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. 2021 Jun 28;50(4):1019-1028.
doi: 10.1093/ageing/afab060.

COVID-19 infection and attributable mortality in UK care homes: cohort study using active surveillance and electronic records (March-June 2020)

Peter F Dutey-Magni  1 , Haydn Williams  2 , Arnoupe Jhass  1   3 , Greta Rait  3   4 , Fabiana Lorencatto  5 , Harry Hemingway  1   4   6 , Andrew Hayward  7 , Laura Shallcross  1
Affiliations

COVID-19 infection and attributable mortality in UK care homes: cohort study using active surveillance and electronic records (March-June 2020)

Peter F Dutey-Magni et al. Age Ageing. .

Abstract

Background: epidemiological data on COVID-19 infection in care homes are scarce. We analysed data from a large provider of long-term care for older people to investigate infection and mortality during the first wave of the pandemic.

Methods: cohort study of 179 UK care homes with 9,339 residents and 11,604 staff. We used manager-reported daily tallies to estimate the incidence of suspected and confirmed infection and mortality in staff and residents. Individual-level electronic health records from 8,713 residents were used to model risk factors for confirmed infection, mortality and estimate attributable mortality.

Results: 2,075/9,339 residents developed COVID-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory-confirmed infections. The incidence of confirmed infection was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days in residents and staff, respectively. Sixty-eight percent (121/179) of care homes had at least one COVID-19 infection or COVID-19-related death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection.Out of 607 residents with confirmed infection, 217 died (case fatality rate: 35.7% [31.9%; 39.7%]). Mortality in residents with no direct evidence of infection was twofold higher in care homes with outbreaks versus those without (adjusted hazard ratio: 2.2 [1.8; 2.6]).

Conclusions: findings suggest many deaths occurred in people who were infected with COVID-19, but not tested. Higher occupancy and lower staffing levels were independently associated with risks of infection. Protecting staff and residents from infection requires regular testing for COVID-19 and fundamental changes to staffing and care home occupancy.

Keywords: COVID-19; SARS-CoV-2; long-term care; morbidity; mortality; older people.

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Conflict of interest statement

F.L., G.R. and L.S. are supported by research funding from the ESRC. L.S. is a member of the Care Home working group, a subgroup of the Scientific Advisory Group for Emergencies. A.H. is a member of the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG). All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Study overview: location of FSHCG care homes and diagram of data sources. Note: NI, Northern Ireland; S, Scotland; W, Wales; NE, North East; NW, North West; YTH, Yorkshire and The Humber; EM, East Midlands; WM, West Midlands; EE, East of England; L, London; SE, South East; SW, South West.
Figure 2
Figure 2
Kaplan–Meier point (solid line) and 95% interval (dashed line) estimates of the cumulative incidence of symptomatic cases, confirmed infections and COVID-related deaths in (A) residents (n = 9,339) and (B) staff (n = 11,604) according to FSHCG aggregate data (24 March 2020–14 June 2020). Note: underlying data available on request from authors, subject to permissions from FHSCG.
See this image and copyright information in PMC

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