By Leon Geffen
Adults > 60 are at highest risk of dying from COVID-19.
Data from Italy which had reported 12462 cases of COVID-19 as at 11 March 2020, with 827 deaths, showed that the mean age of deaths was 81 years, 42.2% of deaths were amongst people aged 80-89 years, 32.4% aged 70 – 79 and 8.4% aged 60 – 69 respectively. More than two-thirds of those that died had diabetes, cardiovascular diseases, or cancer or were former smokers. (1)
Older adults living in long-term care facilities (LTCFs) are at particular risk of respiratory tract infections (RTIs). It is estimated that 5% of adults > 65% live in LTCFs in developed countries and the use of LTCFs in LMICs is growing. People living in LTCFs are particularly vulnerable transmission of RTIs due to a number of factors including living in close proximity to one another, advanced age, multimorbidity and frailty. (2)
In LMICs, LTCFs are often unregulated and may provide poor quality care. The risk of infections in these often overcrowded and under resourced settings is very high.(3)
The WHO is coordinating a global response to the management of COVID-19 and as such wishes to provide guidance to LTCFs in under resourced areas as to measures that can be implemented at short notice, requiring minimal cost and minimal demand on personnel with maximum benefit to the residents of these facilities.
At present there are no evidenced based guidelines and all recommendations are based upon best practice recommendations.
Various national agencies e.g. CDC in the USA (4)& NHS in the UK (5)have provided guidelines for implementation of prevention of spread of COVID-19 in LTCFs. Whilst these guidelines are aimed at residential care facilities in high resource settings, many of the recommendations can be easily implemented in low resource settings.
Websites recommended are:
3) The CDC has published a COVID-19 preparedness checklist available for download at https://www.cdc.gov/coronavirus/2019-ncov/downloads/novel-coronavirus-2019-Nursing-Homes-Preparedness-Checklist_3_13.pdf
Simple measures that can be implemented at short notice include
1) Reduce the risk of transmission from visitors into the facility by screening all visitors and care workers coming into the facility for symptoms of COVID-19 and / or contact with someone who has had COVID-19. This may include stopping all visitors coming into the facility, except under exceptional circumstances e.g. to visit a terminally ill relative.
2) Ensure that all staff are trained in effective hand washing techniques.
3) Ensure adequate supplies of soap and paper towels for hand washing and ensure that supply chain management for necessary materials is in place.
4) If available, alcohol-based hand sanitizer for hand hygiene be available in every resident’s room or in close proximity to their rooms.
5) Trash disposal bins should be plentiful and in easy access of resident’s rooms.
6) The facility should know the contact details of local healthcare services providing care to persons under investigation for COVID-19, as well as the local testing policies.