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ABSTRACT
Objectives
During the COVID-19 pandemic, no country with widespread community transmission has avoided outbreaks or deaths in Residential Aged Care Facilities (RACFs). As RACFs residents are at high risk of morbidity and mortality from COVID-19, understanding disease severity risk factors is imperative.
Design
This retrospective cohort study aimed to compare COVID-19 disease severity (hospitalisation and deaths) and associated risk factors among RACF residents in "[blinded for review]", "[blinded for review]", across Delta and Omicron epidemic periods.
Settings and participants
Resident case hospitalisation risk (HR) and case fatality risk (CFR) were assessed using "[blinded for review]" RACFs COVID-19 outbreaks data across two epidemic periods; Delta, 994 resident cases linked to 86 outbreaks; and Omicron, 1,882 resident cases linked to 209 outbreaks.
Methods
Adjusting for outbreak-level clustering, age, sex, up-to-date vaccination status and time since last vaccination, the odds of hospitalisation and death were compared using mixed effects logistic regression.
Results
The HR and CFR was lower during the Omicron period compared to the Delta period ((HR 8.2% vs 24.6%; OR = 0.17, 95% CI 0.11-0.26) and (CFR 11.4% vs 18.7%; OR = 0.40, 95% CI 0.28-0.56)). During both periods; males had higher odds of hospitalisation and odds of death; being up-to-date with vaccination reduced odds of hospitalisation by 40% (excluding non-emergency patient transfers) and odds of death by 43%; and for each month since last vaccination, odds of hospitalisation increased by 9% and odds of death by 16%.
Conclusions and implications
This study provides empirical evidence of lower COVID-19 severity among RACF residents in the Omicron period and highlights the importance of up-to-date and timely vaccination to reduce disease severity in this cohort.
Key words
Article info
Publication history
Accepted:
January 12,
2023
Received in revised form:
January 11,
2023
Received:
October 11,
2022
Publication stage
In Press Accepted ManuscriptFootnotes
Funding sources: This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors
Brief summary:
This study provides empirical evidence that the risks of hospitalisation and death were lower for aged care residents during the Omicron epidemic period compared to the Delta period, even after controlling for age, sex and vaccination status of cases, and of the increased risk of hospitalisation and death as time since vaccination increased which highlights the need for policy on the frequency of administration of booster doses for aged-care residents.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of AMDA -- The Society for Post-Acute and Long-Term Care Medicine.
