• Suzanne Tang, Marina Sanchez Perez, Maria Saavedra-Campos, Karthik Paranthaman, Richard Myers, Jonathan Fok, Emma Crawley-Boevey, Kate Dun-Campbell, Roshni Janarthanan, Elena Fernandez, Amoolya Vusirikala, Bharat Patel, Thomas Ma, Zahin Amin-Chowdhury, Nandini Shetty, Maria Zambon, Anita Bell, Edward Wynne-Evans, Yimmy Chow, and Shamez Ladhani.
• London Health Protection Team, National Infection Service, Public Health England, London, UK.
• Age Ageing. 2021 May 5; 50 (3): 649-656.

IntroductionPrevious investigations have identified high rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among residents and staff in care homes reporting an outbreak of coronavirus disease 2019 (COVID-19). We investigated care homes reporting a single suspected or confirmed case to assess whether early mass testing might reduce risk of transmission during the peak of the pandemic in London.MethodsBetween 18 and 27 April 2020, residents and staff in care homes reporting a single case of COVID-19 to Public Health England had a nasal swab to test for SARS-CoV-2 infection by reverse transcription polymerase chain reaction and subsequent whole-genome sequencing. Residents and staff in two care homes were re-tested 8 days later.ResultsFour care homes were investigated. SARS-CoV-2 positivity was 20% (65/333) overall, ranging between 3 and 59%. Among residents, positivity ranged between 3 and 76% compared with 3 and 40% in staff. Half of the SARS-CoV-2-positive residents (23/46, 50%) and 63% of staff (12/19) reported symptoms within 14 days before or after testing. Repeat testing 8 days later in two care homes with the highest infection rates identified only two new cases. Genomic analysis demonstrated a small number of introduction of the virus into care homes, and distinct clusters within three of the care homes.ConclusionsWe found extensive but variable rates of SARS-CoV-2 infection among residents and staff in care homes reporting a single case of COVID-19. Although routine whole-home testing has now been adopted into practice, care homes must remain vigilant and should be encouraged to report a single suspected case, which should trigger appropriate outbreak control measures.© The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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