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Risk factors for outbreaks of SARS-CoV-2 infection at retirement homes in Ontario, Canada: a population-level cohort study
Andrew P. Costa, Derek R. Manis, Aaron Jones, Nathan M. Stall, Kevin A. Brown, Veronique Boscart, Adriane Castellino, George A. Heckman, Michael P. Hillmer, Chloe Ma, Paul Pham, Saad Rais, Samir K. Sinha and Jeffrey W. Poss
CMAJ May 10, 2021 193 (19) E672-E680; DOI: https://doi.org/10.1503/cmaj.202756
Andrew P. Costa
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
PhDDerek R. Manis
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
MHScAaron Jones
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
PhDNathan M. Stall
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
MDKevin A. Brown
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
MSc PhDVeronique Boscart
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
RN PhDAdriane Castellino
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
MBAGeorge A. Heckman
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
MD MScMichael P. Hillmer
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
MSc PhDChloe Ma
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
MAPaul Pham
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
BEngSaad Rais
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
MScSamir K. Sinha
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
MD DPhilJeffrey W. Poss
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph’s Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph’s Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women’s College Research Institute, Women’s College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
PhDData supplements
Online appendices
- Appendix 1: Care Services Available to Residents (Directly or Indirectly)
- Appendix 2: Rolling 14-day COVID-10 case count, by Public Health Unit Region, Ontario, Mar 1-Dec. 18 2020
- Appendix 3: Number of Retirement Home Outbreaks per week, Ontario, Mar 1- Dec. 18 2020 (N=770 homes)
- Appendix 4: Cumulative Count of Retirement Home COVID-19 Cases and Deaths, Ontario, Mar 1-Dec. 18 2020 (N=770 homes)
Related Articles
- Costa, A. P., Manis, D. R., Jones, A., Stall, N. M., Brown, K. A., Boscart, V., Castellino, A., Heckman, G. A., Hillmer, M. P., Ma, C., Pham, P., Rais, S., Sinha, S. K., & Poss, J. W. (2021). Facteurs de risque d’éclosion de SRAS-CoV-2 dans les résidences pour aînés en Ontario, au Canada: étude de cohorte à l’échelle de la population. CMAJ, 193(25), E969-E977. Accessed May 13, 2024. https://doi.org/10.1503/cmaj.202756-f.
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Risk factors for outbreaks of SARS-CoV-2 infection at retirement homes in Ontario, Canada: a population-level cohort study
Andrew P. Costa, Derek R. Manis, Aaron Jones, Nathan M. Stall, Kevin A. Brown, Veronique Boscart, Adriane Castellino, George A. Heckman, Michael P. Hillmer, Chloe Ma, Paul Pham, Saad Rais, Samir K. Sinha, Jeffrey W. Poss
CMAJ May 2021, 193 (19) E672-E680; DOI: 10.1503/cmaj.202756
Risk factors for outbreaks of SARS-CoV-2 infection at retirement homes in Ontario, Canada: a population-level cohort study
Andrew P. Costa, Derek R. Manis, Aaron Jones, Nathan M. Stall, Kevin A. Brown, Veronique Boscart, Adriane Castellino, George A. Heckman, Michael P. Hillmer, Chloe Ma, Paul Pham, Saad Rais, Samir K. Sinha, Jeffrey W. Poss
CMAJ May 2021, 193 (19) E672-E680; DOI: 10.1503/cmaj.202756