SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes

J Infect. 2020 Sep;81(3):411-419. doi: 10.1016/j.jinf.2020.05.073. Epub 2020 Jun 3.

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.

Keywords: COVID-19; Care home; Coronavirus; Diagnostic testing; Nursing home; SARS-CoV-2.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / mortality
  • Coronavirus Infections / pathology*
  • Female
  • Humans
  • Male
  • Nursing Homes*
  • Pandemics
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / pathology*
  • SARS-CoV-2
  • Time Factors
  • United Kingdom / epidemiology