Abstract
BackgroundThe population of adult residential care homes has been shown to have high morbidity and mortality in relation to COVID‐19.MethodsWe examined 3115 hospital discharges to a national cohort of 1068 adult care homes and subsequent outbreaks of COVID‐19 occurring between 22 February and 27 June 2020. A Cox proportional hazards regression model was used to assess the impact of time‐dependent exposure to hospital discharge on incidence of the first known outbreak, over a window of 7‐21 days after discharge, and adjusted for care home characteristics, including size and type of provision.ResultsA total of 330 homes experienced an outbreak, and 544 homes received a discharge over the study period. Exposure to hospital discharge was not associated with a significant increase in the risk of a new outbreak (hazard ratio 1.15, 95% CI 0.89, 1.47, P = .29) after adjusting for care home characteristics. Care home size was the most significant predictor. Hazard ratios (95% CI) in comparison with homes of <10 residents were as follows: 3.40 (1.99, 5.80) for 10‐24 residents; 8.25 (4.93, 13.81) for 25‐49 residents; and 17.35 (9.65, 31.19) for 50+ residents. When stratified for care home size, the outbreak rates were similar for periods when homes were exposed to a hospital discharge, in comparison with periods when homes were unexposed.ConclusionOur analyses showed that large homes were at considerably greater risk of outbreaks throughout the epidemic, and after adjusting for care home size, a discharge from hospital was not associated with a significant increase in risk.
Highlights
The population of adult residential care homes has been shown to have high morbidity and mortality in relation to COVID-19
We aimed to use our national surveillance framework to test whether the risk of a COVID-19 outbreak in the period following a discharge from hospital to a care home was increased compared with other periods, in order to better understand the sources of infection and prevent further incidents
The results indicate strong confounding in the raw data by care home size, which was by far the strongest independent predictor of outbreak risk
Summary
The population of adult residential care homes has been shown to have high morbidity and mortality in relation to COVID-19. Exposure to hospital discharge was not associated with a significant increase in the risk of a new outbreak (hazard ratio 1.15, 95% CI 0.89, 1.47, P = .29) after adjusting for care home characteristics. Care homes are settings in which resident populations typically live in close proximity They experience outbreaks of gastrointestinal and respiratory illnesses, including norovirus and influenza, with associated morbidity and mortality; 70% of acute respiratory infection outbreaks in the UK occurred in care homes in the winter of 2018/19.1 Outbreak-associated infections may be introduced via human sources such as new admissions from home or hospital, via staff or via visitors. More recent data from the Care Quality Commission suggest that, to mid-June, 36% of care homes experienced an outbreak (defined as a single laboratory-confirmed case)[7] with a study of care homes across a large Scottish Health Board reporting a figure of 37%.7
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