Increased risk of SARS-CoV-2 infection in staff working across different care homes: enhanced CoVID-19 outbreak investigations in London care Homes. Issue 4 (October 2020)

• Record Type: Journal Article
• Authors: Ladhani, Shamez N; Chow, J. Yimmy; Janarthanan, Roshni; Fok, Jonathan; Crawley-Boevey, Emma; Vusirikala, Amoolya; Fernandez, Elena; Perez, Marina Sanchez; Tang, Suzanne; Dun-Campbell, Kate; Wynne-Evans, Edward; Bell, Anita; Patel, Bharat; Amin-Chowdhury, Zahin; Aiano, Felicity; Paranthaman, Karthik; Ma, Thomas; Saavedra-Campos, Maria; Myers, Richard; Ellis, Joanna; Lackenby, Angie; Gopal, Robin; Patel, Monika; Chand, Meera; Brown, Kevin; Hopkins, Susan; Consortium, CoG; Shetty, Nandini; Zambon, Maria; Ramsay, Mary E
• Is Part Of: Journal of infection. Volume 81:Issue 4(2020)
• Page Start: 621
• Page End: 624
• Publication Date: 2020-10
• Subjects: SARS-CoV-2 -- COVID-19 -- Care homes -- Occupational risk -- Transmission; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2020.07.027
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: 21% of 255 staff working in 6 care homes with a COVID-19 outbreak were SARS-CoV-2 positive. SARS-CoV-2 positivity was similar in staff with regular (18%), occasional (16%) or no (15%) resident contact. SARS-CoV-2 positivity was 3-fold higher in staff working across different care homes. Whole genome sequencing identified distinct clusters involving staff only. Summary: Background: Care homes have been disproportionately affected by the COVID-19 pandemic and continue to suffer large outbreaks even when community infection rates are declining, thus representing important pockets of transmission. We assessed occupational risk factors for SARS-CoV-2 infection among staff in six care homes experiencing a COVID-19 outbreak during the peak of the pandemic in London, England. Methods: Care home staff were tested for SARS-COV-2 infection by RT-PCR and asked to report any symptoms, their contact with residents and if they worked in different care homes. Whole genome sequencing (WGS) was performed on RT-PCR positive samples. Results: In total, 53 (21%) of 254 staff were SARS-CoV-2 positive but only 12/53 (23%) were symptomatic. Among staff working in a single care home, SARS-CoV-2 positivity was 15% (2/13), 16% (7/45) and 18% (30/169) in those reporting no, occasional and regular contact with residents. In contrast, staff working across different care homes (14/27, 52%) had a 3.0-fold (95% CI, 1.9–4.8; P <0.001) higher risk of SARS-CoV-2 positivity than staff working in single care homes (39/227, 17%). WGS identified SARS-CoV-2 clusters involving staff only, including some that included staff working across different care homes. Conclusions: SARS-CoV-2 positivity was significantly higher among staff working across different care homes than those who were working in the same care home. We found local clusters of SARS-CoV-2 infection between staff only, including those with minimal resident contact. Infection control should be extended for all contact, including those between staff, whilst on care home premises.