Connectivity between long-term care homes and subsequent SARS-CoV-2 outbreaks
Abstract Background To examine the relationship between individual workers employed at more than one LTCH (inter-LTCH connectivity) across LTCH and SARS-CoV-2 outbreaks. Methods We conducted a retrospective cohort study using secondary, aggregate data (surveillance and mobile geolocation data) from...
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BMC
2025-08-01
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| Online Access: | https://doi.org/10.1186/s12889-025-23621-3 |
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| author | Yiqing Xia Huiting Ma Kamil Malikov Sharon E. Straus Christine Fahim Gary Moloney Qing Huang Sahar Asgari Jamie M. Boyd Irene Ferro Jaimie Johns Kamran Khan Jaydeep Mistry Linwei Wang Adrienne K. Chan Stefan D. Baral Mathieu Maheu-Giroux Sharmistha Mishra |
| author_facet | Yiqing Xia Huiting Ma Kamil Malikov Sharon E. Straus Christine Fahim Gary Moloney Qing Huang Sahar Asgari Jamie M. Boyd Irene Ferro Jaimie Johns Kamran Khan Jaydeep Mistry Linwei Wang Adrienne K. Chan Stefan D. Baral Mathieu Maheu-Giroux Sharmistha Mishra |
| author_sort | Yiqing Xia |
| collection | DOAJ |
| description | Abstract Background To examine the relationship between individual workers employed at more than one LTCH (inter-LTCH connectivity) across LTCH and SARS-CoV-2 outbreaks. Methods We conducted a retrospective cohort study using secondary, aggregate data (surveillance and mobile geolocation data) from 179 LTCH in the Greater Toronto Area of Ontario, the province where close to one-third of the Canada’s SARS-CoV-2 cases among long-term care homes residents were reported, between 2020-02-26 and 2020-08-31. The main exposure of interest was the inter-LTCH connectivity, generated from geographic location data procured across mobile apps. Three outcomes were examined: 1) at least one SARS-CoV-2 diagnosis among residents, 2) cumulative cases among residents in each facility, and 3) time to first outbreak. Results The median degree of connectivity for LTCH that experienced an outbreak (59%; 106/179) was 1.2 times the degree of those without an outbreak (6 compared to 5). LTCH with higher inter-LTCH connectivity also had larger numbers of residents and beds, and were more likely to have for-profit ownership. After adjusting for facility-level and neighbourhood-level factors, every additional connection to another LTCH increased the odds of an outbreak in the respective LTCH by 8% (adjusted odds ratio=1.08, 90% credible interval [CrI]: 1.02-1.09). Inter-LTCH connectivity was also associated with higher risk of earlier occurrence of a first SARS-CoV-2 case (adjusted hazard ratio=1.05, 90%CrI: 1.02-1.09), but not with outbreak size. Conclusions Staff cohorting was associated with reduced importation risk of SARS-CoV-2 cases into LTCH. However, once importation has occurred, other facility-level factors including facility infrastructure and staff benefits are more important in shaping outbreak size. Implementing these structural strategies to meet the LTCH workers and residents’ needs are pivotal to prevent and manage future respiratory virus outbreaks. |
| format | Article |
| id | doaj-art-d0298efa6d1d4feb8a9fdf799c8abb26 |
| institution | DOAJ |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj-art-d0298efa6d1d4feb8a9fdf799c8abb262025-08-20T03:06:43ZengBMCBMC Public Health1471-24582025-08-012511810.1186/s12889-025-23621-3Connectivity between long-term care homes and subsequent SARS-CoV-2 outbreaksYiqing Xia0Huiting Ma1Kamil Malikov2Sharon E. Straus3Christine Fahim4Gary Moloney5Qing Huang6Sahar Asgari7Jamie M. Boyd8Irene Ferro9Jaimie Johns10Kamran Khan11Jaydeep Mistry12Linwei Wang13Adrienne K. Chan14Stefan D. Baral15Mathieu Maheu-Giroux16Sharmistha Mishra17Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill UniversityCentre for Urban Health Solutions, Li Ka Shing Knowledge Institute, University of TorontoOntario Ministry of HealthSt. Michael’s Hospital Li Ka Shing Knowledge Institute, Unity Health TorontoSt. Michael’s Hospital Li Ka Shing Knowledge Institute, Unity Health TorontoCentre for Urban Health Solutions, Li Ka Shing Knowledge Institute, University of TorontoOntario Ministry of HealthOntario Ministry of HealthSt. Michael’s Hospital Li Ka Shing Knowledge Institute, Unity Health TorontoBlueDot IncBlueDot IncBlueDot IncBlueDot IncCentre for Urban Health Solutions, Li Ka Shing Knowledge Institute, University of TorontoInstitute of Health Policy, Management, and Evaluation, University of TorontoBloomberg School of Public Health, Johns HopkinsDepartment of Epidemiology and Biostatistics, School of Population and Global Health, McGill UniversityCentre for Urban Health Solutions, Li Ka Shing Knowledge Institute, University of TorontoAbstract Background To examine the relationship between individual workers employed at more than one LTCH (inter-LTCH connectivity) across LTCH and SARS-CoV-2 outbreaks. Methods We conducted a retrospective cohort study using secondary, aggregate data (surveillance and mobile geolocation data) from 179 LTCH in the Greater Toronto Area of Ontario, the province where close to one-third of the Canada’s SARS-CoV-2 cases among long-term care homes residents were reported, between 2020-02-26 and 2020-08-31. The main exposure of interest was the inter-LTCH connectivity, generated from geographic location data procured across mobile apps. Three outcomes were examined: 1) at least one SARS-CoV-2 diagnosis among residents, 2) cumulative cases among residents in each facility, and 3) time to first outbreak. Results The median degree of connectivity for LTCH that experienced an outbreak (59%; 106/179) was 1.2 times the degree of those without an outbreak (6 compared to 5). LTCH with higher inter-LTCH connectivity also had larger numbers of residents and beds, and were more likely to have for-profit ownership. After adjusting for facility-level and neighbourhood-level factors, every additional connection to another LTCH increased the odds of an outbreak in the respective LTCH by 8% (adjusted odds ratio=1.08, 90% credible interval [CrI]: 1.02-1.09). Inter-LTCH connectivity was also associated with higher risk of earlier occurrence of a first SARS-CoV-2 case (adjusted hazard ratio=1.05, 90%CrI: 1.02-1.09), but not with outbreak size. Conclusions Staff cohorting was associated with reduced importation risk of SARS-CoV-2 cases into LTCH. However, once importation has occurred, other facility-level factors including facility infrastructure and staff benefits are more important in shaping outbreak size. Implementing these structural strategies to meet the LTCH workers and residents’ needs are pivotal to prevent and manage future respiratory virus outbreaks.https://doi.org/10.1186/s12889-025-23621-3Long-term care homesPublic health emergencyRespiratory virusOutbreak managementStaff cohortingStaff connectivity |
| spellingShingle | Yiqing Xia Huiting Ma Kamil Malikov Sharon E. Straus Christine Fahim Gary Moloney Qing Huang Sahar Asgari Jamie M. Boyd Irene Ferro Jaimie Johns Kamran Khan Jaydeep Mistry Linwei Wang Adrienne K. Chan Stefan D. Baral Mathieu Maheu-Giroux Sharmistha Mishra Connectivity between long-term care homes and subsequent SARS-CoV-2 outbreaks BMC Public Health Long-term care homes Public health emergency Respiratory virus Outbreak management Staff cohorting Staff connectivity |
| title | Connectivity between long-term care homes and subsequent SARS-CoV-2 outbreaks |
| title_full | Connectivity between long-term care homes and subsequent SARS-CoV-2 outbreaks |
| title_fullStr | Connectivity between long-term care homes and subsequent SARS-CoV-2 outbreaks |
| title_full_unstemmed | Connectivity between long-term care homes and subsequent SARS-CoV-2 outbreaks |
| title_short | Connectivity between long-term care homes and subsequent SARS-CoV-2 outbreaks |
| title_sort | connectivity between long term care homes and subsequent sars cov 2 outbreaks |
| topic | Long-term care homes Public health emergency Respiratory virus Outbreak management Staff cohorting Staff connectivity |
| url | https://doi.org/10.1186/s12889-025-23621-3 |
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