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COVID-19 outbreaks in nursing homes in Los Angeles County, March 2020–April 2022

Published online by Cambridge University Press:  07 January 2025

Amanda van Rest Open the ORCID record for Amanda van Rest [Opens in a new window] ,
Anthony Clarke ,
Prabhu Gounder Open the ORCID record for Prabhu Gounder [Opens in a new window] ,
Pingting (Karen) Nie ,
Chandana Das ,
CaSaundra Bush  and
Zachary Rubin
Amanda van Rest*
Affiliation:
Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, USA
Anthony Clarke
Affiliation:
Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, USA
Prabhu Gounder
Affiliation:
Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, USA
Pingting (Karen) Nie
Affiliation:
Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, USA
Chandana Das
Affiliation:
Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, USA
CaSaundra Bush
Affiliation:
Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, USA
Zachary Rubin
Affiliation:
Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, USA
*
Corresponding author: Amanda van Rest; Email: amvrest@gmail.com
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Abstract

Introduction:

Nursing home (NH) residents have an elevated risk of coronavirus disease 2019 (COVID-19) infection and severe outcomes. However, literature regarding outbreak outcomes at the facility level is limited.

Methods:

NH outbreaks beginning between March 1, 2020, and February 22, 2022, at facilities under Los Angeles County jurisdiction were assigned to 1 of 6 time periods defined by dominant variants, surges in community transmission, and vaccination levels. Outbreaks were defined as 1 or more NH resident cases with lab-confirmed COVID-19 infection and no periods of 14 or more days between successive COVID-19 resident cases. Outbreak size and duration were the number of NH resident cases and the number of days between the index case(s) and 14 days after the last resident case(s). Rates of severe outcomes were measured per 100 licensed beds among all outbreaks per time period.

Results:

44,279 cases were analyzed from 1,587 outbreaks. Median outbreak duration peaked during the first winter surge (39 days; time period 3); median outbreak size per 100 licensed beds peaked in time period 6 (17), after widespread vaccination - during the second winter surge. Hospitalizations and deaths per 100 resident cases fell from 31 and 24 prior to widespread vaccination to 11 and 7, respectively, after.

Conclusions:

NH COVID-19 outbreaks may have been affected by vaccine uptake and community transmission levels. Because outbreak size and duration peaked during peak community transmission but severe outcome rates did not, the latter may be preferable to outbreak size and duration as outbreak metrics.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 7
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Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
Copyright
© Los Angeles County Department of Public Health, 2025

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Footnotes

van Rest and Clarke contributed equally to this work.

Current Affiliations: Amanda van Rest: California Emerging Infections Program, Oakland, CA, USA; Anthony Clarke: Health Services Advisory Group, Phoenix, AZ, USA; Prabhu Gounder, Chandana Das, Zachary Rubin: Los Angeles County Department of Public Health, Los Angeles, CA, USA; CaSaundra Bush: Center for Disease Control and Prevention, Atlanta, GA, USA; Pingting (Karen) Nie: My Place Health, Los Angeles, CA, USA

References

Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2021 on CDC WONDER Online Database, released in 2023. Data are from the Multiple Cause of Death Files, 2018-2021, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Available from: http://wonder.cdc.gov/mcd-icd10-expanded.html. Accessed January 25, 2023.Google Scholar
Centers for Disease Control and Prevention. Coronavirus disease, August 15, 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html. Cited by: Chapman S, Harrington C. Policies matter! Factors contributing to nursing home outbreaks during the COVID-19 pandemic. Policy Polit Nurs Pract. 2020;21:191-192.CrossRefGoogle Scholar
Tang, O, Bigelow, BF, Sheikh, F, et al. Outcomes of nursing home COVID-19 patients by initial symptoms and comorbidity: results of universal testing of 1970 residents. J Am Med Dir Assoc 2020;21:1767–1773.e1.CrossRefGoogle ScholarPubMed
Mehta, HB, Li, S, Goodwin, JS. Risk factors associated with SARS-CoV-2 infections, hospitalization, and mortality among US nursing home residents. JAMA Netw Open 2021;4:e216315.CrossRefGoogle ScholarPubMed
Tobolowsky, FA, Bardossy, AC, Currie, DW, et al. Signs, symptoms, and comorbidities associated with onset and prognosis of COVID-19 in a nursing home. J Am Med Dir Assoc 2021;22:498–503.CrossRefGoogle ScholarPubMed
Lee, DS, Ma, S, Chu, A, et al. Predictors of mortality among long-term care residents with SARS-CoV-2 infection. J Am Geriatr Soc 2021;69:3377–3388.CrossRefGoogle ScholarPubMed
Burton, JK, Bayne, G, Evans, C, et al. Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK. Lancet Healthy Longev 2020;1:e21–e31.CrossRefGoogle Scholar
Recker, A, White, EM, Yang, X, et al. Factors affecting SARS-CoV-2 test discordance in skilled nursing facilities. J Am Med Dir Assoc 2022;23:1279–1282.CrossRefGoogle ScholarPubMed
Crèvecoeur, J, Hens, N, Neyens, T, et al. Change in COVID-19 outbreak pattern following vaccination in long-term care facilities in Flanders, Belgium. Vaccine 2022;40:6218–6224.CrossRefGoogle ScholarPubMed
Adams, C, Chamberlain, A, Wang, Y, et al. The role of staff in transmission of SARS-CoV-2 in long-term care facilities. Epidemiology 2022;33:669–677.CrossRefGoogle ScholarPubMed
Chen, R, Kezhekkekara, SG, Kunasekaran, MP, MacIntyre, CR. Universal masking during COVID-19 outbreaks in aged care settings: a systematic review and meta-analysis. Ageing Res Rev 2024;93:102138.CrossRefGoogle ScholarPubMed
Los Angeles County Department of Public Health. Guidelines for preventing & managing COVID-19 in skilled nursing facilities. August 11, 2023. Available from: http://publichealth.lacounty.gov/acd/ncorona2019/healthfacilities/snf/prevention/. Accessed August 25, 2023.Google Scholar
Centers for Disease Control and Prevention. SARS-CoV-2 infection-induced and vaccine-induced immunity. Updated October 29, 2021. Available from: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/vaccine-induced-immunity.html. Accessed March 21, 2023.Google Scholar
Danza, P, Koo, TH, Haddix, M, et al. SARS-CoV-2 infection and hospitalization among adults aged ≥18 years, by vaccination status, before and during SARS-CoV-2 B.1.1.529 (Omicron) variant predominance—Los Angeles County, California, November 7, 2021–January 8, 2022. MMWR Morb Mortal Wkly Rep 2022;71:177–181.CrossRefGoogle ScholarPubMed
Tenforde, MW, Patel, MM, Gaglani, M, et al. Effectiveness of a third dose of Pfizer-BioNTech and Moderna vaccines in preventing COVID-19 hospitalization among immunocompetent and immunocompromised adults—United States, August–December 2021. MMWR Morb Mortal Wkly Rep 2022;71:118–124.CrossRefGoogle ScholarPubMed
Thompson, MG, Natarajan, K, Irving, SA, et al. Effectiveness of a third dose of mRNA vaccines against COVID-19–associated emergency department and urgent care encounters and hospitalizations among adults during periods of Delta and Omicron variant predominance—VISION network, 10 states, August 2021–January 2022. MMWR Morb Mortal Wkly Rep 2022;71:139–145.CrossRefGoogle ScholarPubMed
Johnson, AG, Amin, AB, Ali, AR, et al. COVID-19 incidence and death rates among unvaccinated and fully vaccinated adults with and without booster doses during periods of Delta and Omicron variant emergence—25 U.S. jurisdictions, April 4–December 25, 2021. MMWR Morb Mortal Wkly Rep 2022;71:132–138.CrossRefGoogle Scholar
Silk, BJ, Scobie, HM, Duck, WM, et al. COVID-19 surveillance after expiration of the public health emergency declaration—United States, May 11, 2023. MMWR Morb Mortal Wkly Rep 2023;72:523–528.CrossRefGoogle Scholar
Cronin, CJ, Evans, WN. Nursing home quality, COVID-19 deaths, and excess mortality. J Health Econ 2022;82:102592.CrossRefGoogle ScholarPubMed
Konetzka, RT, White, EM, Pralea, A, Grabowski, DC, Mor, V. A systematic review of long-term care facility characteristics associated with COVID-19 outcomes. J Am Geriatr Soc 2021;69:2766–2777.CrossRefGoogle ScholarPubMed
Khairat, S, Zalla, LC, Adler-Milstein, J, Kistler, CE. U.S. nursing home quality ratings associated with COVID-19 cases and deaths. J Am Med Dir Assoc 2021;22:2021–2025.e1.CrossRefGoogle ScholarPubMed
Li, Y, Temkin-Greener, H, Shan, G, Cai, X. COVID-19 infections and deaths among Connecticut nursing home residents: facility correlates. J Am Geriatr Soc 2020;68:1899–1906.CrossRefGoogle ScholarPubMed
LeRose, JJ, Merlo, C, Duong, P, et al. The role of the social vulnerability index in personal protective equipment shortages, number of cases, and associated mortality during the coronavirus disease 2019 (COVID-19) pandemic in Michigan skilled nursing facilities. Infect Control Hosp Epidemiol 2021;42:877–880.CrossRefGoogle ScholarPubMed