Rapid Risk Assessment: Increase in fatal cases of COVID-19 among long-term care facility residents in the EU/EEA and the UK

Observed all-cause mortality among older people underlines the severe impact of COVID-19 in this population group. Residents in long-term care facilities (LTCFs) are one of the most vulnerable populations, and particular focus should be given to the prevention of SARS-CoV-2 introduction and to outbreak control in LTCFs.

Given the increased vulnerability and other underlying health problems of LTCF residents, COVID-19 outbreaks in this setting can have devastating effects. Social vulnerability in LTCF residents may also be exacerbated if non-pharmaceutical interventions are in place that limit physical personal interactions or impact access to health services.

This risk assessment details the latest epidemiological data in the European Union/European Economic Area (EU/EEA) and the United Kingdom (UK) with a focus on older age groups and national reports of outbreaks among residents of LTCFs. All EU/EEA countries and the UK have experienced outbreaks among LTCF residents since August 2020.

What risk is being assessed?

In light of the current increase in COVID-19 notification rates observed within the general population in the EU/EEA and the UK, this document assesses the risk related to COVID-19 infection among residents in LTCFs in the EU/EEA and the UK.

The probability of COVID-19 introduction into an LTCF depends on the level of SARS-CoV-2 circulation in the community, with a higher risk associated with higher incidence rates in the community. Following introduction, the likelihood of nosocomial transmission of COVID-19 is high, as observed in many facilities. According to the latest data available to ECDC [week 45/2020], all but one of the EU/EEA countries and the UK fall within the category of ‘serious concern’, as they have high or increasing case notification rates and/or test positivity ≥3%, as well as high notification rates in the older age groups and/or high mortality rates.

The overall probability of infection for LTCF residents in these countries is assessed as very high in light of the current epidemiological situation in the EU/EEA and the UK. Given the congregate nature of LTCF, the probability of further spread of the virus within these settings is also very high.

Increased morbidity and mortality have been reported in LTCFs across the EU/EEA and the UK despite the implementation of specific control measures in these settings. Hospital and ICU admissions and occupancy have been increasing and some sub-national areas are experiencing significant pressure on their healthcare services. As a result, the overall impact of infection for LTCF residents is assessed as very high.

For residents of LTCFs, who have a very high probability of infection and a very high impact of disease, the overall risk related to COVID-19 infection is assessed as being very high.