Introduction to and spread of COVID-19 in care homes in Norfolk, UK

Introduction to and spread of COVID-19 in care homes in Norfolk, UK [Preprint]
medRxiv 2020.06.17.20133629; doi: https://doi.org/10.1101/2020.06.17.20133629

• Monitoring of COVID-19 in care homes in Norfolk highlights that counts of non-care workers had strongest relationships to any introduction of COVID-19. After a care home had at least one detected case, higher staff levels and more severe PPE shortages were most linked to higher case counts (p < 0.05). 
• They conclude that better managing aspects of staff interaction with residents and some working practices should help reduce ingression to and spread of COVID-19 within residential homes for the elderly.

Abstract

BACKGROUND: Residential care homes for the elderly have been important settings for transmission of the SARS-CoV-2 virus that causes COVID-19 disease. 

METHODS: We undertook a secondary analysis of a dataset about 248 care homes in the county of Norfolk, eastern England. The dataset recorded categories of staff (nurses, care workers and non-care workers), their status (available, absent due to leave or sickness and extra staff needed to address the coronavirus pandemic) in the period 6 April -6 May 2020. Counts of residents (if any) at each care home with COVID-19 were also available, as well as descriptions of access by the home to personal protection equipment (PPE: gloves, masks, eye protection, aprons and Sanitiser). PPE access was categorised as (most to least) green, amber or red. We undertook two stage modelling, first for any detection of COVID-19 in the homes, and a second model to relate any increases in case counts after introduction to staffing or PPE levels.  

RESULTS: We found that the counts of non-care workers had strongest relationships (and only link significant at p < 0.05) to any introduction of SARS-CoV-2 to the homes. After a home had at least one detected case, higher staff levels and more severe PPE shortages were most linked to higher case counts (p < 0.05) during the monitoring period. 

CONCLUSION: Better managing aspects of staff interaction with residents and some working practices should help reduce ingression to and spread of COVID-19 within residential homes for the elderly.