PDF(Pubmed)
Abstract：
UNASSIGNED: A disproportionate number of COVID-19 deaths occur in Residential Aged Care Facilities (RACFs), where better evidence is needed to target COVID-19 interventions to prevent mortality. This study used an agent-based model to assess the role of community prevalence, vaccination strategies, and non-pharmaceutical interventions (NPIs) on COVID-19 outcomes in RACFs in Victoria, Australia.
UNASSIGNED: The model simulated outbreaks in RACFs over time, and was calibrated to distributions for outbreak size, outbreak duration, and case fatality rate in Victorian RACFs over 2022. The number of incursions to RACFs per day were estimated to fit total deaths and diagnoses over time and community prevalence.Total infections, diagnoses, and deaths in RACFs were estimated over July 2023-June 2024 under scenarios of different: community epidemic wave assumptions (magnitude and frequency); RACF vaccination strategies (6-monthly, 12-monthly, no further vaccines); additional non-pharmaceutical interventions (10, 25, 50% efficacy); and reduction in incursions (30% or 60%).
UNASSIGNED: Total RACF outcomes were proportional to cumulative community infections and incursion rates, suggesting potential for strategic visitation/staff policies or community-based interventions to reduce deaths. Recency of vaccination when epidemic waves occurred was critical; compared with 6-monthly boosters, 12-monthly boosters had approximately 1.2 times more deaths and no further boosters had approximately 1.6 times more deaths over July 2023-June 2024. Additional NPIs, even with only 10-25% efficacy, could lead to a 13-31% reduction in deaths in RACFs.
UNASSIGNED: Future community epidemic wave patterns are unknown but will be major drivers of outcomes in RACFs. Maintaining high coverage of recent vaccination, minimizing incursions, and increasing NPIs can have a major impact on cumulative infections and deaths.
UNASSIGNED: The model simulated outbreaks in RACFs over time, and was calibrated to distributions for outbreak size, outbreak duration, and case fatality rate in Victorian RACFs over 2022. The number of incursions to RACFs per day were estimated to fit total deaths and diagnoses over time and community prevalence.Total infections, diagnoses, and deaths in RACFs were estimated over July 2023-June 2024 under scenarios of different: community epidemic wave assumptions (magnitude and frequency); RACF vaccination strategies (6-monthly, 12-monthly, no further vaccines); additional non-pharmaceutical interventions (10, 25, 50% efficacy); and reduction in incursions (30% or 60%).
UNASSIGNED: Total RACF outcomes were proportional to cumulative community infections and incursion rates, suggesting potential for strategic visitation/staff policies or community-based interventions to reduce deaths. Recency of vaccination when epidemic waves occurred was critical; compared with 6-monthly boosters, 12-monthly boosters had approximately 1.2 times more deaths and no further boosters had approximately 1.6 times more deaths over July 2023-June 2024. Additional NPIs, even with only 10-25% efficacy, could lead to a 13-31% reduction in deaths in RACFs.
UNASSIGNED: Future community epidemic wave patterns are unknown but will be major drivers of outcomes in RACFs. Maintaining high coverage of recent vaccination, minimizing incursions, and increasing NPIs can have a major impact on cumulative infections and deaths.
摘要：
■居住老年人护理设施(RACF)中发生的COVID-19死亡人数不成比例，需要更好的证据来针对COVID-19干预措施以预防死亡。本研究使用基于代理的模型来评估社区患病率的作用，疫苗接种策略,维多利亚州RACF对COVID-19结局的非药物干预（NPI），澳大利亚。
■该模型随时间模拟了RACF中的爆发，并根据爆发规模的分布进行了校准，爆发持续时间，和2022年维多利亚州RACF的病死率。估计每天对RACF的入侵次数符合总死亡人数和随时间和社区患病率的诊断。总感染，诊断,在2023年7月至2024年6月的不同情景下，估计了RACF的死亡人数：社区流行波假设（幅度和频率）；RACF疫苗接种策略（6个月，12个月，没有进一步的疫苗）；其他非药物干预措施（10、25、50％的疗效）；并减少了侵入（30％或60％）。
■总的RACF结果与累积的社区感染和侵入率成正比，建议战略访问/工作人员政策或基于社区的干预措施以减少死亡的潜力。流行浪潮发生时接种疫苗的时间至关重要；与6个月的助推器相比，在2023年7月至2024年6月期间，12个月的助推器的死亡人数增加了约1.2倍，没有进一步的助推器的死亡人数增加了约1.6倍。额外的NPI,即使只有10-25%的功效，可能导致RACF死亡减少13-31%。
■未来的社区流行浪潮模式是未知的，但将是RACF结果的主要驱动因素。保持近期疫苗接种的高覆盖率，尽量减少入侵，增加NPI会对累积感染和死亡产生重大影响。
■该模型随时间模拟了RACF中的爆发，并根据爆发规模的分布进行了校准，爆发持续时间，和2022年维多利亚州RACF的病死率。估计每天对RACF的入侵次数符合总死亡人数和随时间和社区患病率的诊断。总感染，诊断,在2023年7月至2024年6月的不同情景下，估计了RACF的死亡人数：社区流行波假设（幅度和频率）；RACF疫苗接种策略（6个月，12个月，没有进一步的疫苗）；其他非药物干预措施（10、25、50％的疗效）；并减少了侵入（30％或60％）。
■总的RACF结果与累积的社区感染和侵入率成正比，建议战略访问/工作人员政策或基于社区的干预措施以减少死亡的潜力。流行浪潮发生时接种疫苗的时间至关重要；与6个月的助推器相比，在2023年7月至2024年6月期间，12个月的助推器的死亡人数增加了约1.2倍，没有进一步的助推器的死亡人数增加了约1.6倍。额外的NPI,即使只有10-25%的功效，可能导致RACF死亡减少13-31%。
■未来的社区流行浪潮模式是未知的，但将是RACF结果的主要驱动因素。保持近期疫苗接种的高覆盖率，尽量减少入侵，增加NPI会对累积感染和死亡产生重大影响。
