Abstract
COVID-19 poses a major challenge to care homes, as SARS-CoV-2 is readily transmitted and causes disproportionately severe disease in older people. Here, 1167 residents from 337 care homes were identified from a dataset of 6600 COVID-19 cases from the East of England. Older age and being a care home resident were associated with increased mortality. SARS-CoV-2 genomes were available for 700 residents from 292 care homes. By integrating genomic and temporal data, 409 viral clusters within the 292 homes were identified, indicating two different patterns - outbreaks among care home residents and independent introductions with limited onward transmission. Approximately 70% of residents in the genomic analysis were admitted to hospital during the study, providing extensive opportunities for transmission between care homes and hospitals. Limiting viral transmission within care homes should be a key target for infection control to reduce COVID-19 mortality in this population.
Highlights
Care homes are at high risk of experiencing outbreaks of SARS-CoV-2
The study population included almost half of the COVID-19 cases diagnosed in the East of England (EoE) at this time (Public Health England, 2020a), with the remainder being tested at other laboratory sites. 122 1,167 / 6,413 (18.2%) of the study population were identified as care home residents from 337 care 123 homes. 193 / 337 (57.3%) care homes were residential homes and 144 / 337 (42.7%) were nursing homes, with the majority located in five counties across EoE: Essex, Hertfordshire, Bedfordshire, Suffolk and Cambridgeshire (Figure 2)
Care home residents comprised a large fraction of COVID-19 diagnoses in the “first wave” of the pandemic in this region: up to a quarter of patients in the peak weeks of late March and early April tested at Cambridge University Hospitals (CUH) were admitted from care homes
Summary
Care homes are at high risk of experiencing outbreaks of SARS-CoV-2. COVID-19 is associated with higher mortality in older people and those with comorbidities including cardiovascular and respiratory disease (Williamson et al, 2020), making the care home population especially vulnerable. SARS-CoV-2 transmission in care homes has not been systematically studied with linkage of epidemiological and genomic data on a large scale. While clusters involving care home residents and healthcare workers were observed, the study was not intended to analyse care home transmission and focused on samples tested at CUH to provide information for IPC on potentially hospital-acquired infections. Previous epidemiological studies of COVID-19 in care homes have been limited in population size, temporal scale and/or the amount of genomic data included (Arons et al, 2020; Burton et al, 2020; Graham et al, 2020; Kemenesi et al, 2020; Quicke et al, 2020). Genomic epidemiology is used to investigate viral transmission dynamics in care home residents across the East of England (EoE), the fourth largest of the nine official regions in England (Office for National Statistics, 2011). Several key questions of public health concern are addressed: What is the burden of care home-associated COVID-19 tested in the region? What are the outcomes for care home residents admitted to hospital with COVID-19? Does SARS-CoV-2 spread between care home residents from the same care home via a single introduction and subsequent transmission, or through multiple independent acquisitions of the virus among residents? is there evidence of viral transmission between care homes and hospitals?
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