The Government of Canada, through its COVID-19 Immunity Task Force (CITF), is supporting a study in the Maritimes aimed at determining which health factors cause long-term care residents to experience severe COVID-19 outcomes, including death.

The study is also investigating vaccine effectiveness in its elderly population over the next year. This $1.9 million study will be carried out by a team of experts in frailty research, immunology, virology and clinical infectious disease. The team is led by Dr. Lisa Barrett, an expert in infectious diseases and a clinician scientist at Dalhousie University and Nova Scotia Health.

“We still do not understand why residents in long-term care homes have been so badly affected by COVID-19,” says Dr. Barrett. “Our study aims to determine which health factors cause elderly people to be more susceptible to severe or fatal cases of COVID-19. What role does frailty play in COVID-19 outcomes? Do very frail people form an adequate antibody response to ward off reinfection? Does the presence of other viral infections affect COVID-19 disease severity? We aim to find out.”

Long-term protection?

Dr. Barrett’s study will involve residents of long-term care facilities in Halifax, Nova Scotia. As of September 2020, two of the facilities included in the study had accounted for over 30 per cent of Nova Scotia’s COVID-19 cases and 82 per cent of the province’s COVID-19-related deaths. Interestingly, while one facility had a COVID-19 outbreak last spring, the other had very few cases. This will allow the study team to compare the immune response in residents who were never infected, residents who were highly exposed but never infected, residents who had moderate cases of COVID-19 and residents who had severe cases of the disease. In the first-wave cohort, residents of the facilities all enthusiastically volunteered to participate in the research, which has provided meaningful data. 

The study is also investigating whether vaccines protect residents in long-term care facilities from reinfection, or at least from severe cases of the disease.

“Although all vaccines undergo rigorous trials before being approved, the trials did not include frail elderly people,” explains Dr. Barrett. “We took blood samples before vaccination and have taken another blood sample after the first dose of vaccine. We will be taking four blood samples after the second dose from all residents participating over the next year. This will allow us to study their body’s immune response over time to see if the vaccines work effectively in frail elderly people.”

In addition to examining the immunologic changes associated with COVID-19, this study will also help provide an understanding of immunology in an older population, which will be important for vaccine development and healthy aging.

“COVID-19 has taken an enormous toll on the elderly and studies like this one are needed so we can better protect them going forward,” says Gail Tomblin Murphy, vice-president, research, innovation and discovery and chief nurse executive, Nova Scotia Health and CITF Leadership Group member. “We need to understand what makes people more at-risk of severe COVID-19. We also need to understand how effective the vaccines are in stopping the spread of COVID-19 in long-term care facilities. This study will help provide those answers.”

Ensuring effective vaccine use

“There has never been a greater need to conduct medical and health-related research to collect real-time evidence to inform practice, policy and decision-making during the COVID-19 pandemic,” says Alice Aiken, vice-president research and innovation at Dalhousie. “We are incredibly proud of Dr. Barrett, who is at the centre of the fight against COVID-19 as one of Canada’s leading voices on infectious-disease mitigation.”

“This study will contribute to our understanding of COVID-19 and of vaccine-induced immunity in seniors living in long-term care facilities, who have been disproportionately affected by COVID-19,” state, Dr. Theresa Tam, Canada’s chief public health officer. “Vaccines are critical to limiting the spread of COVID-19, and this research will support their most effective use.”