TY - JOUR
T1 - Increased risk of SARS-CoV-2 infection in staff working across different care homes
T2 - enhanced CoVID-19 outbreak investigations in London care Homes
AU - London Care Home Investigation Team
AU - Ladhani, Shamez N
AU - Chow, J Yimmy
AU - Janarthanan, Roshni
AU - Fok, Jonathan
AU - Crawley-Boevey, Emma
AU - Vusirikala, Amoolya
AU - Fernandez, Elena
AU - Perez, Marina Sanchez
AU - Tang, Suzanne
AU - Dun-Campbell, Kate
AU - Wynne-Evans, Edward
AU - Bell, Anita
AU - Patel, Bharat
AU - Amin-Chowdhury, Zahin
AU - Aiano, Felicity
AU - Paranthaman, Karthik
AU - Ma, Thomas
AU - Saavedra-Campos, Maria
AU - Myers, Richard
AU - Ellis, Joanna
AU - Lackenby, Angie
AU - Gopal, Robin
AU - Patel, Monika
AU - Chand, Meera
AU - Brown, Kevin
AU - Hopkins, Susan
AU - Consortium, CoG
AU - Shetty, Nandini
AU - Zambon, Maria
AU - Ramsay, Mary E
AU - Bashton, Matthew
AU - Smith, Darren
AU - Nelson, Andrew
N1 - Copyright © 2020. Published by Elsevier Ltd.
PY - 2020/10
Y1 - 2020/10
N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.
AB - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.
KW - Betacoronavirus/genetics
KW - COVID-19
KW - Coronavirus Infections/epidemiology
KW - England/epidemiology
KW - Genome, Viral/genetics
KW - Homes for the Aged/statistics & numerical data
KW - Humans
KW - Infection Control/methods
KW - London/epidemiology
KW - Medical Staff/statistics & numerical data
KW - Nursing Homes/statistics & numerical data
KW - Occupational Exposure/adverse effects
KW - Pandemics
KW - Pneumonia, Viral/epidemiology
KW - SARS-CoV-2
KW - Whole Genome Sequencing
U2 - 10.1016/j.jinf.2020.07.027
DO - 10.1016/j.jinf.2020.07.027
M3 - Article
C2 - 32735893
SN - 0163-4453
VL - 81
SP - 621
EP - 624
JO - Journal of Infection
JF - Journal of Infection
IS - 4
ER -