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.
MethodsProspective 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.
ResultsThere 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.
ConclusionThe 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.
The COVID-19 pandemic has precipitated significant challenges to individuals living in Long-Term Care Facilities (LTCFs). Following the declaration of the pandemic by the World Health Organization (WHO) in March 2020, reports emerged of severe outbreaks within LTCFs, particularly affecting the elderly.1-4
Long-term care facilities are environments where frail older individuals predominate, with multiples morbidities. These factors increase the risk of developing severe forms of COVID-19.5-12 Before the advent of vaccines, the lethality in older persons due to COVID-19 was around 14.8%,12 reaching about 50% for older people who needed hospitalization in Intensive Care Units (ICU).5,13 Some studies have assessed the average mortality rate from COVID-19 in the face of an outbreak in LTCF in about 25% to 33% of the total number of older residents infected.7,8
In Brazil, the National Health Surveillance Agency (ANVISA) prepared technical guidelines for measures to reduce the risk of transmission of COVID-19 in health services. It instructed health services to develop clear protocols to reduce the transmissibility of COVID-19, management of hospital clothing, and waste from health services.14
Although the LTCFs are not health units, it was necessary to create specific guidelines for this environment to reduce contagious by COVID-19. Isolation of residents with a suspected or confirmed case for 14 days in individual rooms was recommended and if it was impossible, the resident was should be transferred to an external service for testing and stay until the test result. Positive cases should stay out for 14 days from the first day of symptoms.14-17
The Municipal Health Department (MHD) had previously identified LTCFs with structural or logistic problems to face the pandemic and classified those as highly vulnerable LTCFs. In order to prevent a disaster in the most vulnerable LTCFs to COVID-19, MHD and the Hospital das Clínicas of the Federal University of Minas Gerais (HC-UFMG) created the project entitled ILPI BH project aimed at monitoring and assisting LTCFs. It proposed to quickly identify and block COVID-19 outbreaks in LTCFs, with the key measure being the immediate transfer of LTCFs residents with suspected COVID-19 to a new care environment ‒ Provisional Reception Unit (UAPI) ‒ a non-hospital unit prepared to receive these people.
The objective of the present study was to analyze the results of this pioneering initiative and to understand the factors associated with a higher risk of incidence, hospitalization, and mortality from COVID-19, regarding the characteristics of residents and LTCFs, as well as the implementation of the proposed strategies.
As respiratory viruses are the principal causes of pandemics, this study may contribute to the understanding of the behavior of respiratory virus outbreaks in a LTCF and possible strategies that can facilitate planning for other health emergency situations in the future.
MethodsThis is a prospective cohort study, quantitative in nature. The data was daily extracted from the care records of the geriatrics service of the HC-UFMG, since the team that conducted the study coordinated the care work. The residents of the LTCFs registered in the ILPI BH project were followed from May 2020 to January 2021. HC-UFMG consented to use the data upon signature of the Data Use Agreement (DUA) by all researchers.
To help the LTCFs, which voluntarily joined the program, the geriatrics and gerontology service of the HC UFMG formed five multiprofessional teams composed of two Geriatric physicians, one nurse, and three to four physicians in training in geriatrics. Each team was responsible for monitoring and providing remote assistance to a group of LTCFs, together with the primary care of the Unified Health System (SUS). The first author of this study was one of the geriatricians responsible for the conference of the data collection and registration process and for conducting weekly meetings with the members for operational evaluation of the program and analysis of epidemiological data.
The geriatrics teams remotely organized and evaluated the information of all residents. The technical person in charge of the LTCF was asked to fill out a spreadsheet containing the following data: name, gender, date of birth, taxpayer's number (CPF), coverage (or not) by private health plan, degree of functionality by the Visual Frailty Scale (VFS),18 Degree of Resolution of the Collegiate Board of Directors (RDC) n° 502, of May 27, 2021,19 Clinical-Functional Vulnerability Index (IVCF-20).20 The IVCF-20 and the Visual Frailty Scale are instruments proposed by the Brazilian Ministry of Health.21 In addition, the technical person in charge of the LTCFs had to inform the lists of chronic morbidities and medications in use. The characterization of the study population was made from this information.
The inclusion and exclusion criteria in the study coincide with those of the assistance program:
Inclusion criteria: All residents of LTCFs registered in the ILPI BH project.
Exclusion criteria: Residents of LTCFs who do not participate in the ILPI BH project; persons whose LTCF has not sent the registration sheet.
The research implemented a communication network among the geriatric's teams, LTCFs, and primary care, using videoconferencing tools, e-mail, and an instant messaging application (WhatsApp