Penetration and impact of COVID-19 in long term care facilities in England: population surveillance study

Abstract

Background Long-term care facilities (LTCF) worldwide have suffered high rates of COVID-19, reflecting the vulnerability of the persons who live there and the institutional nature of care delivered. This study describes the impact of the pandemic on incidences and deaths in LTCF across England. Methods Laboratory-confirmed SARS-CoV-2 cases in England, notified to Public Health England from 01 Jan to 25 Dec 2020, were address-matched to an Ordnance Survey reference database to identify residential property classifications. Data were analysed to characterize cases and identify clusters. Associated deaths were defined as death within 60 days of diagnosis or certified as cause of death. Results Of 1 936 315 COVID-19 cases, 81 275 (4.2%) and 10 050 (0.52%) were identified as resident or staff in an LTCF, respectively, with 20 544 associated deaths in residents, accounting for 31.3% of all COVID-19 deaths. Cases were identified in 69.5% of all LTCFs in England, with 33.1% experiencing multiple outbreaks. Multivariable analysis showed a 67% increased odds of death in residents [adjusted odds ratio (aOR): 1.67, 95% confidence interval (CI): 1.63–1.72], compared with those not residing in LTCFs. A total of 10 321 outbreaks were identified at these facilities, of which 8.2% identified the first case as a staff member. Conclusions Over two-thirds of LTCFs have experienced large and widespread outbreaks of COVID-19, and just under one-third of all COVID-19 deaths occurring in this setting in spite of early policies. A key implication of our findings is upsurges in community incidences seemingly leading to increased outbreaks in LTCFs; thus, identifying and shielding residents from key sources of infection are vital to reduce the number of future outbreaks.

Increased Residential Clustering of COVID-19 Cases Associated With SARS-CoV-2 Variant of Concern B.1.1.7

“…Positive SARS-CoV-2 patients were matched using residential address data in PHE’s surveillance system to reference databases to derive Unique Property Reference Number and Basic Land and Property Unit. 10 The surveillance system holds two addresses for each case from: National Health Service (NHS) summary care record (a minimum data set for all persons registered with the NHS) and laboratory information management system. The latter address was used preferentially as it should reflect the address at time of testing, as opposed to the centrally held NHS address which may not include recent or temporary address changes.…”

Differential Impact of Quarantine Policies for Recovered COVID-19 Cases in England: A Case Cohort Study of Surveillance Data, June to December 2020

“…Data on laboratory-con rmed COVID-19 cases in England noti ed to Public Health England, as per statutory obligation, through national surveillance infrastructure for the period 29th June to 28th December 2020 were extracted [18]. Residential address data as reported at the time of testing, or National Health Service (NHS) summary care records if unavailable, were matched to Ordnance Survey reference databases to identify property type [19,20]. Analyses were restricted to cases resident in private dwellings (Basic Land and Property Unit codes: RD, RD01-04, RD06-08, RD10, RH01-03, PP) and registered Houses of Multiple Occupancy (HMOs) (RH, RH01-03).…”

“…Relative deprivation was assessed using deciles of the Index of Multiple Deprivation (IMD) linked to residential lower super output area, by use of postcode data supplied by reporting laboratories [19].…”

“…An increasing gradient in likelihood of subsequent household cases within 11-28 days was seen according to increasing levels of socioeconomic deprivation (IMD 1 vs. 10; aOR = 1.13, 95% CI = 1.09-1. 19). Compared to cases living in terraced houses, those living in semi-detached (aOR: 1.04, 95% CI: 1.02-1.07) and detached (aOR = 1.13, 95% CI = 1.10-1.16) housing had higher likelihood of further cases within 11-28 days, whereas ats were least likely to give rise to further cases (aOR = 0.59, 95% CI = 0.57-0.61).…”

“…Germany [12], Norway [13] and Cyprus [14] were among several countries to adopt quarantine exemptions on the basis of a "recovered" status, typically for individuals recovered from COVID-19 in the last six months. The emergence of novel COVID-19 variants will necessitate a review of such policies to assess if exemption on the basis of natural infection alone is appropriate; 9.5% of Omicron cases in the UK were detected among individuals with previous infection (≥ 90 days prior) as of 19 December 2021 compared to < 1.0% prior to the Omicron epidemic [15,16].…”