Surveillance of COVID-19 in long-term care facilities in the EU/EEA 2021-2023

Surveillance and monitoring

European Centre for Disease Prevention and Control. Surveillance of COVID-19 in long-term care facilities in the EU/EEA, 2020–2023. Stockholm: ECDC; 2024.

Long-term care facilities (LTCFs) such as nursing homes or residential care homes, often serve as residencies for elderly individuals who have medical and social vulnerabilities. Before the COVID-19 pandemic, the EU/EEA lacked national incidence surveillance systems for healthcare-associated infections (HAIs) in long-term care facilities (LTCFs). In 2020, ECDC prepared a protocol for the surveillance of COVID-19 in European LTCFs, and countries started reporting data to The European Surveillance System (TESSy) in January 2021. From March 2021, ECDC published reports using these surveillance data.

Executive Summary

From 2020 to March 2023, 17 EU/EEA countries have reported data to the voluntary surveillance system via TESSy; seven of them continuously during this period. All participating countries reported at least one indicator related to confirmed COVID-19 cases and fatalities, allowing the surveillance to reach its primary objective of monitoring national-level trends of COVID-19 in LTCFs. The highest incidence of COVID-19 in LTCFs was reported in 2020, and also from late 2021 until early 2022, depending on the country. The largest number of fatalities was reported during the spring and autumn of 2020. 

The surveillance system also allowed analyses to support the assessment of the impact of COVID-19 on LTCFs in the EU/EEA. The case fatality rate (CFR) in pooled data from seven countries, weighted by number of reported cases in each country, declined from 21.3% in Q4-2020 to 16.3% in Q1-2021, remaining between 11 and 17% for the remainder of 2021, until declining further to 3.4% in Q1-2022, and remaining at 3 to 4% throughout 2022 and until Q1-2023.

Comparisons between different countries' weekly national data and indicators should be made with caution due to differences in national definitions, limited availability of denominator data, and changes in national testing strategies over time.

Prior to the COVID-19 pandemic, there were largely no established incidence surveillance systems for healthcare-associated infections (HAIs) in LTCFs in EU/EEA countries due to the low resources for surveillance in these settings. European-level surveillance of HAIs in LTCFs was performed through periodic point prevalence surveys (PPSs) in 2010, 2013, and 2016–2017 [3,4,5]. These surveys estimated that there were as many HAIs in LTCFs each year as in acute care hospitals in the EU/EEA [6].

The people who reside in LTCFs are commonly elderly people who have an increased vulnerability to respiratory tract infections, including COVID-19, and often suffer from an adverse outcome if ill with these infections. An EU/EEA network of national COVID-19 LTCF surveillance networks was established in 2020 [7], with data collection starting in early 2021. Retrospective data for 2020 was collected where possible [8].

These surveillance data were regularly reported in the ECDC weekly COVID-19 reports from spring 2021 until summer 2023, and in a separate technical report which was published in November 2021 [1,2]. This report collects all COVID-19 LTCF data reported to ECDC from 2021 and concludes the EU/EEA LTCF COVID-19 specific surveillance data collection from 2021-2023.