Structural and Managerial Risk Factors for COVID-۱۹ Occurrence in French Nursing Homes

Background  Nursing home (NH) residents accounted for half of the deaths during the ۲۰۲۰ spring wave of the coronavirus disease ۲۰۱۹ (COVID-۱۹) epidemic in France. Our objective was to identify structural and managerial factors associated with COVID-۱۹ outbreaks in NHs.Methods  We conducted in July ۲۰۲۰ a retrospective study by questionnaire addressed to NH directors in the Brittany region of France. The questions related to structural characteristics of the establishment, human resources, and crisis management decisions. The primary endpoint was the occurrence of at least one confirmed case of COVID-۱۹ among residents between March ۱, ۲۰۲۰ and May ۳۱, ۲۰۲۰. The secondary endpoint was total mortality during this period. We used multivariate regressions to identify factors associated with these outcomes.Results  Responses were collected from ۲۳۱ NHs hosting ۲۰,۸۸۱ residents, representing a participation rate of ۴۷%. In ۲۴ (۱۰%) NHs, at least one resident presented confirmed COVID-۱۹. NHs often implemented stringent protective measures, with ۶۵% of them choosing to confine residents to their rooms. In multivariate analysis, factors associated with a reduced risk of case occurrence were in-room meal service, early ban of family visits, and daily access to an outdoor space. No association was found between mortality and the factors studied. Our results show an early and strict implementation of lockdown measures, with good epidemiological results in a context of shortage of personal protective equipment (PPE) and non-vaccination. Nevertheless, it raises ethical questions concerning respect of residents’ wellbeing and rights.Conclusion  Cessation of communal dining seems to be the main measure likely to be effective in preventive terms. It does not seem that room lockdown and cessation of group activities should be recommended, particularly if mask wearing is possible.

Keywords:

COVID-۱۹ , Nursing Home , Lockdown , Communal Dining , Personal Protective Equipment , France