{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:16:28Z","timestamp":1790792188709,"version":"4.1.0"},"reference-count":51,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T00:00:00Z","timestamp":1663632000000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008196","name":"M\u00e9decins Sans Fronti\u00e8res","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,9,1]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p&lt;0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p&lt;0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p&lt;0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation\/quarantine policy, etc) that affected case fatality and residents\u2019 and caregivers\u2019 overall well-being and mental health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-060276","type":"journal-article","created":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T12:06:24Z","timestamp":1663675584000},"page":"e060276","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0642-6606","authenticated-orcid":false,"given":"Morgane","family":"Dujmovic","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Training, Epicentre, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1733-8721","authenticated-orcid":false,"given":"Thomas","family":"Roederer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Training, Epicentre, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Severine","family":"Frison","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Training, Epicentre, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Melki","sequence":"additional","affiliation":[{"name":"Emergency Cell, M\u00e9decins Sans Fronti\u00e8res, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Lauvin","sequence":"additional","affiliation":[{"name":"Emergency Cell, M\u00e9decins Sans Fronti\u00e8res, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9736-414X","authenticated-orcid":false,"given":"Emmanuel","family":"Grellety","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Training, Epicentre, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,9,20]]},"reference":[{"key":"2025121605492867000_12.9.e060276.1","unstructured":"Etude DREES . En 2020, trois Ehpad sur quatre ONT EU Au moins un r\u00e9sident infect\u00e9 PAR La Covid-19, 2020. Available: https:\/\/drees.solidarites-sante.gouv.fr\/sites\/default\/files\/2021-07\/ER1196.pdf"},{"key":"2025121605492867000_12.9.e060276.2","unstructured":"Comas-Herrera A , Zalakain J L . Mortality associated with COVID-19 in care homes: international evidence, 2021. 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