Mass testing after a single suspected or confirmed case of COVID-19 in London care homes, April–May 2020: implications for policy and practice

Abstract

Introduction: Previous investigations have identified high rates of SARS-CoV-2 infection among residents and staff in care homes reporting an outbreak of COVID-19. We investigated care homes reporting a single suspected or confirmed case to assess whether early mass testing might reduce risk of transmission during the peak of the pandemic in London. Methods: Between 18–27 April 2020, residents and staff in care homes reporting a single case of COVID-19 to Public Health England had a nasal swab to test for SARS-CoV-2 infection by RT-PCR and subsequent whole genome sequencing. Residents and staff in two care homes were re-tested eight days later. Results: Four care homes were investigated. SARS-CoV-2 positivity was 20% (65/333) overall, ranging between 3–59%. Among residents, positivity ranged between 3–76% compared to 3–40% in staff. Half of the SARS-CoV-2 positive residents (23/46, 50%) and 63% of staff (12/19) reported symptoms within 14 days before or after testing. Repeat testing 8 days later in two care homes with the highest infection rates identified only two new cases. Genomic analysis demonstrated a small number of introductions of the virus into care homes, and distinct clusters within three of the care homes. Conclusions: We found extensive but variable rates of SARS-CoV-2 infection among residents and staff in care homes reporting a single case of COVID-19. While routine whole home testing has now been adopted into practice, care homes must remain vigilant and should be encouraged to report a single suspected case, which should trigger appropriate outbreak control measures.

Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses

“…Furthermore, nursing homes with open-layout designs and large rooms divided into smaller individual rooms by use of wooden screens may have contributed to outbreaks in Hong Kong nursing homes due to inadequate ventilation. In these homes, four-foot high wooden screens were used to divide whole floors into numerous single-person bedspaces [ 23 ].…”

“…In some countries, the previous occurrence of other viral epidemics (e.g. SARS-CoV, MERS-CoV, H1N1) meant that there was a degree of understanding and preparedness surrounding mitigation of transmission in relation to PPE and sanitation [ 23 ]. However, for nursing homes in many other countries, COVID-19 represented their first learning curve.…”

“…To maintain social connection, numerous methods were observed, for example via window or behind-glass visiting [ 23 ]. Video calls alongside letters and telephone calls were reported to aid in reducing depression among nursing home residents, and were also associated with positive social interaction, decreased loneliness, and better quality of life [ 74 , 75 ].…”

Case–control study to estimate odds of death within 28 days of positive test for SARS-CoV-2 prior to vaccination for residents of long-term care facilities in England, 2020–2021

“…Studies have shown that once SARS-CoV-2 infection is introduced into an LTCF, it is difficult to limit transmission despite implementation of robust control measures. 13 14 Given these challenges, key preventive measures include ensuring high vaccination uptake for residents and staff, including booster doses for waning immunity and maintenance of good infection control measures to prevent introduction and transmission of SARS-CoV-2. 15…”

“…In contrast, residents of LTCFs are less likely to be able to minimise their exposure to infectious persons because they are likely to be regularly exposed to staff providing care and may require more frequent contact with healthcare professionals due to medical needs. Studies have shown that once SARS-CoV-2 infection is introduced into an LTCF, it is difficult to limit transmission despite implementation of robust control measures 13 14. Given these challenges, key preventive measures include ensuring high vaccination uptake for residents and staff, including booster doses for waning immunity and maintenance of good infection control measures to prevent introduction and transmission of SARS-CoV-2 15…”