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. 2021 Jan 7;118(1):e2015455118.
doi: 10.1073/pnas.2015455118.

Nursing home staff networks and COVID-19

M Keith Chen  1 , Judith A Chevalier  2   3 , Elisa F Long  4
Affiliations

Nursing home staff networks and COVID-19

M Keith Chen et al. Proc Natl Acad Sci U S A. .

Abstract

Nursing homes and other long-term care facilities account for a disproportionate share of COVID-19 cases and fatalities worldwide. Outbreaks in US nursing homes have persisted despite nationwide visitor restrictions beginning in mid-March. An early report issued by the Centers for Disease Control and Prevention identified staff members working in multiple nursing homes as a likely source of spread from the Life Care Center in Kirkland, WA, to other skilled nursing facilities. The full extent of staff connections between nursing homes-and the role these connections serve in spreading a highly contagious respiratory infection-is currently unknown given the lack of centralized data on cross-facility employment. We perform a large-scale analysis of nursing home connections via shared staff and contractors using device-level geolocation data from 50 million smartphones, and find that 5.1% of smartphone users who visited a nursing home for at least 1 h also visited another facility during our 11-wk study period-even after visitor restrictions were imposed. We construct network measures of connectedness and estimate that nursing homes, on average, share connections with 7.1 other facilities. Traditional federal regulatory metrics of nursing home quality are unimportant in predicting outbreaks, consistent with recent research. Controlling for demographic and other factors, a home's staff network connections and its centrality within the greater network strongly predict COVID-19 cases.

Keywords: COVID-19; complex networks; nursing homes; smartphone data.

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Conflict of interest statement

The authors declare no competing interest.

Figures

Fig. 1.
Fig. 1.
Degree distribution of nursing homes with and without COVID cases (reported to CMS as of May 31, 2020).
Fig. 2.
Fig. 2.
Network structure of selected nursing home facilities in Alabama (A), California (B), Florida (C), Georgia (D), New York (E), and Pennsylvania (F). Details for each hub facility are provided in Table 2.
See this image and copyright information in PMC

References

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