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. 2021 Sep 10;11(1):18093.
doi: 10.1038/s41598-021-97612-w.

Continued need for non-pharmaceutical interventions after COVID-19 vaccination in long-term-care facilities

Jay Love  1 , Lindsay T Keegan  2 , Frederick J Angulo  3 , John M McLaughlin  3 , Kimberly M Shea  3 , David L Swerdlow  3 , Matthew H Samore  2 , Damon J A Toth  2
Affiliations

Continued need for non-pharmaceutical interventions after COVID-19 vaccination in long-term-care facilities

Jay Love et al. Sci Rep. .

Abstract

Long-term care facilities (LTCFs) bear disproportionate burden of COVID-19 and are prioritized for vaccine deployment. LTCF outbreaks could continue occurring during vaccine rollout due to incomplete population coverage, and the effect of vaccines on viral transmission are currently unknown. Declining adherence to non-pharmaceutical interventions (NPIs) against within-facility transmission could therefore limit the effectiveness of vaccination. We built a stochastic model to simulate outbreaks in LTCF populations with differing vaccination coverage and NPI adherence to evaluate their interacting effects. Vaccination combined with strong NPI adherence produced the least morbidity and mortality. Healthcare worker vaccination improved outcomes in unvaccinated LTCF residents but was less impactful with declining NPI adherence. To prevent further illness and deaths, there is a continued need for NPIs in LTCFs during vaccine rollout.

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Conflict of interest statement

Drs. Angulo, Mclaughlin, Shea, and Swerdlow reported being employed by Pfizer Vaccines. This work was supported by Pfizer. Pfizer Inc. reviewed this manuscript and approved the decision to submit the manuscript for publication. Drs. Love, Keegan, Samore, and Toth received funding from Pfizer in support of this study.

Figures

Figure 1
Figure 1
Disease outcomes by scenario. Comparison of total infections, severe infections in residents, hospitalizations, and deaths over 100 days in simulated populations of 100 residents and 51 healthcare workers at long-term care facilities. Scenarios 1, 2, and 3 paired vaccination with strong, gradually reduced, and weak adherence to NPIs, respectively. Scenario BL (baseline) included no vaccination but strong adherence to NPIs. Reduction in infection and disease burden was weaker under relaxing or weak NPI adherence when compared to the strong NPI adherence scenario. Boxplots show median, 1st and 3rd quartile, and whiskers extend to 1.5 times the interquartile range. Statistical outliers included as open circles.
Figure 2
Figure 2
Impact of vaccine coverage on COVID-19 deaths (top row) and infections (bottom row). Heatmaps of the impact of vaccine coverage on COVID-19 deaths (top) and infections (bottom) in simulated long-term care facility populations of 51 healthcare workers and 100 residents for three scenarios with different NPI adherence. Warmer colors indicate more deaths/infections. Per vaccine, vaccinating healthcare workers prevents more deaths when NPI adherence is high (Scenario 1, left), but that impact declines substantially when NPI adherence wanes (Scenario 2, middle) or is low (Scenario 3, right).
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