Care-home outbreaks of COVID-19 in Scotland March to May 2020: national linked data cohort analysis

Abstract

Background: understanding care-home outbreaks of COVID-19 is a key public health priority in the ongoing pandemic to help protect vulnerable residents.

Objective: to describe all outbreaks of COVID-19 infection in Scottish care-homes for older people between 01/03/2020 to 31/03/2020, with follow-up to 30/06/2020.

Design and setting: national linked data cohort analysis of Scottish care-homes for older people.

Methods: data linkage was used to identify outbreaks of COVID-19 in care-homes. Care-home characteristics associated with the presence of an outbreak were examined using logistic regression. Size of outbreaks was modelled using negative binomial regression.

Results: 334 (41%) Scottish care-homes for older people experienced an outbreak, with heterogeneity in outbreak size (1-63 cases; median = 6) and duration (1-94 days; median = 31.5 days). Four distinct patterns of outbreak were identified: 'Typical' (38% of outbreaks, mean 11.2 cases and 48 days duration), Severe (11%, mean 29.7 cases and 60 days), Contained (37%, mean 3.5 cases and 13 days), and Late-onset (14%, mean 5.4 cases and 17 days). Risk of a COVID-19 outbreak increased with increasing care-home size (for ≥90 beds vs <20, adjusted OR = 55.4, 95%CI 15.0-251.7) and rising community prevalence (OR = 1.2 [1.0-1.4] per 100 cases/100,000 population increase). No routinely available care-home characteristic was associated with outbreak size.

Conclusions: reducing community prevalence of COVID-19 infection is essential to protect those living in care-homes. More systematic national data collection to understand care-home residents and the homes in which they live is a priority in ensuring we can respond more effectively in future.

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This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com.

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DOI

https://doi.org/10.1093/ageing/afab099

Repository URI

http://eprints.gla.ac.uk/240259/