Infection and transmission of SARS-CoV-2 in London care homes reporting no cases or outbreaks of COVID-19: Prospective observational cohort study, England 2020

Care homes have been disproportionately affected by the COVID-19 pandemic. We investigated the potential role of asymptomatic infection and silent transmission in London care homes that reported no cases of COVID-19 during the first wave of the pandemic. Five care homes with no cases and two care ho...

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Vydáno v:The Lancet regional health. Europe Ročník 3; s. 100038
Hlavní autoři: Jeffery-Smith, Anna, Dun-Campbell, Kate, Janarthanan, Roshni, Fok, Jonathan, Crawley-Boevey, Emma, Vusirikala, Amoolya, Fernandez Ruiz De Olano, Elena, Sanchez Perez, Marina, Tang, Suzanne, Rowland, Thomas AJ, Wynne-Evans, Edward, Bell, Anita, Patel, Bharat, Amin-Chowdhury, Zahin, Aiano, Felicity, Paranthaman, Karthik, Ma, Thomas, Saavedra-Campos, Maria, Ellis, Joanna, Lackenby, Angie, Whitaker, Heather, Myers, Richard, Höschler, Katja, Brown, Kevin, Ramsay, Mary E, Shetty, Nandini, Chow, J. Yimmy, Ladhani, Shamez, Zambon, Maria
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Elsevier Ltd 01.04.2021
Elsevier
Témata:
Asymptomatic transmission
Care home
Internal Medicine
Public Health
Research Paper
SARS-CoV-2 outbreak
Care home
SARS-CoV-2 outbreak
Asymptomatic transmission
ISSN:2666-7762, 2666-7762
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Shrnutí:Care homes have been disproportionately affected by the COVID-19 pandemic. We investigated the potential role of asymptomatic infection and silent transmission in London care homes that reported no cases of COVID-19 during the first wave of the pandemic. Five care homes with no cases and two care homes reporting a single case of COVID-19 (non-outbreak homes) were investigated with nasal swabbing for SARS-CoV-2 RT-PCR and serology for SARS-CoV-2 antibodies five weeks later. Whole genome sequencing (WGS) was performed on RT-PCR positive samples. Serology results were compared with those of six care homes with recognised outbreaks. Across seven non-outbreak homes, 718 (387 staff, 331 residents) individuals had a nasal swab and 651 (386 staff, 265 residents) had follow-up serology. Sixteen individuals (13 residents, 3 staff) in five care homes with no reported cases were RT-PCR positive (care home positivity rates, 0 to 7.6%) compared to 13 individuals (3.0 and 10.8% positivity) in two homes reporting a single case. Seropositivity across these seven homes varied between 10.7-56.5%, with four exceeding community seroprevalence in London (14.8%). Seropositivity rates for staff and residents correlated significantly (rs 0.84, [95% CI 0.51-0.95] p <0.001) across the 13 homes. WGS identified multiple introductions into some homes and silent transmission of a single lineage between staff and residents in one home. We found high rates of asymptomatic infection and transmission even in care homes with no COVID-19 cases. The higher seropositivity rates compared to RT-PCR positivity highlights the true extent of the silent outbreak. PHE
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ISSN:2666-7762
2666-7762
DOI:10.1016/j.lanepe.2021.100038