Dataset Information

State social distancing restrictions and nursing home outcomes.

ABSTRACT: The COVID-19 poses a disproportionate threat to nursing home residents. Although recent studies suggested the effectiveness of state social distancing measures in the United States on curbing COVID-19 morbidity and mortality among the general population, there is a lack of evidence as to how these state orders may have affected nursing home patients or what potential negative health consequences they may have had. In this longitudinal study, we evaluated changes in state strength of social distancing restrictions from June to August of 2020, and their associations with the weekly numbers of new COVID-19 cases, new COVID-19 deaths, and new non-COVID-19 deaths in nursing homes of the US. We found that stronger state social distancing measures were associated with improved COVID-19 outcomes (case and death rates), reduced across-facility disparities in COVID-19 outcomes, and somewhat increased non-COVID-19 death rate, although the estimates for non-COVID-19 deaths were sensitive to alternative model specifications.

SUBMITTER: Li Y

PROVIDER: S-EPMC8776882 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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State social distancing restrictions and nursing home outcomes.

Li Yue Y Cheng Zijing Z Cai Xueya X Mao Yunjiao Y Temkin-Greener Helena H

Scientific reports 20220120 1

The COVID-19 poses a disproportionate threat to nursing home residents. Although recent studies suggested the effectiveness of state social distancing measures in the United States on curbing COVID-19 morbidity and mortality among the general population, there is a lack of evidence as to how these state orders may have affected nursing home patients or what potential negative health consequences they may have had. In this longitudinal study, we evaluated changes in state strength of social dista ...[more]

PMID: 35058532

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Project description:Early in the pandemic, slowing the spread of novel coronavirus disease 2019 (COVID-19) relied on non-pharmaceutical interventions. All U.S. states adopted social-distancing restrictions in March and April of 2020, though policies varied both in timing and scope. Compared to states with Democratic governors, those with Republican governors often adopted measures for shorter durations and with greater resistance from their residents. In Kentucky, an extremely close gubernatorial election immediately prior to the discovery of SARS-CoV-2 replaced a Republican incumbent with a Democrat, despite Republicans easily winning all other statewide races. This chance election result offers a unique opportunity to examine the impact of early social distancing policies in a relatively conservative, rural, white-working-class state. Our study begins by estimating an event-study model to link adoption of several common social distancing measures-public school closures, bans on large gatherings, closures of entertainment-related businesses such as restaurants, and shelter-in-place orders (SIPOs)-to the growth rate of cases across counties in the Midwest and South in the early stages of the pandemic. These policies combined to slow the daily growth rate of COVID-19 cases by 9 percentage points after 16 days, with SIPOs and entertainment establishment closures accounting for the entire effect. In order to obtain results with more direct applicability to Kentucky, we then estimate a model that interacts the policy variables with a "white working class" index characterized by political conservatism, rurality, and high percentages of white, evangelical Christian residents without college degrees. We find that the effectiveness of early social distancing measures decreased with higher values of this index. The results imply that the restrictions combined to slow the spread of COVID-19 by 12 percentage points per day in Kentucky's two largest urban counties but had no statistically detectable effect across the rest of the state.

Project description:Stay-at-home restrictions such as closure of non-essential businesses were effective at reducing SARS-CoV-2 transmission in New York City (NYC) in the spring of 2020. Relaxation of these restrictions was desirable for resuming economic and social activities, but could only occur in conjunction with measures to mitigate the expected resurgence of new infections, in particular social distancing and mask-wearing. We projected the impact of individuals' adherence to social distancing and mask-wearing on the duration, frequency, and recurrence of stay-at-home restrictions in NYC. We applied a stochastic discrete time-series model to simulate community transmission and household secondary transmission in NYC. The model was calibrated to hospitalizations, ICU admissions, and COVID-attributable deaths over March-July 2020 after accounting for the distribution of age and chronic health conditions in NYC. We projected daily new infections and hospitalizations up to May 31, 2021 under the different levels of adherence to social distancing and mask-wearing after relaxation of stay-at-home restrictions. We assumed that the relaxation of stay-at-home policies would occur in the context of adaptive reopening, where a new hospitalization rate of ≥ 2 per 100,000 residents would trigger reinstatement of stay-at-home restrictions while a new hospitalization rate of ≤ 0.8 per 100,000 residents would trigger relaxation of stay-at-home restrictions. Without social distancing and mask-wearing, simulated relaxation of stay-at-home restrictions led to epidemic resurgence and necessary reinstatement of stay-at-home restrictions within 42 days. NYC would have stayed fully open for 26% of the time until May 31, 2021, alternating reinstatement and relaxation of stay-at-home restrictions in four cycles. At a low (50%) level of adherence to mask-wearing, NYC would have needed to implement stay-at-home restrictions between 8% and 32% of the time depending on individual adherence to social distancing. At moderate to high levels of adherence to mask-wearing without social distancing, NYC would have needed to implement stay-at-home restrictions. In threshold analyses, avoiding reinstatement of stay-at-home restrictions required a minimum of 60% adherence to mask-wearing at 50% adherence to social distancing. With low adherence to mask-wearing and social distancing, reinstatement of stay-at-home restrictions in NYC was inevitable. High levels of adherence to social distancing and mask-wearing could have attributed to avoiding recurrent surges without reinstatement of stay-at-home restrictions.

Project description:SARS-CoV-2 is primarily transmitted through person-to-person contacts. It is important to collect information on age-specific contact patterns because SARS-CoV-2 susceptibility, transmission, and morbidity vary by age. To reduce the risk of infection, social distancing measures have been implemented. Social contact data, which identify who has contact with whom especially by age and place are needed to identify high-risk groups and serve to inform the design of non-pharmaceutical interventions. We estimated and used negative binomial regression to compare the number of daily contacts during the first round (April-May 2020) of the Minnesota Social Contact Study, based on respondent's age, gender, race/ethnicity, region, and other demographic characteristics. We used information on the age and location of contacts to generate age-structured contact matrices. Finally, we compared the age-structured contact matrices during the stay-at-home order to pre-pandemic matrices. During the state-wide stay-home order, the mean daily number of contacts was 5.7. We found significant variation in contacts by age, gender, race, and region. Adults between 40 and 50 years had the highest number of contacts. The way race/ethnicity was coded influenced patterns between groups. Respondents living in Black households (which includes many White respondents living in inter-racial households with black family members) had 2.7 more contacts than respondents in White households; we did not find this same pattern when we focused on individual's reported race/ethnicity. Asian or Pacific Islander respondents or in API households had approximately the same number of contacts as respondents in White households. Respondents in Hispanic households had approximately two fewer contacts compared to White households, likewise Hispanic respondents had three fewer contacts than White respondents. Most contacts were with other individuals in the same age group. Compared to the pre-pandemic period, the biggest declines occurred in contacts between children, and contacts between those over 60 with those below 60.

Project description:AIMS AND OBJECTIVES:To explore nursing home residents' perspectives on their relationships with other residents, family members and staff. BACKGROUND:The cultivation of social relationships is central to promoting well-being in nursing homes, as these relationships allow residents, family members and staff to be valued as unique persons and empowered as partners in care. Few studies have examined how nursing home residents perceive the relationships in their social networks, both within and beyond the facility. DESIGN:Qualitative secondary analysis. METHODS:We analysed individual and group interviews obtained during "stakeholder engagement sessions" with cognitively intact residents (N = 11 sessions; N = 13 participants) from two nursing homes in North Carolina. The interviews were conducted as part of a larger study on person-directed care planning. We integrated thematic and narrative analytic approaches to guide the analysis of interview data, using a three-cycle coding approach. The COREQ checklist was followed. RESULTS:Four broad themes emerged from this analysis: (a) peer relationships foster a sense of belonging, purpose, achievement and significance; (b) residents' relationships with family members support a sense of belonging, continuity and significance; (c) mutual respect and reciprocity between residents and nursing home staff promote a sense of belonging and significance; and (d) organisational factors pose barriers to forging meaningful relationships. Each type of relationship-peer, family and staff-made distinctive contributions residents' psychosocial well-being. CONCLUSION:Recognising the diverse roles of different actors from residents' social networks raises questions for future research to optimise the distinctive contributions of network members that promote residents' psychosocial well-being. RELEVANCE TO CLINICAL PRACTICE:This study highlights the need for nursing home staff to understand how residents' social relationships influence residents' psychosocial outcomes. Staff training programmes are needed to support residents' rights and to dispel inaccurate interpretations of regulations that threaten sustained meaningful relationships.

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State social distancing restrictions and nursing home outcomes.

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State social distancing restrictions and nursing home outcomes.

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