COVID-19 transmission and case fatality in long-term care facilities during the epidemic first wave

Abstract

Institutionalized populations experience a higher risk of several infectious diseases especially in settings with frequent interpersonal close contact and overcrowding. Besides the higher risk of infection, institutionalized people tend to be more vulnerable to its consequences as they are older and present multiple and severe comorbidities. Large proportions of cases and deaths due to COVID-19 occurred in long-term care facilities (LTCF) in several countries: in May 2020, 37–66% of COVID-19 fatal cases occurred in LTCF. In Portugal, by November 2020 about 34% of COVID-19 deaths had occurred in these facilities. The heterogeneity of COVID-19 impact raises the hypotheses of transmission inside LTCF merely reflect the infection dynamics in the surrounding community or COVID-19 more severely affect those institutionalized. Thus, we estimated the cumulative incidence and the case fatality rate of SARS-CoV-2 infection in LTCF, considering age-adjusted comparisons to the general population.