scholarly journals Low-Impact Social Distancing Interventions to Mitigate Local Epidemics of SARS-CoV-2

2020 ◽  
Author(s):  
Michael L. Jackson
Keyword(s):  
Nursing Home ◽  
Hospital Admissions ◽  
Herd Immunity ◽  
Nursing Home Residents ◽  
King County ◽  
Rapid Testing ◽  
School Closures ◽  
Agent Based ◽  
Social Distancing ◽  
Hospital Occupancy

AbstractBackgroundAfter many jurisdictions have implemented intensive social distancing to suppress SARS-CoV-2 transmission, the challenge now is to mitigate the ongoing COVID-19 epidemic without overburdening economic and social activities. This report explores “low-impact” interventions to mitigate SARS-CoV-2 with a minimum of social and economic disruption.MethodsAn agent-based model simulated the population of King County, Washington, with agents that interact in homes, schools, workplaces, and other community sites. SARS-CoV-2 transmission probabilities were estimated by fitting simulated to observed hospital admissions from February – May 2020. Interventions considered were (a) encouraging telecommuting; (b) reducing contacts to seniors and nursing home residents; (c) modest reductions to contacts outside of the home; (d) encouraging self-isolation of persons with COVID-19 symptoms; (e) rapid testing and household quarantining.ResultsIndividual interventions are not expected to have a large impact on COVID-19 hospitalizations. No intervention reduced COVID-19 hospitalizations by more than 12.7% (95% confidence interval [CI], 12.0% to 13.3%). Removing all interventions would result in nearly 42,000 COVID- 19 hospitalizations between June 2020 and January 2021, with peak hospital occupancy exceeding available beds 6-fold. Combining the interventions is predicted to reduce total hospitalizations by 48% (95% CI, 47-49%), with peak COVID-19 hospital occupancy of 70% of total beds. Targeted school closures can further reduce the peak occupancy.ConclusionsCombining low-impact interventions may mitigate the course of the COVID-19 epidemic, keeping hospital burden within the capacity of the healthcare system. Under this approach SARS-CoV-2 can spread through the community, moving toward herd immunity, while minimizing social and economic disruption.

scholarly journals 299 A Retrospective Review of Unscheduled Hospital Admissions of Nursing Home Residents Over a Two Year Period

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Aoife McFeely ◽  
Cliona Small ◽  
Susie Hyland ◽  
Jonathan O'Keeffe ◽  
Graham Hughes ◽  
...  
Keyword(s):  
Nursing Home ◽  
Older People ◽  
Hospital Admissions ◽  
Nursing Home Residents ◽  
Integrated Approach ◽  
Care Team ◽  
Similar Data ◽  
Readmission Rates ◽  
Increased Risk ◽  
One Year

Abstract Background Older people living in Nursing Homes (NHs) represent a frail and vulnerable group. With multiple co-morbidities they are at increased risk of acute health deterioration prompting urgent hospital transfer. Our aim was to examine the outcomes for nursing home residents following unscheduled hospital attendances. Methods A prospective database was collected between 1 January 2016 and 31 December 2017. This recorded all emergency admissions of older people from NHs. The data was retrospectively analysed. Outcomes assessed included: length of stay (LOS), 30-day readmission rates, number of readmissions within one year and mortality. We compared these results to similar data collected in 2012-13. Results Over a two-year period, there were 1435 hospital admissions; a 7% increase from 1015 in 2012. 60% were female and 40% male with a mean age of 84.7 years. The average LOS was 9.58 days (vs 11.2 days in 2012-13). The 30-day readmission rate was 9.8% (vs 14% in 2012-13). 30.45% of all patients went on to have 2 or more readmissions within one year, an increase from 21.1% in 2012-13. The total in-hospital mortality was 14%. Conclusion An increase in the number of NH residents presenting to an acute hospital over the past 5 years was observed. Despite this, we have seen reductions in average LOS and 30 day readmission rates. There is, however, an increasing number of recurrent admissions (≥ 2) to the hospital within one year. These results highlight the importance of an integrated approach to patient care; from the primary care team, hospital team, palliative and community care services. We believe the continued development of Nursing Home Outreach Programmes and community liaison services, combined with the evolving role of the in-hospital Geriatric ANP and liaison palliative care team, will help reduce inappropriate ED referrals and encourage advanced care planning.

scholarly journals Paramedics’ Perspectives on the Hospital Transfers of Nursing Home Residents—A Qualitative Focus Group Study

2020 ◽  
Vol 17 (11) ◽  
pp. 3778
Author(s):  
Alexandra Pulst ◽  
Alexander Maximilian Fassmer ◽  
Falk Hoffmann ◽  
Guido Schmiemann
Keyword(s):  
Nursing Home ◽  
Nursing Staff ◽  
Hospital Admissions ◽  
Urinary Catheter ◽  
Nursing Home Residents ◽  
Point Of View ◽  
Focus Group Study ◽  
Professional Groups ◽  
Catheter Complications ◽  
Ed Visits

Emergency department (ED) visits and hospital admissions are common among nursing home residents (NHRs). Little is known about the perspectives of emergency medical services (EMS) which are responsible for hospital transports. The aim of this study was to explore paramedics’ experiences with transfers from nursing homes (NHs) and their ideas for possible interventions that can reduce transfers. We conducted three focus groups following a semi-structured question guide. The data were analyzed by content analysis using the software MAXQDA. In total, 18 paramedics (mean age: 33 years, male n = 14) participated in the study. Paramedics are faced with complex issues when transporting NHRs to hospital. They mainly reported on structural reasons (e.g., understaffing or lacking availability of physicians), which led to the initiation of an emergency call. Handovers were perceived as poorly organized because required transfer information (e.g., medication lists, advance directives (ADs)) were incomplete or nursing staff was insufficiently prepared. Hospital transfers were considered as (potentially) avoidable in case of urinary catheter complications, exsiccosis/infections and falls. Legal uncertainties among all involved professional groups (nurses, physicians, dispatchers, and paramedics) seemed to be a relevant trigger for hospital transfers. In paramedics’ point of view, emergency standards in NHs, trainings for nursing staff, the improvement of working conditions and legal conditions can reduce potentially avoidable hospital transfers from NHs.

scholarly journals Modelling transmission and control of the COVID-19 pandemic in Australia

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Sheryl L. Chang ◽  
Nathan Harding ◽  
Cameron Zachreson ◽  
Oliver M. Cliff ◽  
Mikhail Prokopenko
Keyword(s):  
Computational Simulation ◽  
International Travel ◽  
School Closures ◽  
Agent Based ◽  
Social Distancing ◽  
Fine Grained ◽  
Trade Offs ◽  
Travel Restrictions ◽  
High Level ◽  
And Control

Abstract There is a continuing debate on relative benefits of various mitigation and suppression strategies aimed to control the spread of COVID-19. Here we report the results of agent-based modelling using a fine-grained computational simulation of the ongoing COVID-19 pandemic in Australia. This model is calibrated to match key characteristics of COVID-19 transmission. An important calibration outcome is the age-dependent fraction of symptomatic cases, with this fraction for children found to be one-fifth of such fraction for adults. We apply the model to compare several intervention strategies, including restrictions on international air travel, case isolation, home quarantine, social distancing with varying levels of compliance, and school closures. School closures are not found to bring decisive benefits unless coupled with high level of social distancing compliance. We report several trade-offs, and an important transition across the levels of social distancing compliance, in the range between 70% and 80% levels, with compliance at the 90% level found to control the disease within 13–14 weeks, when coupled with effective case isolation and international travel restrictions.

scholarly journals Modeling the Spread and Control of COVID-19

Systems ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 53
Author(s):  
Ashutosh Trivedi ◽  
Nanda Kishore Sreenivas ◽  
Shrisha Rao
Keyword(s):  
Herd Immunity ◽  
Black Box ◽  
Personal Hygiene ◽  
Confined Space ◽  
Real Situation ◽  
Seir Model ◽  
Agent Based ◽  
Social Distancing ◽  
The Difference ◽  
And Control

Data-centric models of COVID-19 have been attempted, but have certain limitations. In this work, we propose an agent-based model of the epidemic in a confined space of agents representing humans. An extension to the SEIR model allows us to consider the difference between the appearance (black-box view) of the spread of disease and the real situation (glass-box view). Our model allows for simulations of lockdowns, social distancing, personal hygiene, quarantine, and hospitalization, with further considerations of different parameters, such as the extent to which hygiene and social distancing are observed in a population. Our results provide qualitative indications of the effects of various policies and parameters, for instance, that lockdowns by themselves are extremely unlikely to bring an end to an epidemic and may indeed make things worse, that social distancing is more important than personal hygiene, and that the growth of infection is significantly reduced for moderately high levels of social distancing and hygiene, even in the absence of herd immunity.

scholarly journals Antibiotic Prescribing Choices and Their Comparative C. Difficile Infection Risks: A Longitudinal Case-Cohort Study

2020 ◽  
Author(s):  
Kevin Antoine Brown ◽  
Bradley Langford ◽  
Kevin L Schwartz ◽  
Christina Diong ◽  
Gary Garber ◽  
...  
Keyword(s):  
Nursing Home ◽  
Hospital Admissions ◽  
Cohort Analysis ◽  
Nursing Home Residents ◽  
Quantitative Information ◽  
Antibiotic Prescribing ◽  
Adjusted Relative Risk ◽  
Increased Risk ◽  
Antibiotic Duration ◽  
Antibiotic Courses

Abstract Background Antibiotic use is the strongest modifiable risk factor for the development of Clostridioides difficile infection, but prescribers lack quantitative information on comparative risks of specific antibiotic courses. Our objective was to estimate risks of C. difficile infection associated with receipt of specific antibiotic courses. Methods We conducted a longitudinal case-cohort analysis representing over 90% of Ontario nursing home residents, between 2012 and 2017. Our primary exposure was days of antibiotic receipt in the prior 90 days. Adjustment covariates included: age, sex, prior emergency department or acute care stay, Charlson comorbidity index, prior C. difficile infection, acid suppressant use, device use, and functional status. We examined incident C. difficile infection, including cases identified within the nursing home, and those identified during subsequent hospital admissions. Adjusted and unadjusted regression models were used to measure risk associated with 5- to 14-day courses of 18 different antibiotics. Results We identified 1708 cases of C. difficile infection (1.27 per 100 000 resident-days). Longer antibiotic duration was associated with increased risk: 10- and 14-day courses incurred 12% (adjusted relative risk [ARR] = 1.12, 95% confidence interval [CI]: 1.09, 1.14) and 27% (ARR = 1.27, 95% CI: 1.21,1.30) more risk compared to 7-day courses. Among 7-day courses with similar indications: moxifloxacin resulted in 121% more risk than amoxicillin (ARR = 2.21, 95% CI: 1.67, 3.08), ciprofloxacin engendered 89% more risk than nitrofurantoin (ARR = 1.89, 95% CI: 1.45, 2.68), and clindamycin resulted in 112% (ARR = 2.12, 95% CI: 1.32, 3.78) more risk than cloxacillin. Conclusions C. difficile infection risk increases with antibiotic duration, and there are wide disparities in risks associated with antibiotic courses used for similar indications.

scholarly journals Caring for nursing home residents with COVID-19: a “hospital-at-nursing home” intermediate care intervention

2021 ◽  
Author(s):  
Enrico Benvenuti ◽  
Giulia Rivasi ◽  
Matteo Bulgaresi ◽  
Riccardo Barucci ◽  
Chiara Lorini ◽  
...  
Keyword(s):  
Nursing Home ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Hospital Admissions ◽  
Nursing Home Residents ◽  
Nursing Home Care ◽  
Intermediate Care ◽  
Healthcare Model ◽  
Set Up ◽  
The Impact

Abstract Background Nursing home (NH) residents have been dramatically affected by COVID-19, with extremely high rates of hospitalization and mortality. Aims To describe the features and impact of an assistance model involving an intermediate care mobile medical specialist team (GIROT, Gruppo Intervento Rapido Ospedale Territorio) aimed at delivering “hospital-at-nursing home” care to NH residents with COVID-19 in Florence, Italy. Methods The GIROT activity was set-up during the first wave of the pandemic (W1, March–April 2020) and became a structured healthcare model during the second (W2, October 2020–January 2021). The activity involved (1) infection transmission control among NHs residents and staff, (2) comprehensive geriatric assessment including prognostication and geriatric syndromes management, (3) on-site diagnostic assessment and protocol-based treatment of COVID-19, (4) supply of nursing personnel to understaffed NHs. To estimate the impact of the GIROT intervention, we reported hospitalization and infection lethality rates recorded in SARS-CoV-2-positive NH residents during W1 and W2. Results The GIROT activity involved 21 NHs (1159 residents) and 43 NHs (2448 residents) during W1 and W2, respectively. The percentage of infected residents was higher in W2 than in W1 (64.5% vs. 38.8%), while both hospitalization and lethality rates significantly decreased in W2 compared to W1 (10.1% vs 58.2% and 23.4% vs 31.1%, respectively). Discussion Potentiating on-site care in the NHs paralleled a decrease of hospital admissions with no increase of lethality. Conclusions An innovative “hospital-at-nursing home” patient-centred care model based on comprehensive geriatric assessment may provide a valuable contribution in fighting COVID-19 in NH residents.

scholarly journals Modeling the Spread and Control of COVID-19

2020 ◽  
Author(s):  
Ashutosh Trivedi ◽  
Nanda Kishore Sreenivas ◽  
Shrisha Rao
Keyword(s):  
Herd Immunity ◽  
Black Box ◽  
Personal Hygiene ◽  
Confined Space ◽  
Real Situation ◽  
Seir Model ◽  
Agent Based ◽  
Social Distancing ◽  
The Difference ◽  
And Control

ABSTRACTData-centric models of COVID-19 have been tried, but have certain limitations. In this work, we propose an agent-based model of the epidemic in a confined space of agents representing humans. An extension to the SEIR model allows us to consider the difference between the appearance (black-box view) of the spread of disease, and the real situation (glass-box view). Our model allows for simulations of lockdowns, social distancing, personal hygiene, quarantine, and hospitalization, with further considerations of different parameters such as the extent to which hygiene and social distancing are observed in a population. Our results give qualitative indications of the effects of various policies and parameters; for instance, that lockdowns by themselves are extremely unlikely to bring an end to an epidemic and may indeed make things worse, that social distancing matters more than personal hygiene, and that the growth of infection comes down significantly for moderately high levels of social distancing and hygiene, even in the absence of herd immunity.

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