COVID-19 outbreak in long-term care facilities from Spain. Many lessons to learn

PLoS One. 2020 Oct 27;15(10):e0241030. doi: 10.1371/journal.pone.0241030. eCollection 2020.

Abstract

Background/objectives: To analyze mortality, costs, residents and personnel characteristics, in six long-term care facilities (LTCF) during the outbreak of COVID-19 in Spain.

Design: Epidemiological study.

Setting: Six open LTCFs in Albacete (Spain).

Participants: 198 residents and 190 workers from LTCF A were included, between 2020 March 6 and April 5. Epidemiological data were also collected from six LTCFs of Albacete for the same period of time, including 1,084 residents.

Measurements: Baseline demographic, clinical, functional, cognitive and nutritional variables were collected. 1-month and 3-month mortality was determined, excess mortality was calculated, and costs associated with the pandemics were analyzed.

Results: The pooled mortality rate for the first month and first three months of the outbreak were 15.3% and 28.0%, and the pooled excess mortality for these periods were 564% and 315% respectively. In facility A, the percentage of probable COVID-19 infected residents were 33.6%. Probable infected patients were older, frail, and with a worse functional situation than those without COVID-19. The most common symptoms were fever, cough and dyspnea. 25 residents were transferred to the emergency department, 21 were hospitalized, and 54 were moved to the facility medical unit. Mortality was higher upon male older residents, with worse functionality, and higher comorbidity. During the first month of the outbreak, 65 (24.6%) workers leaved, mainly with COVID-19 symptoms, and 69 new workers were contracted. The mean number of days of leave was 19.2. Costs associated with the COVID-19 in facility A were estimated at € 276,281/month, mostly caused by resident hospitalizations, leaves of workers, staff replacement, and interventions of healthcare professionals.

Conclusion: The COVID-19 pandemic posed residents at high mortality risk, mainly in those older, frail and with worse functional status. Personal and economic costs were high.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • COVID-19
  • Comorbidity
  • Coronavirus Infections / economics
  • Coronavirus Infections / epidemiology*
  • Cost of Illness
  • Cross Infection / economics
  • Cross Infection / epidemiology
  • Frail Elderly
  • Health Facilities / economics
  • Health Facilities / statistics & numerical data*
  • Health Personnel / statistics & numerical data
  • Hospital Mortality
  • Hospitalization / economics
  • Humans
  • Long-Term Care* / economics
  • Male
  • Mortality
  • Occupational Diseases / epidemiology
  • Pandemics* / economics
  • Pneumonia, Viral / economics
  • Pneumonia, Viral / epidemiology*
  • SARS-CoV-2
  • Spain / epidemiology

Grants and funding

We declare that this work was supported by CIBERFES, Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, España. Ayuda cofinanciada por el Fondo Europeo de Desarrollo Regional FEDER. Una Manera de hacer Europa (Grant number CB16/10/00408), Grant received by PA, and by Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, España (Grant number COV20/00004), Grant received by PA. The sponsor did not have any role in the study. There was no additional external funding received for this study.