions, and increasing vaccination would significantly reduce the infection rates.