Abstract
Care homes are vulnerable to widespread transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) with poor outcomes for staff and residents. Infection control interventions in care homes need to not only be effective in containing the spread of coronavirus disease 2019 (COVID-19) but also feasible to implement in this special setting which is both a healthcare institution and a home. We developed an agent-based model that simulates the transmission dynamics of COVID-19 via contacts between individuals, including residents, staff members, and visitors in a care home setting. We explored a representative care home in Scotland in our base case and explore other care home setups in an uncertainty analysis. We evaluated the effectiveness of a range of intervention strategies in controlling the spread of COVID-19. In the presence of the reference interventions that have been implemented in many care homes, including testing of new admissions, isolation of symptomatic residents, and restricted public visiting, routine testing of staff appears to be the most effective and practical approach. Routine testing of residents is no more effective as a reference strategy while routine testing of both staff and residents only shows a negligible additive effect. Modeling results are very sensitive to transmission probability per contact, but the qualitative finding is robust to varying parameter values in our uncertainty analysis. Our model predictions suggest that routine testing should target staff in care homes in conjunction with adherence to strict hand hygiene and using personal protective equipment to reduce risk of transmission per contact.
Highlights
Care homes are vulnerable to widespread transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) with poor outcomes for staff and residents
We present an Agent-based models (ABMs) that captures heterogeneity and stochasticity of individuals’ disease progression and interaction patterns and their effect on transmission dynamics of SARS-CoV-2 and the effectiveness of control interventions in a care-home setting
Care homes are diverse in terms of their resident population, structure and management, and ABMs have more flexibility compared to simpler epidemiological compartment models to reflect this variation and to examine how it influences findings
Summary
Care homes are vulnerable to widespread transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) with poor outcomes for staff and residents. Infection control interventions in care homes need to be effective in containing the spread of coronavirus disease 2019 (COVID-19) and feasible to implement in this special setting which is both a healthcare institution and a home. Methods: We developed an agent-based model that simulates the transmission dynamics of COVID-19 via contacts between individuals, including residents, staff members, and visitors in a care home setting. We evaluated the effectiveness of a range of intervention strategies in controlling the spread of COVID-19. Results: In the presence of the reference interventions that have been implemented in many care homes, including testing of new admissions, isolation of symptomatic residents, and restricted public visiting, routine testing of staff appears to be the most effective and practical approach. Conclusions: Our model predictions suggest that routine testing should target staff in care homes in conjunction with adherence to strict hand hygiene and using personal protective equipment to reduce risk of transmission per contact. (Received 27 August 2020; accepted 8 December 2020; electronically published 14 December 2020)
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