Public Health England (PHE), North West, UK.
Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
J Hosp Infect. 2021 May;111:89-95. doi: 10.1016/j.jhin.2020.12.024. Epub 2021 Jan 13.
COVID-19 care home outbreaks represent a significant proportion of COVID-19 morbidity and mortality in the UK. National testing initially focused on symptomatic care home residents, before extending to asymptomatic cohorts.
The aim was to describe the epidemiology and transmission of COVID-19 in outbreak free care homes.
A two-point prevalence survey of COVID-19, in 34 Liverpool care homes, was performed in April and May 2020. Changes in prevalence were analysed. Associations between care home characteristics, reported infection, prevention and control interventions, and COVID-19 status were described and analysed.
No resident developed COVID-19 symptoms during the study. There was no significant difference between: the number of care homes containing at least one test positive resident between the first (17.6%, 95% confidence interval (CI) 6.8-34.5) and second round (14.7%, 95% CI 5.0-31.1) of testing (p>0.99); and the number of residents testing positive between the first (2.1%, 95% CI 1.2-3.4) and second round (1.0%, 95% CI 0.5-2.1) of testing (P=0.11). Care homes providing nursing care (risk ratio (RR) 7.99, 95% CI 1.1-57.3) and employing agency staff (RR 8.4, 95% CI 1.2-60.8) were more likely to contain test positive residents. Closing residents shared space was not associated with residents testing positive (RR 2.63, 95% CI 0.4-18.5).
Asymptomatic COVID-19 care homes showed no evidence of disease transmission or development of outbreaks; suggesting that current infection prevention and control measures are effective in preventing transmission. Repeat testing at two to three weeks had limited or no public health benefits over regular daily monitoring of staff and residents for symptoms. These results should inform policies calling for regular testing of asymptomatic residents.
在英国，新冠病毒在护理院的爆发占了新冠病毒发病和死亡的很大一部分。最初，国家检测的重点是有症状的护理院居民，然后扩展到无症状人群。
描述无疫情爆发的护理院的新冠病毒流行病学和传播情况。
在 2020 年 4 月和 5 月，对利物浦的 34 个护理院进行了两次新冠病毒的患病率调查。分析了患病率的变化。描述和分析了护理院特征、报告感染、预防和控制干预措施以及新冠病毒状况之间的关联。
在研究期间，没有居民出现新冠病毒症状。在以下方面，第一轮（17.6%，95%置信区间[CI] 6.8-34.5）和第二轮（14.7%，95%CI 5.0-31.1）检测中，至少有一个检测阳性居民的护理院数量没有显著差异（P>0.99）；第一轮（2.1%，95%CI 1.2-3.4）和第二轮（1.0%，95%CI 0.5-2.1）检测中，检测阳性的居民数量也没有显著差异（P=0.11）。提供护理服务的护理院（风险比[RR] 7.99，95%CI 1.1-57.3）和使用代理员工的护理院（RR 8.4，95%CI 1.2-60.8）更有可能有检测阳性的居民。关闭居民共享空间与居民检测阳性无关（RR 2.63，95%CI 0.4-18.5）。
无症状的新冠病毒护理院没有疾病传播或爆发的证据；这表明目前的感染预防和控制措施在预防传播方面是有效的。每两到三周进行一次重复检测，与对员工和居民的日常症状监测相比，没有带来公共卫生方面的益处。这些结果应告知有关定期对无症状居民进行检测的政策。
