The Difficult Balance between Ensuring the Right of Nursing Home Residents to Communication and Their Safety

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Abstract

The COVID-19 epidemic has had a profound impact on healthcare systems worldwide. The number of infections in nursing homes for the elderly particularly is significantly high, with a high mortality rate as a result. In order to contain infection risks for both residents and employees of such facilities, the Italian government passed emergency legislation during the initial stages of the pandemic to restrict outside visitor access. On 30 November 2020, the Italian President of the Council of Ministers issued a new decree recognizing the social and emotional value of visits to patients from family and friends. In addition, it indicated prevention measures for the purposes of containing the infection risk within nursing homes for the elderly. This article comments on these new legislative provisions from the medicolegal perspective, providing indications that can be used in clinical practice.

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Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

Melissa M. Arons, Kelly Hatfield, Sujan Reddy … (2020)

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can spread rapidly within skilled nursing facilities. After identification of a case of Covid-19 in a skilled nursing facility, we assessed transmission and evaluated the adequacy of symptom-based screening to identify infections in residents. Methods We conducted two serial point-prevalence surveys, 1 week apart, in which assenting residents of the facility underwent nasopharyngeal and oropharyngeal testing for SARS-CoV-2, including real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), viral culture, and sequencing. Symptoms that had been present during the preceding 14 days were recorded. Asymptomatic residents who tested positive were reassessed 7 days later. Residents with SARS-CoV-2 infection were categorized as symptomatic with typical symptoms (fever, cough, or shortness of breath), symptomatic with only atypical symptoms, presymptomatic, or asymptomatic. Results Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2. Among 76 residents who participated in point-prevalence surveys, 48 (63%) tested positive. Of these 48 residents, 27 (56%) were asymptomatic at the time of testing; 24 subsequently developed symptoms (median time to onset, 4 days). Samples from these 24 presymptomatic residents had a median rRT-PCR cycle threshold value of 23.1, and viable virus was recovered from 17 residents. As of April 3, of the 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit) and 15 had died (mortality, 26%). Of the 34 residents whose specimens were sequenced, 27 (79%) had sequences that fit into two clusters with a difference of one nucleotide. Conclusions Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.

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Age-dependent effects in the transmission and control of COVID-19 epidemics

Nicholas Davies, Petra Klepac, Yang Liu … (2020)

The COVID-19 pandemic has shown a markedly low proportion of cases among children1-4. Age disparities in observed cases could be explained by children having lower susceptibility to infection, lower propensity to show clinical symptoms or both. We evaluate these possibilities by fitting an age-structured mathematical model to epidemic data from China, Italy, Japan, Singapore, Canada and South Korea. We estimate that susceptibility to infection in individuals under 20 years of age is approximately half that of adults aged over 20 years, and that clinical symptoms manifest in 21% (95% credible interval: 12-31%) of infections in 10- to 19-year-olds, rising to 69% (57-82%) of infections in people aged over 70 years. Accordingly, we find that interventions aimed at children might have a relatively small impact on reducing SARS-CoV-2 transmission, particularly if the transmissibility of subclinical infections is low. Our age-specific clinical fraction and susceptibility estimates have implications for the expected global burden of COVID-19, as a result of demographic differences across settings. In countries with younger population structures-such as many low-income countries-the expected per capita incidence of clinical cases would be lower than in countries with older population structures, although it is likely that comorbidities in low-income countries will also influence disease severity. Without effective control measures, regions with relatively older populations could see disproportionally more cases of COVID-19, particularly in the later stages of an unmitigated epidemic.

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COVID-19 and the consequences of isolating the elderly

Richard A. Armitage, Laura Nellums (2020)

As countries are affected by coronavirus disease 2019 (COVID-19), the elderly population will soon be told to self-isolate for “a very long time” in the UK, and elsewhere. 1 This attempt to shield the over-70s, and thereby protect over-burdened health systems, comes as worldwide countries enforce lockdowns, curfews, and social isolation to mitigate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, it is well known that social isolation among older adults is a “serious public health concern” because of their heightened risk of cardiovascular, autoimmune, neurocognitive, and mental health problems. 2 Santini and colleagues 3 recently demonstrated that social disconnection puts older adults at greater risk of depression and anxiety. If health ministers instruct elderly people to remain home, have groceries and vital medications delivered, and avoid social contact with family and friends, urgent action is needed to mitigate the mental and physical health consequences. Self-isolation will disproportionately affect elderly individuals whose only social contact is out of the home, such as at daycare venues, community centres, and places of worship. Those who do not have close family or friends, and rely on the support of voluntary services or social care, could be placed at additional risk, along with those who are already lonely, isolated, or secluded. Online technologies could be harnessed to provide social support networks and a sense of belonging, 4 although there might be disparities in access to or literacy in digital resources. Interventions could simply involve more frequent telephone contact with significant others, close family and friends, voluntary organisations, or health-care professionals, or community outreach projects providing peer support throughout the enforced isolation. Beyond this, cognitive behavioural therapies could be delivered online to decrease loneliness and improve mental wellbeing. 5 Isolating the elderly might reduce transmission, which is most important to delay the peak in cases, and minimise the spread to high-risk groups. However, adherence to isolation strategies is likely to decrease over time. Such mitigation measures must be effectively timed to prevent transmission, but avoid increasing the morbidity of COVID-19 associated with affective disorders. This effect will be felt greatest in more disadvantaged and marginalised populations, which should be urgently targeted for the implementation of preventive strategies.

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Author and article information

Contributors

Paul B. Tchounwou: Role: Academic Editor

Stefano Ferracuti: Role: Academic Editor

Raffaele La Russa: Role: Academic Editor

Journal

Journal ID (nlm-ta): Int J Environ Res Public Health

Journal ID (iso-abbrev): Int J Environ Res Public Health

Journal ID (publisher-id): ijerph

Title: International Journal of Environmental Research and Public Health

Publisher: MDPI

ISSN (Print): 1661-7827

ISSN (Electronic): 1660-4601

Publication date (Electronic): 03 March 2021

Publication date Collection: March 2021

Volume: 18

Issue: 5

Electronic Location Identifier: 2484

Affiliations

[1 ]Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; danielec.rodriguez@ 123456gmail.com (D.R.); anna.aprile@ 123456unipd.it (A.A.)

[2 ]Department of Medicine and Health Sciences “V. Tiberio,” University of Molise, 86100 Campobasso, Italy

[3 ]Forensic Medicine, Department of Law, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy; giulio.dimizio@ 123456unicz.it

[4 ]Department of Emergency Medicine, Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), Catholic University of Rome-Teaching Hospital Foundation A, 00168 Rome, Italy; andrea.piccioni@ 123456policlinicogemelli.it

[5 ]Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy; alessandro.feola@ 123456unicampania.it

[6 ]Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; alessandro.bonsignore@ 123456unige.it (A.B.); camilla.tettamanti85@ 123456gmail.com (C.T.)

[7 ]Department of Health Sciences, Section of History of Medicine and Bioethics, University of Genova, 16126 Genova, Italy; rosellaciliberti@ 123456yahoo.it

Author notes

[* ]Correspondence: matteo.bolcato@ 123456unipd.it (M.B.); marco.trabuccoaurilio@ 123456unimol.it (M.T.A.); Tel.: +39-0499941096 (M.B.); +39-081-778-316 (M.T.A.)

Author information

Matteo Bolcato https://orcid.org/0000-0002-8784-8463

Giulio Di Mizio https://orcid.org/0000-0001-7279-3693

Andrea Piccioni https://orcid.org/0000-0001-5703-8737

Alessandro Feola https://orcid.org/0000-0002-9666-2636

Alessandro Bonsignore https://orcid.org/0000-0001-6616-0347

Article

Publisher ID: ijerph-18-02484

DOI: 10.3390/ijerph18052484

PMC ID: 7967622

PubMed ID: 33802378

SO-VID: cf84b831-61a2-476d-a60f-25a21983ac71

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

The Difficult Balance between Ensuring the Right of Nursing Home Residents to Communication and Their Safety

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Abstract

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Novel Coronavirus Disease COVID-19

Most cited references 76

Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

Age-dependent effects in the transmission and control of COVID-19 epidemics

COVID-19 and the consequences of isolating the elderly

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