The impact of COVID-19 first wave on long term care facilities of an Italian Province: an historical reference

Abstract

The coronavirus disease 2019 (COVID-19) pandemic will leave a profound imprint in the collective memory of humanity. In Italy, Long-Term Care Facilities (LTCFs) have seen a disproportionally high number of deaths during and the COVID-19 pandemic and, certainly, they may be considered as its epicenter. Aiming to leave a symbolic mark of what the pandemic did in these care settings, we report on an outbreak in a single LTCF where, 53 out of 64 residents, resulted infected. Our narration is based on an epidemiological field investigation together with a calendar of passages through the stages of disease in the infected population. We found an age-gradient in all clinical and epidemiological variables explored such as symptoms onset, illness severity, recovery from symptoms and deaths. According to the disease staging, 26 (49%) were asymptomatic; 9 (17%) had a mild disease; 7 (13%) a moderate stage and 11 (21%) a severe illness severity of whom 10 died. For a more comprehensive description of the impact of the pandemic on LTCFs, we compared the standard mortality ratio (SMR) in the first six months of 2020 to that of 2018 and 2019 in all the 34 facilities of the Vicenza province. Overall, there was a SMR higher 60% than the equivalent period of the previous years. Introduction On December 12, 2019, 27 cases of pneumonia of unknown causes were reported in Wuhan, Hubei Province, China. With the evolving pandemic, the coronavirus disease 2019 (COVID-19) spread rapidly from China around the entire world. Italy was the first European nation to be affected by COVID-19. On January 31, 2020, two Chinese tourists resulted positive at the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) swab test in Rome. An outbreak of 16 confirmed cases, never been travelling from and to China, were then reported in the Veneto and in the Lombardy Regions.1 The number of cases rose rapidly with a geometric progression in the two Regions (Veneto and Lombardy) and through all the country. In response to the growing pandemic of COVID-19, the Italian government imposed a national quarantine, restricting the movement of the population except for necessities such as work and health circumstances. On May 31, the Italian Ministry of Health reported 233,515 confirmed total cases and 33,530 deaths.2 Preliminary studies found that, at a community-level, COVID-19 had a rapid spread and high morbidity and mortality among older adults in Long Term Care Facilities (LTCFs) A retrospective analysis of individual cases data from China, and elsewhere, showed a strong age gradient in the case fatality ratio.3-5 Cardiovascular diseases, hypertension, diabetes mellitus were the comorbidities most frequently associated with COVID-19. All these comorbidities are common among dependent elderly housed in institution and many elderly died by the association between their original comorbidities and the novel virus.6 In the initial emergency, data from LTCFs not only stressed the vulnerability of their patients and residents and this led to national headlines. Major Italian newspapers reported figures and accounts of incredibly high numbers of deaths in residential care settings denouncing lack of guidelines, medical procedures, testing for COVID-19 and supply of personal protective equipment (PPE). The National Institute of Health has done a dedicated survey in the month of April 2020. The responding LTCFs reported a mortality of 8.4% in the month of March. Among the 3859 total deaths, only 133 were officially classified as COVID-19 after appropriate testing though, 1310 had flu and COVID19 related symptoms.7 The National Institute of Health affirmed that these two numbers should be analyzed jointly accounting for the 37.4% of the deaths of the period as COVID-19 related.6 However, the real impact in terms of mortality in LTCFs by COVID-19 is still unknown in Italy. This paper describes the impact of COVID-19 in the LTCFs of the Vicenza Province (Italy). It is structured into two parts: first, it focuses on an outbreak in a single LTCF where over eighty per cent of an LTCF residents resulted positives to COVID-19. The distribution of COVID-19 clinical manifestations and the risk factors associated to different health outcomes have been analyzed. Secondly, an epidemiological analysis of mortality was carried out in all LTCFs of the Vicenza Province using standard epidemiological measures. This paper would like to be a bottle with a message inside for future research on pandemics. Geriatric Care 2021; volume 7:9654 Correspondence: Andrea Tramarin, Primary Health Care, AULSS8, Contrà Lodi 48, 36100 Vicenza, Italy. E-mail: tramarinandrea@gmail.com