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Rockhampton researchers publish largest global study on COVID-19 outbreaks in aged care facilities

8 March 2021

A team of Rockhampton researchers, led by CQ Health’s Director of Public Health and Director of Clinical Research Professor Gulam Khandaker, has done an international research project on COVID-19 outbreaks in residential aged care facilities.

The research has been published in the Lancet Group Open access journal EClinicalMedicine. The Lancet is among the world’s oldest and best-known general medical journals, and it is every medical researcher’s dream in terms of publication goals.

Prof Khandaker and the research team screened through more than 5000 documents and identified 49 studies from 14 countries across 4 continents, reporting data on 214,380 residents in 8502 care homes, with 25,567 confirmed cases of COVID-19 which has been analysed and reported in this paper.

One of the researchers, a joint CQ Public Health Unit and CQUniversity PhD student Rashidul Hashan, was writing the paper from his hospital bed in Bangladesh while being treated for COVID-19.

“This is testament to the dedication of the team members to this project,” Prof Khandaker said. “We have a very modest team working in Rockhampton and we’ve led the largest study in the world of COVID-19 outbreaks in aged care.

“It shows that regional public health units can do good quality and valuable research with the right support, and we thank the Director-General and Queensland Health for their support to allow us to do this study.”

CQ Health Chief Executive Steve Williamson says the team’s work is of global significance.

“It is fantastic that our CQ Health team is at the leading edge of important COVID research to protect some of the most vulnerable in society,” Mr Williamson said.

In 2019 Prof Khandaker was awarded a Queensland Advancing Clinical Research Fellowship by Queensland Health’s Health Innovation, Investment and Research Office (HIIRO), through the Office of the Director General, to establish an active regional disease surveillance mechanism to investigate the burden and preventive strategies for vaccine preventable infectious diseases in aged-care facilities. His study began looking into surveillance of aged-care facilities of infectious diseases and their impact, including influenza, shingles, pneumonia and whooping cough.

These were all vaccine-preventable conditions and he wanted to know the rates of infections, of hospitalisation and the impact of vaccination, public health response including timely outbreak management and infection control measures. He was working on moving to active surveillance of aged-care facilities to improve timeliness of reporting and response, and therefore more opportunities to make a difference by stopping the spread of infections in the homes.

“Then COVID came, and as a group we were best prepared to answer some of the questions that were arising about the behaviour of the virus in aged-care facilities,” Prof Khandaker said.

“While we had an outbreak at North Rockhampton Nursing Centre with one case identified, we knew we had to look at the bigger picture to get meaningful data.

“This led to this systematic review and meta-analysis, where we took data from all outbreaks across the world and combined them to this report. This gives greater confidence and power and the highest level of evidence to get to the truth.”

The study shows that aged care residents form a distinct vulnerable population with COVID-19 attack rates of 45% and case fatality rates of 23% during outbreaks. Moreover, nearly one third (31%) of COVID-19 cases during aged-care outbreaks were asymptomatic (no symptoms) and more than one third (37%) of the confirmed cases required hospitalisation. Outbreaks were introduced into aged-care facilities by both residents (58%) and staff (42%).

Prof Khandaker says what they found was timely, relevant and extremely valuable evidence that can be used in developing prevention strategies, royal commissions and inquiries and now with vaccine prioritisation, given the impact of the virus on aged-care facilities.

“We found both high attack and fatality rates, but many asymptomatic cases too. Preventing the introduction of COVID-19 infection into aged-care facilities should be an urgent priority. During outbreaks, early case identification through facility-wide serial testing of all residents and staff plus reducing staff movements within and between aged-care facilities are proven strategies to decrease the impact of COVID-19 in aged-care facilities.”

Prof Khandaker is extremely proud of the team’s work and is delighted it will be shared widely across the world through publication in a well-respected global journal.

Researchers are Mohammad Rashidul Hashan from CQ Public Health Unit and CQUniversity, Dr Nicolas Smoll (CQ Public Health Unit), Dr Catherine King (National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead), Dr Hannah Ockenden-Muldoon (CQ Public Health Unit), Jacina Walker (CQ Public Health Unit), Dr Andrew Wattiaux (Gold Coast Public Health Unit), Dr Julieanne Graham (CQ Health Executive Director Medical Services), Professor Robert Booy (National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead), and Prof Gulam Khandaker.

Public health researchers

Last updated: 8 March 2021

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