Whole Care Home Testing for Covid-19 in a Local Authority Area in the United Kingdom

Starling, Anna; White, Eleanor; Showell, Danny; Wyllie, David; Kapadia, Smita; Balakrishnan, Ravikumar

Objectives: To describe the point prevalence of SARS-CoV-2 in care homes reporting low numbers of cases of COVID-19. Design: A cross-sectional study of care homes, ascertaining perceived disease burden using interviews with care home managers and SARS-CoV-2 RNA detection in residents and staff using nose and throat swabbing. Setting: 15 Care homes in Essex, United Kingdom, all of which had reported either zero or one case of COVID-19 to the Health Protection Team. Participants: 912 residents and staff of care homes were tested. Residents were eligible to be tested regardless of symptoms. Main outcome measure: Detection of SARS-CoV-2 in residents and staff. Results: In the 15 care homes studied, SARS-CoV-2 was detected in 23 (5.2%)of 441 residents. Of these 23, 21/23 (91%) were asymptomatic as reported by the care home managers. SARS-CoV-2 was detected in 8/471 (1.7%) of staff. This differs from that in residents (p=0.003). Conclusions: The findings of the study suggest that symptoms, as reported by care home managers, are an insensitive method of defining the extent of SARS-CoV-2 infection in nursing homes. Viral detection from residents is more common than from staff. Microbiological screening is a more sensitive method for defining the extent of SARS-CoV-2 in care homes than managerial reporting of resident symptoms.