Why are some outbreaks worse than others? COVID-19 outbreak management strategies from a PHU perspective.

BACKGROUND: From a Public Health Unit (PHU) perspective, this review aimed to examine factors associated with adverse outbreak outcomes, to identify evidence based focal strategies of managing COVID-19 outbreaks in aged care settings. METHODS: A retrospective review of PHU documentation examined all 55 COVID-19 outbreaks in Wide Bay RACFs across the first 3 COVID-19 waves in Queensland, through thematic and statistical analysis. ​. RESULTS: Thematic analysis using the framework approach identified 5 themes associated with outcomes of COVID-19 outbreaks in RACFs. These were analysed for statistical significance against outbreak outcomes including duration, attack rate and case fatality rate. There was a significant relationship between memory support unit (MSU) involvement and adverse outbreak outcomes. Attack rate was significantly associated with communication frequency, symptom monitoring and case detection approach, staff shortages and cohorting. Staff shortages were also significantly associated with a prolonged outbreak duration. There was no statistically significant relationship between outbreak outcomes and resource availability or infection control strategy. ​. CONCLUSIONS: This emphasises the importance of frequent communication between PHUs and RACFs during active outbreaks, as well as the need for regular symptom monitoring and prompt case detection, to minimise viral transmission. Staff shortages and cohorting are also crucial factors to be addressed during outbreak management. IMPLICATIONS FOR PUBLIC HEALTH: This review adds to the evidence basis of COVID-19 outbreak management strategies to improve PHU advice to RACFs, to mitigate viral transmission and ultimately reduce the burden of disease associated with COVID-19 and other communicable diseases.