Abstract
BACKGROUND: COVID-19 outbreaks still occur in English care homes despite the interventions in place.
METHODS: We developed a stochastic compartmental model to simulate the spread of SARS-CoV-2 within an English care home. We quantified the outbreak risk with baseline non-pharmaceutical interventions (NPIs) already in place, the role of community prevalence in driving outbreaks, and the relative contribution of all importation routes into a fully susceptible care home. We also considered the potential impact of additional control measures in care homes with and without immunity, namely: increasing staff and resident testing frequency, using lateral flow antigen testing (LFD) tests instead of polymerase chain reaction (PCR), enhancing infection prevention and control (IPC), increasing the proportion of residents isolated, shortening the delay to isolation, improving the effectiveness of isolation, restricting visitors and limiting staff to working in one care home. We additionally present a Shiny application for users to apply this model to their facility of interest, specifying care home, outbreak and intervention characteristics.
RESULTS: The model suggests that importation of SARS-CoV-2 by staff, from the community, is the main driver of outbreaks, that importation by visitors or from hospitals is rare, and that the past testing strategy (monthly testing of residents and daily testing of staff by PCR) likely provides negligible benefit in preventing outbreaks. Daily staff testing by LFD was 39% (95% 18-55%) effective in preventing outbreaks at 30 days compared to no testing.
CONCLUSIONS: Increasing the frequency of testing in staff and enhancing IPC are important to preventing importations to the care home. Further work is needed to understand the impact of vaccination in this population, which is likely to be very effective in preventing outbreaks.
| Original language | English |
|---|---|
| Article number | 324 |
| Journal | BMC Infectious Diseases |
| Volume | 22 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 1 Apr 2022 |
Bibliographical note
Funding Information: AR acknowledges funding from the National Institute for Health Research (Grant: PR-OD-1017–20002). RCB acknowledges funding from the European Union Horizon 2020 Research and Innovation programme, project EpiPose (101003688), throughout the duration of the study. DS is supported by a Canadian Institutes of Health Research Doctoral Foreign Study Award (Funding Reference Number 164263) and the French National Research Agency project SPHINX-17-CE36-0008–01. GMK is supported by the UK Medical Research Council (Grant: MR/P014658/1). The development of the Shiny application COS-LTCF was funded by the World Health Organization. The funders of this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had full access to all of the data and the final responsibility to submit for publication.CMMID COVID-19 modelling working group funding statements: CABP (B&MGF: NTD Modelling Consortium OPP1184344, FCDO/Wellcome Trust: Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z), TJ (Global Challenges Research Fund: ES/P010873/1, UK Public Health Rapid Support Team, NIHR: Health Protection Research Unit for Modelling Methodology HPRU-2012-10096, UK MRC: MC_PC_19065), SRP (B&MGF: INV-016832), GFM (B&MGF: NTD Modelling Consortium OPP1184344), JH (Wellcome Trust: 210758/Z/18/Z), BJQ (NIHR: 16/137/109, NIHR: 16/136/46, B&MGF: OPP1139859), YL (B&MGF: INV-003174, NIHR: 16/137/109, European Commission: 101003688, UK MRC: MC_PC_19065), SFlasche (Wellcome Trust: 208812/Z/17/Z), SA (Wellcome Trust: 210758/Z/18/Z), RME (HDR UK: MR/S003975/1, UK MRC: MC_PC_19065, NIHR: NIHR200908), RL (Royal Society: Dorothy Hodgkin Fellowship), YJ UKRI: MR/V028456/1, CIJ (Global Challenges Research Fund: ES/P010873/1), NRW(MRC: MR/N013638/1), JDM(Wellcome Trust: 210758/Z/18/Z), AG (European Commission: 101003688), NIB (HPRU: NIHR200908), PK (Royal Society: RP\EA\180004, European Commission: 101003688), AE (Nakajima Foundation), AJK (Wellcome Trust: 206250/Z/17/Z, NIHR: NIHR200908), RCB (European Commission: 101003688), Sfunk (Wellcome Trust: 210758/Z/18/Z), KvZ (Elrha R2HC/UK FCDO/Wellcome Trust/NIHR, FCDO/Wellcome Trust: Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z), WJE (European Commission: 101003688, UK MRC: MC_PC_19065, NIHR: PR-OD-1017-20002), WW (MRC: MR/V027956/1), ESN (B&MGF: OPP1183986), SRM (Wellcome Trust: 210758/Z/18/Z), FGS (NIHR: NIHR200929), FK (Innovation Fund: 01VSF18015, Wellcome Trust: UNS110424), NGD (UKRI Research England, NIHR: NIHR200929, UK MRC: MC_PC_19065), SC (Wellcome Trust: 208812/Z/17/Z, UK MRC: MC_PC_19065), MQ (ERC Starting Grant: #757699, B&MGF: INV-001754), KA (BMGF: INV-016832; OPP1157270), TWR (Wellcome Trust: 206250/Z/17/Z), FYS (NIHR: 16/137/109), MJ (B&MGF: INV-003174, NIHR: 16/137/109, NIHR: NIHR200929, European Commission: 101003688), MK (Wellcome Trust 221303/Z/20/Z), KP (B&MGF: INV-003174, European Commission: 101003688), JYL Gates (INV-003174), KO'R (B&MGF: OPP1191821), HPG (EDCTP2: RIA2020EF-2983-CSIGN, UK DHSC/UK Aid/NIHR: PR-OD-1017-20001), OJB (Wellcome Trust: 206471/Z/17/Z)
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Publisher Copyright: © 2022. The Author(s).
Citation: Rosello, A., Barnard, R.C., Smith, D.R.M. et al. Impact of non-pharmaceutical interventions on SARS-CoV-2 outbreaks in English care homes: a modelling study. BMC Infect Dis 22, 324 (2022).
DOI: https://doi.org/10.1186/s12879-022-07268-8
Keywords
- COVID-19
- Care home
- Long-term care facility
- Mathematical model
- Non-pharmaceutical interventions
- PCR
- SARS-CoV-2
- Testing
