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Penetration and Impact of COVID-19 in Care Homes in England: Population Surveillance Study

Background: Care homes worldwide have suffered high rates of COVID-19, reflecting their inherent vulnerability and the institutional nature of care delivered. This study describes the impact of the pandemic in care homes across England. 
 
Method: Laboratory confirmed SARS-CoV-2 cases in England notified to PHE from 01 Jan to 25 Dec 2020 were address-matched to identify residential property classifications. Data were analysed to characterise cases and identify clusters. Associated deaths were defined as death within 60 days of diagnosis or certified as cause of death. 
 
Findings: Of 1,936,315 COVID-19 cases, 81,275 (4·2%) and 10,050 (0·52%) were identified as resident or staff in a care home, respectively, with 20,544 associated deaths identified, accounting for 31·3% of all COVID-19 deaths. Cases were identified in 69·5% of all care homes in England, with 33.1% experiencing multiple outbreaks. Multivariable analysis showed a 67% increased odds of death in care home residents ( aOR: 1·67, 95% CI: 1·63-1·72) . A total of 10,321 outbreaks were identified at these facilities, of which 8·2% identified the first case as a staff member. 
 
Interpretation: Care homes have experienced large and widespread outbreaks of COVID-19, with almost 70% affected, and just under one-third of all COVID-19 deaths occurring in this setting in-spite of early policies. A key implication of our findings is upsurges in community incidences seemingly leading to increased care homes outbreaks, thus identifying and shielding residents from key sources of infection, particularly surrounding staff, is vital to reduce the number of future outbreaks. 
 
Funding Statement: Funded by Public Health England 
 
Declaration of Interests: We declare no conflicts of interest. 
 
Ethics Approval Statement: All data were collected within statutory approvals granted to Public Health England for infectious disease surveillance and control. Information was held securely and in accordance with the Data Protection Act 2018 and Caldicott guidelines.