Blog
About

1
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Investigation of SARS-CoV-2 outbreaks in six care homes in London, April 2020

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background: Care homes are experiencing large outbreaks of COVID-19 associated with high case-fatality rates. We conducted detailed investigations in six London care homes reporting suspected COVID-19 outbreaks during April 2020.

          Methods: Residents and staff had nasal swabs for SARS CoV-2 testing using RT-PCR and were followed-up for 14 days. They were categorized as symptomatic, post-symptomatic or pre-symptomatic if they had symptoms at the time of testing, in the two weeks before or two weeks after testing, respectively, or asymptomatic throughout. Virus isolation and whole genome sequencing (WGS) was also performed.

          Findings: Across the six care homes, 105/264 (39.8%) residents were SARS CoV-2 positive, including 28 (26.7%) symptomatic, 10 (9.5%) post-symptomatic, 21 (20.0%) pre-symptomatic and 46 (43.8%) who remained asymptomatic. Case-fatality at 14-day follow-up was highest among symptomatic SARS-CoV-2 positive residents (10/28, 35.7%) compared to asymptomatic (2/4, 4.2%), post-symptomatic (2/10, 20.0%) or pre-symptomatic (3/21,14.3%) residents. Among staff, 53/254 (20.9%) were SARS-CoV-2 positive and 26/53 (49.1%) remained asymptomatic. RT-PCR cycle-thresholds and live-virus recovery were similar between symptomatic/asymptomatic residents/staff. Higher RT-PCR cycle threshold values (lower virus load) samples were associated with exponentially decreasing ability to recover infectious virus ( P<0.001). WGS identified multiple (up to 9) separate introductions of different SARS-CoV-2 strains into individual care homes.

          Interpretation: A high prevalence of SARS-CoV-2 positivity was found in care homes residents and staff, half of whom were asymptomatic and potential reservoirs for on-going transmission. A third of symptomatic SARS-CoV-2 residents died within 14 days. Symptom-based screening alone is not sufficient for outbreak control.

          Funding: None

          Related collections

          Most cited references 5

          • Record: found
          • Abstract: found
          • Article: not found

          Types of infectious outbreaks and their impact in elderly care facilities: a review of the literature.

          infectious outbreaks in long-term care facilities (LTCFs) tend to have a significant impact on infection rates and mortality rates of the residents. this review aimed to update the information on pathogens identified in such outbreaks and to try to explore indicators that reflect the impact of outbreaks among residents and health care workers (HCWs). MEDLINE (1966-2008) was used to identify outbreaks using the following thesaurus terms: 'Cross-Infection', 'Disease Outbreaks', 'Urinary-Tract Infections' and 'Blood-Borne Pathogens'. Elderly care facilities were identified with the following thesaurus terms: 'Long-Term Care', 'Assisted-Living Facilities', 'Homes for the Aged' and 'Nursing Homes'. Age category was limited using 'Aged'. thirty-seven pathogens were associated with 206 outbreaks. The largest number of reported outbreaks by a single pathogen involved the influenza virus, followed by noroviruses. Among residents, the highest median attack rate for respiratory infection outbreaks was caused by Chlamydia pneumoniae (46%), followed by respiratory syncytial virus (40%). In gastrointestinal tract infection outbreaks, high median attack rates were caused by Clostridium perfringens (48%) and noroviruses (45%). Outbreaks with high median case fatality rates were caused by Group A Streptococci (50%) and Streptococcus pneumoniae (44%). High median attack rates for HCWs were caused by C. pneumoniae (41%), noroviruses (42%) and scabies (36%). a variety of infectious agents were identified as the cause of outbreaks in the elderly and HCWs in LTCFs. Attack rates and case fatality rates are useful indicators for setting priorities for education and prevention of the outbreaks.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            COVID-19 in Nursing Homes

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              A combined oropharyngeal/nares swab is a suitable alternative to nasopharyngeal swabs for the detection of SARS-CoV-2

              Given the global shortage of nasopharyngeal (NP) swabs typically used for respiratory virus detection, alternative collection methods were evaluated during the COVID-19 pandemic. This study showed that a combined oropharyngeal/nares swab is a suitable alternative to NP swabs for the detection of SARS-CoV-2, with sensitivities of 91.7% and 94.4%, respectively.
                Bookmark

                Author and article information

                Journal
                EClinicalMedicine
                EClinicalMedicine
                EClinicalMedicine
                Published by Elsevier Ltd.
                2589-5370
                9 September 2020
                9 September 2020
                Affiliations
                [a ]Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
                [b ]Paediatric Infectious Diseases Research Group, St. George's University of London, UK
                [c ]London Health Protection team, Public Health England, London, UK
                [d ]Field Service, National Infection Service, Public Health England, London, UK
                [e ]Infectious Disease Informatics, Public Health England, London, UK
                [f ]Virus Reference Department, Public Health England, London, UK
                [g ]Antimicrobial Resistance and Hospital Acquired Infection Department, Public Health England, London, UK
                Author notes
                [* ]Corresponding author at: Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
                Article
                S2589-5370(20)30277-7 100533
                10.1016/j.eclinm.2020.100533
                7480335
                Crown Copyright © 2020 Published by Elsevier Ltd.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                Categories
                Article

                symptoms, case-fatality rate, care homes, covid-19

                Comments

                Comment on this article