Covid-19 in the Community and Outbreaks in Long-Term Residential Care in Ireland

This Bulletin summarises the findings from: Walsh, Brendan; Connolly, Sheelah and Wren, Maev-Ann., “Covid-19 in the Community and Outbreaks in Long-Term Residential Care in Ireland”, Journal of Long-Term Care, Available online: https://journal.ilpnetwork.org/articles/10.31389/jltc.191

Overview

Long-Term Residential Care (LTRC) homes were at the centre of the Covid-19 pandemic. In Ireland and other countries, a substantial proportion of Covid-19 deaths were linked to outbreaks in LTRC. The Health Protection and Surveillance Centre (HPSC) estimated that between March and December 2020, over half of all Covid-19 deaths were linked to outbreaks in LTRC settings in Ireland. Internationally, a range of factors have been found to be associated with Covid-19 outbreaks in LTRC including facility size, form of ownership and community rates of Covid-19. This research examines the factors associated with Covid-19 outbreaks and outbreak severity in LTRC homes in Ireland across the first three waves of the pandemic.

Methods

This study matched data on Covid-19 in LTRC and non-LTRC settings with information on LTRC home characteristics. These data allowed us to track Covid-19 outbreaks and assess the severity of each outbreak in terms of cases and deaths across all LTRC homes between March 2020 and March 2021.The study analysed whether the probability of outbreaks was associated with factors such as home size (measured by the number of beds) and whether the LTRC home was public or private. In addition, the study examined the extent to which being located in an area with high rates of Covid-19 in the community resulted in an increased risk of a Covid-19 outbreak and the severity of such an outbreak.

Findings

The study found that two-thirds of all LTRC homes had at least one Covid-19 outbreak between March 2020 and March 2021. In total, there were over 8,500 confirmed Covid-19 cases among LTRC residents and over 2,100 deaths. We estimate that larger LTRC homes were 2.5 times more likely to have a Covid-19 outbreak. No difference in the probability of an outbreak was observed between public and private LTRC homes.

Being located in a county with high community rates of Covid-19 was found to have the largest association with the probability of a Covid-19 outbreak. We estimate that LTRC homes located in counties with the highest community rates of Covid-19 were seven times more likely to have an outbreak compared to LTRC homes located in counties with the lowest rates. Community Covid-19 rates were positively associated with larger outbreaks and outbreaks with higher Covid-19 mortality.

Policy Implications

These findings show the devastating impact Covid-19 had on LTRC in Ireland in terms of cases and deaths. We find that community rates of Covid-19 were the key determinant of Covid-19 outbreaks in LTRC homes in Ireland, in line with findings from the HPSC and the Health Information Quality Authority (HIQA). The results also align with international evidence. While various measures such as infection and control protocols and the implementation of vaccination programs reduced the impact of the pandemic in LTRC homes, community levels of disease were clearly important. The results should inform the understanding of the factors associated with Covid-19 and provide lessons on how to mitigate the impact of future waves of Covid-19 or other infectious diseases.