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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 TAJ, 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. 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 2021; 3:100038. [PMID: 33870248 PMCID: PMC7826003 DOI: 10.1016/j.lanepe.2021.100038] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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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Affiliation(s)
- Anna Jeffery-Smith
- Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - 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
| | | | - 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
| | | | - Thomas Ma
- 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
| | - Maria Zambon
- Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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