Linwei Wang1, Huiting Ma1, Kristy C Y Yiu1, Andrew Calzavara1, David Landsman1, Linh Luong1, Adrienne K Chan1, Rafal Kustra1, Jeffrey C Kwong1, Marie-Claude Boily1, Stephen Hwang1, Sharon Straus1, Stefan D Baral1, Sharmistha Mishra2. 1. MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md. 2. MAP Centre for Urban Health Solutions (Wang, Ma, Yiu, Landsman, Luong, Hwang, Mishra), St. Michael's Hospital, University of Toronto; ICES (Calzavara, Kwong); Division of Infectious Diseases, Department of Medicine (Chan, Mishra), University of Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences Centre, University of Toronto; Dalla Lana School of Public Health (Kustra), University of Toronto; Department of Family and Community Medicine (Kwong), Faculty of Medicine, University of Toronto, Toronto, Ont.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology (Boily), Faculty of Medicine, Imperial College, London, UK; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Bloomberg School of Public Health (Baral), Johns Hopkins University, Baltimore, Md. sharmistha.mishra@utoronto.ca.
Abstract
BACKGROUND: Congregate settings have been disproportionately affected by coronavirus disease 2019 (COVID-19). Our objective was to compare testing for, diagnosis of and death after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across 3 settings (residents of long-term care homes, people living in shelters and the rest of the population). METHODS: We conducted a population-based prospective cohort study involving individuals tested for SARS-CoV-2 in the Greater Toronto Area between Jan. 23, 2020, and May 20, 2020. We sourced person-level data from COVID-19 surveillance and reporting systems in Ontario. We calculated cumulatively diagnosed cases per capita, proportion tested, proportion tested positive and case-fatality proportion for each setting. We estimated the age- and sex-adjusted rate ratios associated with setting for test positivity and case fatality using quasi-Poisson regression. RESULTS: Over the study period, a total of 173 092 individuals were tested for and 16 490 individuals were diagnosed with SARS-CoV-2 infection. We observed a shift in the proportion of cumulative cases from all cases being related to travel to cases in residents of long-term care homes (20.4% [3368/16 490]), shelters (2.3% [372/16 490]), other congregate settings (20.9% [3446/16 490]) and community settings (35.4% [5834/16 490]), with cumulative travel-related cases at 4.1% (674/16490). Cumulatively, compared with the rest of the population, the diagnosed cases per capita was 64-fold and 19-fold higher among long-term care home and shelter residents, respectively. By May 20, 2020, 76.3% (21 617/28 316) of long-term care home residents and 2.2% (150 077/6 808 890) of the rest of the population had been tested. After adjusting for age and sex, residents of long-term care homes were 2.4 (95% confidence interval [CI] 2.2-2.7) times more likely to test positive, and those who received a diagnosis of COVID-19 were 1.4-fold (95% CI 1.1-1.8) more likely to die than the rest of the population. INTERPRETATION: Long-term care homes and shelters had disproportionate diagnosed cases per capita, and residents of long-term care homes diagnosed with COVID-19 had higher case fatality than the rest of the population. Heterogeneity across micro-epidemics among specific populations and settings may reflect underlying heterogeneity in transmission risks, necessitating setting-specific COVID-19 prevention and mitigation strategies. Copyright 2020, Joule Inc. or its licensors.
BACKGROUND: Congregate settings have been disproportionately affected by coronavirus disease 2019 (COVID-19). Our objective was to compare testing for, diagnosis of and death after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across 3 settings (residents of long-term care homes, people living in shelters and the rest of the population). METHODS: We conducted a population-based prospective cohort study involving individuals tested for SARS-CoV-2 in the Greater Toronto Area between Jan. 23, 2020, and May 20, 2020. We sourced person-level data from COVID-19 surveillance and reporting systems in Ontario. We calculated cumulatively diagnosed cases per capita, proportion tested, proportion tested positive and case-fatality proportion for each setting. We estimated the age- and sex-adjusted rate ratios associated with setting for test positivity and case fatality using quasi-Poisson regression. RESULTS: Over the study period, a total of 173 092 individuals were tested for and 16 490 individuals were diagnosed with SARS-CoV-2 infection. We observed a shift in the proportion of cumulative cases from all cases being related to travel to cases in residents of long-term care homes (20.4% [3368/16 490]), shelters (2.3% [372/16 490]), other congregate settings (20.9% [3446/16 490]) and community settings (35.4% [5834/16 490]), with cumulative travel-related cases at 4.1% (674/16490). Cumulatively, compared with the rest of the population, the diagnosed cases per capita was 64-fold and 19-fold higher among long-term care home and shelter residents, respectively. By May 20, 2020, 76.3% (21 617/28 316) of long-term care home residents and 2.2% (150 077/6 808 890) of the rest of the population had been tested. After adjusting for age and sex, residents of long-term care homes were 2.4 (95% confidence interval [CI] 2.2-2.7) times more likely to test positive, and those who received a diagnosis of COVID-19 were 1.4-fold (95% CI 1.1-1.8) more likely to die than the rest of the population. INTERPRETATION: Long-term care homes and shelters had disproportionate diagnosed cases per capita, and residents of long-term care homes diagnosed with COVID-19 had higher case fatality than the rest of the population. Heterogeneity across micro-epidemics among specific populations and settings may reflect underlying heterogeneity in transmission risks, necessitating setting-specific COVID-19 prevention and mitigation strategies. Copyright 2020, Joule Inc. or its licensors.
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