The COVID-19 Pandemic and Responses in Nursing Homes: A Cross-Sectional Study in Four European Countries

Background: Studies comparing how the European nursing homes (NHs) handled the first wave of the COVID-19 pandemic remain scarce. Methods: A cross-sectional study was conducted during the first wave in a private NHs network in Belgium, France, Germany and Italy. Mortality rates were estimated, and prevention and control measures were described by country. Data from the Oxford governmental response tracker project were used to elaborate a "modified stringency index" measuring the magnitude of the COVID-19 global response. Results: Of the 580 NHs surveyed, 383 responded to the online questionnaire. The COVID-19 mortality rate was similar in France (3.9 deaths per 100 residents) and Belgium (4.5). It was almost four times higher in Italy (11.9) and particularly low in Germany (0.3). Prevention and control measures were diversely implemented: residents' sectorization was mainly carried out in France and Italy (similar to 90% versus similar to 30% in Germany and Belgium). The "modified stringency index" followed roughly the same pattern in each country. Conclusion: This study, conducted in a European network of NHs, showed differences in mortality rate which could be explained by the characteristics of the residents, the magnitude of the first wave and the prevention and control measures implemented. These results may inform future European preparedness plans.