SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes

N. S.N. Graham, C. Junghans, R. Downes, C. Sendall, H. Lai, A. McKirdy, P. Elliott, R. Howard, D. Wingfield, M. Priestman, M. Ciechonska, L. Cameron, M. Storch, M. A. Crone, P. S. Freemont, P. Randell, R. McLaren, N. Lang, Shamez Ladhani, F. Sanderson*D. J. Sharp

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

148 Citations (Scopus)


Objectives: To understand SARS-Co-V-2 infection and transmission in UK nursing homes in order to develop preventive strategies for protecting the frail elderly residents. Methods: An outbreak investigation involving 394 residents and 70 staff, was carried out in 4 nursing homes affected by COVID-19 outbreaks in central London. Two point-prevalence surveys were performed one week apart where residents underwent SARS-CoV-2 testing and had relevant symptoms documented. Asymptomatic staff from three of the four homes were also offered SARS-CoV-2 testing. Results: Overall, 26% (95% CI 22–31) of residents died over the two-month period. All-cause mortality increased by 203% (95% CI 70–336) compared with previous years. Systematic testing identified 40% (95% CI 35–46) of residents as positive for SARS-CoV-2, and of these 43% (95% CI 34–52) were asymptomatic and 18% (95% CI 11–24) had only atypical symptoms; 4% (95% CI −1 to 9) of asymptomatic staff also tested positive. Conclusions: The SARS-CoV-2 outbreak in four UK nursing homes was associated with very high infection and mortality rates. Many residents developed either atypical or had no discernible symptoms. A number of asymptomatic staff members also tested positive, suggesting a role for regular screening of both residents and staff in mitigating future outbreaks.

Original languageEnglish
Pages (from-to)411-419
Number of pages9
JournalJournal of Infection
Issue number3
Publication statusPublished - Sep 2020

Bibliographical note

Funding Information:
NL convened the outbreak investigation with FS, DJS, RM and SL. The process was supported by RD, CS, NSNG, RM and CJ who performed testing and clinical/demographic/outcome information ascertainment. PR facilitated laboratory testing. MAC, MS, MP, MC and PSF established the automated RNA extraction platform and MAC, MP carried out RNA extraction from positive samples. LC, MAC, MP, MC and MS performed all the sample preparation for sequencing and analysed the NGS data. LC, MAC, MS and PSF interpreted this data and contributed to the writing of the manuscript. NSNG and CJ performed the analyses. HL assisted analysis and data visualisation. NSNG, CJ, DJS, and FS wrote the draft. AM assisted literature review, and alongside DW and AM writing and revision of the paper. PE and SL critically reviewed and revised the manuscript. All authors contributed to aspects of investigation design/acquisition/analysis/data interpretation; reviewing/revising the paper; approved the final version and agree to be accountable for the work.

Funding Information:
UK DRI Centre for Care Research and Technology: financially supported the work. Independent of the investigation process and write-up.


  • COVID-19
  • Care home
  • Coronavirus
  • Diagnostic testing
  • Nursing home
  • SARS-CoV-2


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