Effectiveness of a On-Site Medicalization Program for Nursing Homes with COVID-19 Outbreaks
Bernabeu-Wittel et al.
, Effectiveness of a On-Site Medicalization Program for Nursing Homes with COVID-19 Outbreaks
, J. Gerontol. A Biol. Sci. Med. Sci., doi:10.1093/gerona/glaa192
Retrospective 272 nursing home residents showing significantly improved survival after establishing a treatment program including HCQ with or without lopinavir/ritonavir and with the addition of adjuvant and antimicrobial treatments depending on circumstances. Dosage details are in the supplementary appendix. Mortality relative risk is from [Alexander]
risk of death, 59.0% lower, RR 0.41, p = 0.03, treatment 189, control 83.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Bernabeu-Wittel et al., 1 Aug 2020, retrospective, Spain, peer-reviewed, 13 authors, dosage 400mg bid day 1, 200mg bid days 2-7, this trial uses multiple treatments in the treatment arm (combined with lopinavir/ritonavir and antimicrobial treatments) - results of individual treatments may vary.
Abstract: EFFECTIVENESS OF A ON-SITE MEDICALIZATION PROGRAM FOR NURSING
HOMES WITH COVID-19 OUTBREAKS
Bernabeu-Wittel M*1,2(MD, PhD), Ternero-Vega JE1, Nieto-Martín MD1 (MD, PhD),
PhD), Rincón-Gómez M1 (MD, PhD), Díaz-Jiménez P1 (MD), Giménez-Miranda L1 (MD),
Lomas-Cabezas JM3 (MD, PhD), Muñoz-García MM4 (MD), Calzón-Fernández S5 (MD,
PhD), Ollero-Baturone M (MD, PhD)1.
Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
Full professor. Department of Medicine. University of Seville
Infectious Diseases Department, University Hospital Virgen del Rocío, Seville, Spain
Bermejales Primary Care Center. Primary Care District of Seville, Spain
Epidemiology and Public Health Department. Primary Care District of Seville, Spain
Internal Medicine Department. Hospital Universitario Virgen del Rocío
Avda. Manuel Siurot, s/n. 41013 Sevilla, SPAIN.
© The Author(s) 2020. Published by Oxford University Press on behalf of The
Gerontological Society of America. All rights reserved. For permissions, please e-mail:
Moreno-Gaviño L1 (MD, PhD), Conde-Guzmán C1 (MD, PhD), Delgado-Cuesta J1 (MD,
BACKGROUND: Nursing homes are highly vulnerable to the occurrence of COVID-19
outbreaks, which result in high lethality rates. Most of them are not prepared to SARS-CoV-2
METHODS: A coordinated on-site medicalization program (MP) in response to a sizeable
COVID-19 outbreak in four nursing homes was organized, with the objectives of improving
survival, offering humanistic palliative care to residents in their natural environment, and
reducing hospital referrals. Ten key processes and interventions were established (provision
of informatics infrastructure, medical equipment, and human resources, universal testing,
separation of 'clean' and 'contaminated' areas, epidemiological surveys, and unified protocols
stratifying for active or palliative care approach, among others). Main outcomes were a
composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to
RESULTS: 272 out of 457 (59.5%) residents and 85 out of 320 (26.5%) staff members were
affected. The SOPC, survival, and referrals to hospital, occurred in 77%, 72.5%, and 29% of
patients diagnosed before MP start, with respect to 97%, 83.7% and 17% of those diagnosed
during the program, respectively. The SOPC was independently associated to MP (OR=15
[3-81]); and survival in patients stratified to active approach, to the use of any antiviral
treatment (OR=28 [5-160]). All outbreaks were controlled in 39 [37-42] days.
CONCLUSIONS: A coordinated on-site medicalization program of nursing homes with
COVID-19 outbreaks achieved a higher survival or optimal palliative care rate, and a
reduction in referrals to hospital, thus ensuring rigorous but also humanistic and gentle care
KEYWORDS: COVID-19, SARS-CoV-2, community-based long-term care, frailty,
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