SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes - 06/08/20

Doi : 10.1016/j.jinf.2020.05.073

N.S.N. Graham ^a,^b,^{^{1
These authors contributed equally (joint 1st author).}}, C. Junghans ^c,^{^{1
These authors contributed equally (joint 1st author).}}, R. Downes ^d, C. Sendall ^d, H. Lai ^a,^b, A. McKirdy ^e, P. Elliott ^f,^g,^h,ⁱ, R. Howard ^j, D. Wingfield ^k,^c, M. Priestman ^l,^m,^a, M. Ciechonska ^l,^m,^a, L. Cameron ^m,^a, M. Storch ^l,^m,^a, M.A. Crone ^l,^m,^a, P.S. Freemont ^l,^m,^a, P. Randell ^n,^o, R. McLaren ^p, N. Lang ^q, S. Ladhani ^r, F. Sanderson ^s,^⁎,^{^{2
These authors contributed equally (joint senior author).}} , D.J. Sharp ^a,^b,^{^{2
These authors contributed equally (joint senior author).}}
^a UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
^b Department of Brain Sciences, Imperial College London, UK
^c Department of Primary Care and Public Health, Imperial College London, UK
^d Department of Elderly Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
^e North West London Health Protection Team, Public Health England, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK
^f UK DRI Centre at Imperial, Imperial College London, UK
^g MRC Centre for Environment and Health, Imperial College London, UK
^h BHF Centre of Excellence, Imperial College London, UK
ⁱ Imperial NIHR Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, UK
^j Division of Psychiatry, UCL, 149 Tottenham Court Road, London W1T 7NF, UK
^k Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
^l London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK
^m Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK
ⁿ North West London Pathology, Charing Cross Hospital, London W6 8RF, UK
^o Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
^p Park Medical Centre, Hammersmith, London W6 0QG, UK
^q Hammersmith and Fulham Council, 3 Shortlands, Hammersmith W6 8DA, UK
^r Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
^s Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK

^⁎Corresponding author.

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Summary

Objectives

To understand SARS-Co-V-2 infection and transmission in UK nursing homes in order to develop preventive strategies for protecting the frail elderly residents.

Methods

An outbreak investigation involving 394 residents and 70 staff, was carried out in 4 nursing homes affected by COVID-19 outbreaks in central London. Two point-prevalence surveys were performed one week apart where residents underwent SARS-CoV-2 testing and had relevant symptoms documented. Asymptomatic staff from three of the four homes were also offered SARS-CoV-2 testing.

Results

Overall, 26% (95% CI 22–31) of residents died over the two-month period. All-cause mortality increased by 203% (95% CI 70–336) compared with previous years. Systematic testing identified 40% (95% CI 35–46) of residents as positive for SARS-CoV-2, and of these 43% (95% CI 34–52) were asymptomatic and 18% (95% CI 11–24) had only atypical symptoms; 4% (95% CI −1 to 9) of asymptomatic staff also tested positive.

Conclusions

The SARS-CoV-2 outbreak in four UK nursing homes was associated with very high infection and mortality rates. Many residents developed either atypical or had no discernible symptoms. A number of asymptomatic staff members also tested positive, suggesting a role for regular screening of both residents and staff in mitigating future outbreaks.

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Keywords : Coronavirus, COVID-19, SARS-CoV-2, Nursing home, Care home, Diagnostic testing

Plan

Introduction

Methods

Outbreak investigation

Symptom ascertainment, demographics and comorbidities

Statistical analysis

Viral sequencing

Ethical approval and patient and public involvement

Results

Nursing home mortality

SARS-CoV-2 testing results and clinical features

Staff sickness and asymptomatic viral carriage

SARS-CoV-2 sequencing

Discussion

Author contributions

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Vol 81 - N° 3

P. 411-419 - septembre 2020 Retour au numéro

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SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes - 06/08/20

Summary

Objectives

Methods

Results

Conclusions

Plan

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