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Graham NSN, Junghans C, Downes R, Sendall C, Lai H, McKirdy A, Elliott P, Howard R, Wingfield D, Priestman M, Ciechonska M, Cameron L, Storch M, Crone MA, Freemont PS, Randell P, McLaren R, Lang N, Ladhani S, Sanderson F, Sharp DJ. SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes. J Infect 2020; 81:411-419. [PMID: 32504743 PMCID: PMC7836316 DOI: 10.1016/j.jinf.2020.05.073] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 12/25/2022]
Abstract
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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Affiliation(s)
- N S N Graham
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK; Department of Brain Sciences, Imperial College London, UK
| | - C Junghans
- Department of Primary Care and Public Health, Imperial College London, UK
| | - R Downes
- Department of Elderly Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - C Sendall
- Department of Elderly Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - H Lai
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK; Department of Brain Sciences, Imperial College London, UK
| | - A McKirdy
- North West London Health Protection Team, Public Health England, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK
| | - P Elliott
- UK DRI Centre at Imperial, Imperial College London, UK; MRC Centre for Environment and Health, Imperial College London, UK; BHF Centre of Excellence, Imperial College London, UK; Imperial NIHR Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, UK
| | - R Howard
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London W1T 7NF, UK
| | - D Wingfield
- Department of Metabolism, Digestion and Reproduction, Imperial College London, UK; Department of Primary Care and Public Health, Imperial College London, UK
| | - M Priestman
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - M Ciechonska
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - L Cameron
- Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - M Storch
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - M A Crone
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - P S Freemont
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - P Randell
- North West London Pathology, Charing Cross Hospital, London W6 8RF, UK; Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - R McLaren
- Park Medical Centre, Hammersmith, London W6 0QG, UK
| | - N Lang
- Hammersmith and Fulham Council, 3 Shortlands, Hammersmith W6 8DA, UK
| | - S Ladhani
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - F Sanderson
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK.
| | - D J Sharp
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK; Department of Brain Sciences, Imperial College London, UK
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Fanselow DL, Pathak MA, Crone MA, Ersfeld DA, Raber PB, Trancik RJ, Dahl MV. Reusable ultraviolet monitors: design, characteristics, and efficacy. J Am Acad Dermatol 1983; 9:714-23. [PMID: 6643769 DOI: 10.1016/s0190-9622(83)70185-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Reusable ultraviolet dosimetry badges have been developed that provide a visual indication of daily cumulative ultraviolet (UV) exposure. These two-sided, tapelike devices measure UV radiation emitted by sunlight or an artificial UV light source exposure by means of a photochromic aziridine color change reaction that is UV-integrating but optically reversible. UV radiation falling on the exposure side of the badge generates a color change that can be seen from the opposite or readout side. End points are indicated by a visual match of the photochromic with a surrounding reference. This paper describes the construction, component characteristics, and clinical testing of two versions of a new photochromic dosimeter that selectively responds to either UVB (280-320 nm) radiation or UVA (320-400 nm) radiation of the solar spectrum. One version of this monitor, sensitive only to the mid-range UVB, has a peak sensitivity to 300 nm and has four end point markers revealing color changes corresponding to 0.4, 0.8, 2.2, and 6.5 times the minimal erythema dose of an average Caucasian. A second version, sensitive only to UVA, has a peak sensitivity at 355 nm and can monitor exposures ranging from 0.8 to 10 joules/cm2. Outdoor efficacy testing has shown that the UVB monitor is an effective predictor of UV dose-related 24-hour erythema response induced by sunlight. Following a measurement, these monitors can be rezeroed by exposing the readout side to sunlight for a few minutes. They can be reused for eight to ten times. The limitation of the sunlight-calibrated UVB monitor tag is its failure to predict erythema response produced by artificial UVB sources such as FS40 sunlamps.
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