Increased risk of SARS-CoV-2 infection in staff working across different care homes: enhanced CoVID-19 outbreak investigations in London care Homes

•21% of 255 staff working in 6 care homes with a COVID-19 outbreak were SARS-CoV-2 positive.•SARS-CoV-2 positivity was similar in staff with regular (18%), occasional (16%) or no (15%) resident contact.•SARS-CoV-2 positivity was 3-fold higher in staff working across different care homes.•Whole genom...

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Published in:The Journal of infection Vol. 81; no. 4; pp. 621 - 624
Main Authors: Ladhani, Shamez N, Chow, J. Yimmy, Janarthanan, Roshni, Fok, Jonathan, Crawley-Boevey, Emma, Vusirikala, Amoolya, Fernandez, Elena, Perez, Marina Sanchez, Tang, Suzanne, Dun-Campbell, Kate, Wynne-Evans, Edward, Bell, Anita, Patel, Bharat, Amin-Chowdhury, Zahin, Aiano, Felicity, Paranthaman, Karthik, Ma, Thomas, Saavedra-Campos, Maria, Myers, Richard, Ellis, Joanna, Lackenby, Angie, Gopal, Robin, Patel, Monika, Chand, Meera, Brown, Kevin, Hopkins, Susan, Consortium, CoG, Shetty, Nandini, Zambon, Maria, Ramsay, Mary E
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01.10.2020
Published by Elsevier Ltd on behalf of The British Infection Association
Subjects:
Betacoronavirus - genetics
Care homes
Coronavirus Infections - epidemiology
Coronavirus Infections - transmission
COVID-19
England - epidemiology
Genome, Viral - genetics
Homes for the Aged - statistics & numerical data
Humans
Infection Control - methods
London - epidemiology
Medical Staff - statistics & numerical data
Nursing Homes - statistics & numerical data
Occupational Exposure - adverse effects
Occupational risk
Pandemics
Pneumonia, Viral - epidemiology
Pneumonia, Viral - transmission
SARS-CoV-2
Transmission
Whole Genome Sequencing
England
London
COVID-19
SARS-CoV-2
Occupational risk
Transmission
Care homes
ISSN:0163-4453, 1532-2742, 1532-2742
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Summary:•21% of 255 staff working in 6 care homes with a COVID-19 outbreak were SARS-CoV-2 positive.•SARS-CoV-2 positivity was similar in staff with regular (18%), occasional (16%) or no (15%) resident contact.•SARS-CoV-2 positivity was 3-fold higher in staff working across different care homes.•Whole genome sequencing identified distinct clusters involving staff only. Care homes have been disproportionately affected by the COVID-19 pandemic and continue to suffer large outbreaks even when community infection rates are declining, thus representing important pockets of transmission. We assessed occupational risk factors for SARS-CoV-2 infection among staff in six care homes experiencing a COVID-19 outbreak during the peak of the pandemic in London, England. Care home staff were tested for SARS-COV-2 infection by RT-PCR and asked to report any symptoms, their contact with residents and if they worked in different care homes. Whole genome sequencing (WGS) was performed on RT-PCR positive samples. In total, 53 (21%) of 254 staff were SARS-CoV-2 positive but only 12/53 (23%) were symptomatic. Among staff working in a single care home, SARS-CoV-2 positivity was 15% (2/13), 16% (7/45) and 18% (30/169) in those reporting no, occasional and regular contact with residents. In contrast, staff working across different care homes (14/27, 52%) had a 3.0-fold (95% CI, 1.9–4.8; P<0.001) higher risk of SARS-CoV-2 positivity than staff working in single care homes (39/227, 17%). WGS identified SARS-CoV-2 clusters involving staff only, including some that included staff working across different care homes. SARS-CoV-2 positivity was significantly higher among staff working across different care homes than those who were working in the same care home. We found local clusters of SARS-CoV-2 infection between staff only, including those with minimal resident contact. Infection control should be extended for all contact, including those between staff, whilst on care home premises.
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ISSN:0163-4453
1532-2742
1532-2742
DOI:10.1016/j.jinf.2020.07.027