Death rate in Covid-19 hit nursing homes 'more than double' normal level

Death rate in Covid-19 hit nursing homes 'more than double' normal level

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The number of deaths recorded in nursing homes with Covid-19 outbreaks was “more than double” the normal or standardised mortality rate expected over a three-month period, a new research study has found.

The study, led by the Department of Age-Related Healthcare at Tallaght hospital, analysed Covid-19 infection and mortality rates at 28 nursing homes in the eastern region of the country, 21 of which had viral outbreaks between February 29 and May 22. Four nursing homes had no outbreaks and three facilities had staff-related infections that were not deemed Covid-19 outbreaks.

The researchers found that one quarter of nursing home residents and staff with Covid-19 did not show any symptoms of infection and that mass testing is “essential” to detect, trace, and isolate infections in a nursing home environment.

In 21 nursing homes with Covid-19 outbreaks, 44% of residents contracted the virus and 27% showed no symptoms. A similar rate of 25% of staff were asymptomatic.

Of the 764 nursing home residents that contracted the virus , 211 or 26.7% died from Covid-19 , a s ignificantly higher case fatality rate than the national average of 5.6%.

The mortality rate in nursing homes with a Covid-19 outbreak was significantly higher at 17% compared to the 7% expected mortality rate over a three-month period, the researchers found.

Infection and mortality rates were also higher in public facilities assessed compared to private nursing homes, although the researchers cautioned that the sample size was small and suggested public nursing homes tend to cater for frailer residents with more complex care needs.

There have been 291 Covid-19 clusters in nursing homes to date, with five new outbreaks confirmed last week and 26 outbreaks deemed active across the country.

The high number of deaths in nursing homes during the pandemic - 851 deaths confirmed as of May 20 – has led to calls for a public inquiry.

The researchers noted that Covid-19 mortality rates identified in the study were consistent with other countries internationally, which had found a 26% case fatality rate in similar US and UK studies.

Professor Sean Kennelly, one of the authors of the study, said the findings "put clarity on the devastating impact of Covid-19" in nursing homes. 

“The findings are very much representative of the international experience that nursing homes in every country account for the majority of deaths due to Covid-19."

The findings also highlight the importance of serial or mass testing to detect asymptomatic cases, something which was not detected during the early phase of the pandemic.

Ireland was the first country in the world to roll out mass testing in nursing homes and when it did, the research showed it made a difference, Professor Kennelly said: “A similar number of infections were detected but the outbreaks came under control much quicker and there was an indication that fewer residents were dying”.

In addition to the importance of testing, he said a longer-term lesson was the need to develop alternative models of care to larger congregated nursing home settings.

“We do need to look at a better model and environment to support older people ageing in their own homes with community supports. Should people need long-term care we need a better design of longer-term care that we currently have,” he said.

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