• Shamez N Ladhani, J Yimmy Chow, Roshni Janarthanan, Jonathan Fok, Emma Crawley-Boevey, Amoolya Vusirikala, Elena Fernandez, Perez Marina Sanchez MS London Health Protection team, National Infection Service, Public Health England, London, UK., Suzanne Tang, Kate Dun-Campbell, Edward Wynne-Evans, Anita Bell, Bharat Patel, Zahin Amin-Chowdhury, Felicity Aiano, Karthik Paranthaman, Thomas Ma, Maria Saavedra-Campos, Richard Myers, Joanna Ellis, Angie Lackenby, Robin Gopal, Monika Patel, Meera Chand, Kevin Brown, Susan Hopkins, CoG Consortium, Nandini Shetty, Maria Zambon, Mary E Ramsay, and London Care Home Investigation Team.
• 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. Electronic address: shamez.ladhani@phe.gov.uk.
• J. Infect. 2020 Oct 1; 81 (4): 621-624.

BackgroundCare homes have been disproportionately affected by the COVID-19 pandemic and continue to suffer large outbreaks even when community infection rates are declining, thus representing important pockets of transmission. We assessed occupational risk factors for SARS-CoV-2 infection among staff in six care homes experiencing a COVID-19 outbreak during the peak of the pandemic in London, England.MethodsCare home staff were tested for SARS-COV-2 infection by RT-PCR and asked to report any symptoms, their contact with residents and if they worked in different care homes. Whole genome sequencing (WGS) was performed on RT-PCR positive samples.ResultsIn total, 53 (21%) of 254 staff were SARS-CoV-2 positive but only 12/53 (23%) were symptomatic. Among staff working in a single care home, SARS-CoV-2 positivity was 15% (2/13), 16% (7/45) and 18% (30/169) in those reporting no, occasional and regular contact with residents. In contrast, staff working across different care homes (14/27, 52%) had a 3.0-fold (95% CI, 1.9-4.8; P<0.001) higher risk of SARS-CoV-2 positivity than staff working in single care homes (39/227, 17%). WGS identified SARS-CoV-2 clusters involving staff only, including some that included staff working across different care homes.ConclusionsSARS-CoV-2 positivity was significantly higher among staff working across different care homes than those who were working in the same care home. We found local clusters of SARS-CoV-2 infection between staff only, including those with minimal resident contact. Infection control should be extended for all contact, including those between staff, whilst on care home premises.Copyright © 2020. Published by Elsevier Ltd.

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