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

Anna Jeffery-Smith; Kate Dun-Campbell; Roshni Janarthanan; Jonathan Fok; Emma Crawley-Boevey; Amoolya Vusirikala; Elena Fernandez Ruiz De Olano; Marina Sanchez Perez; Suzanne Tang; Thomas AJ Rowland; Edward Wynne-Evans; Anita Bell; Bharat Patel; Zahin Amin-Chowdhury; Felicity Aiano; Karthik Paranthaman; Thomas Ma; Maria Saavedra-Campos; Joanna Ellis; Angie Lackenby; Heather Whitaker; Richard Myers; Katja Höschler; Kevin Brown; Mary E Ramsay; Nandini Shetty; J. Yimmy Chow; Shamez Ladhani; Maria Zambon

The Lancet Regional Health. Europe (Apr 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

Anna Jeffery-Smith,
Kate Dun-Campbell,
Roshni Janarthanan,
Jonathan Fok,
Emma Crawley-Boevey,
Amoolya Vusirikala,
Elena Fernandez Ruiz De Olano,
Marina Sanchez Perez,
Suzanne Tang,
Thomas AJ Rowland,
Edward Wynne-Evans,
Anita Bell,
Bharat Patel,
Zahin Amin-Chowdhury,
Felicity Aiano,
Karthik Paranthaman,
Thomas Ma,
Maria Saavedra-Campos,
Joanna Ellis,
Angie Lackenby,
Heather Whitaker,
Richard Myers,
Katja Höschler,
Kevin Brown,
Mary E Ramsay,
Nandini Shetty,
J. Yimmy Chow,
Shamez Ladhani,
Maria Zambon

Affiliations

Anna Jeffery-Smith: Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Corresponding authors.
Kate Dun-Campbell: London Health Protection team, National Infection Service, Public Health England, London, UK
Roshni Janarthanan: London Health Protection team, National Infection Service, Public Health England, London, UK
Jonathan Fok: London Health Protection team, National Infection Service, Public Health England, London, UK
Emma Crawley-Boevey: London Health Protection team, National Infection Service, Public Health England, London, UK
Amoolya Vusirikala: London Health Protection team, National Infection Service, Public Health England, London, UK
Elena Fernandez Ruiz De Olano: London Health Protection team, National Infection Service, Public Health England, London, UK
Marina Sanchez Perez: London Health Protection team, National Infection Service, Public Health England, London, UK
Suzanne Tang: London Health Protection team, National Infection Service, Public Health England, London, UK
Thomas AJ Rowland: Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
Edward Wynne-Evans: London Health Protection team, National Infection Service, Public Health England, London, UK
Anita Bell: London Health Protection team, National Infection Service, Public Health England, London, UK
Bharat Patel: London Health Protection team, National Infection Service, Public Health England, London, UK
Zahin Amin-Chowdhury: Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
Felicity Aiano: Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
Karthik Paranthaman: Field Service, National Infection Service, Public Health England, UK
Thomas Ma: Field Service, National Infection Service, Public Health England, UK
Maria Saavedra-Campos: Field Service, National Infection Service, Public Health England, UK
Joanna Ellis: Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
Angie Lackenby: Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
Heather Whitaker: Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
Richard Myers: Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
Katja Höschler: Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
Kevin Brown: Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
Mary E Ramsay: Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
Nandini Shetty: Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
J. Yimmy Chow: London Health Protection team, National Infection Service, Public Health England, London, UK
Shamez Ladhani: Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Paediatric Infectious Diseases Research Group, St. George's University of London, UK; Corresponding author at: Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Maria Zambon: Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Corresponding authors.

Journal volume & issue: Vol. 3
p. 100038

Abstract

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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

Published in The Lancet Regional Health. Europe

ISSN: 2666-7762 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanepe/home

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