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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.

Jeffery-Smith, A; Dun-Campbell, K; Janarthanan, R; Fok, J; Crawley-Boevey, E; Vusirikala, A; Fernandez Ruiz De Olano, E; Sanchez Perez, M; Tang, S; Rowland, TA; et al. Jeffery-Smith, A; Dun-Campbell, K; Janarthanan, R; Fok, J; Crawley-Boevey, E; Vusirikala, A; Fernandez Ruiz De Olano, E; Sanchez Perez, M; Tang, S; Rowland, TA; Wynne-Evans, E; Bell, A; Patel, B; Amin-Chowdhury, Z; Aiano, F; Paranthaman, K; Ma, T; Saavedra-Campos, M; Ellis, J; Lackenby, A; Whitaker, H; Myers, R; Höschler, K; Brown, K; Ramsay, ME; Shetty, N; Chow, JY; Ladhani, S; Zambon, M (2021) 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. Lancet Reg Health Eur, 3. p. 100038. ISSN 2666-7762 https://doi.org/10.1016/j.lanepe.2021.100038
SGUL Authors: Ladhani, Shamez Nizarali

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Abstract

Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: PHE.

Item Type: Article
Additional Information: Crown Copyright © 2021 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Keywords: Asymptomatic transmission, Care home, SARS-CoV-2 outbreak, SARS-CoV-2 outbreak, Care home, Asymptomatic transmission
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Lancet Reg Health Eur
ISSN: 2666-7762
Language: eng
Dates:
DateEvent
April 2021Published
22 January 2021Published Online
18 January 2021Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
PubMed ID: 33870248
Web of Science ID: WOS:000654684600004
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/113358
Publisher's version: https://doi.org/10.1016/j.lanepe.2021.100038

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