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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Burton, J., McMinn, M., Vaughan, J., Fleuriot, J. & Guthrie, B. 2021, 'Care-home outbreaks of COVID-19 in Scotland March to May 2020: national linked data cohort analysis', Age and Ageing, 50(5), pp. 1482-1492. https://doi.org/10.1093/ageing/afab099