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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, Anna; Dun-Campbell, Kate; Janarthanan, Roshni; Fok, Jonathan; Crawley-Boevey, Emma; Vusirikala, Amoolya; Fernandez Ruiz De Olano, Elena; Sanchez Perez, Marina; Tang, Suzanne; Rowland, Thomas Aj; Wynne-Evans, Edward; Bell, Anita; Patel, Bharat; Amin-Chowdhury, Zahin; Aiano, Felicity; Paranthaman, Karthik; Ma, Thomas; Saavedra-Campos, Maria; Ellis, Joanna; Lackenby, Angie; Whitaker, Heather; Myers, Richard; Höschler, Katja; Brown, Kevin; Ramsay, Mary E; Shetty, Nandini; Chow, J Yimmy; Ladhani, Shamez; Zambon, Maria.
  • Jeffery-Smith A; Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Dun-Campbell K; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Janarthanan R; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Fok J; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Crawley-Boevey E; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Vusirikala A; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Fernandez Ruiz De Olano E; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Sanchez Perez M; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Tang S; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Rowland TA; Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Wynne-Evans E; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Bell A; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Patel B; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Amin-Chowdhury Z; Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Aiano F; Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Paranthaman K; Field Service, National Infection Service, Public Health England, UK.
  • Ma T; Field Service, National Infection Service, Public Health England, UK.
  • Saavedra-Campos M; Field Service, National Infection Service, Public Health England, UK.
  • Ellis J; Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Lackenby A; Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Whitaker H; Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Myers R; Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Höschler K; Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Brown K; Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Ramsay ME; Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Shetty N; Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Chow JY; London Health Protection team, National Infection Service, Public Health England, London, UK.
  • Ladhani S; Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
  • Zambon M; Paediatric Infectious Diseases Research Group, St. George's University of London, UK.
Lancet Reg Health Eur ; 3: 100038, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1192394
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.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Prognostic study Language: English Journal: Lancet Reg Health Eur Year: 2021 Document Type: Article Affiliation country: J.lanepe.2021.100038

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Prognostic study Language: English Journal: Lancet Reg Health Eur Year: 2021 Document Type: Article Affiliation country: J.lanepe.2021.100038