Whole Care Home Testing for Covid-19 in a Local Authority Area in the United Kingdom

ObjectivesTo describe the point prevalence of SARS-CoV-2 in care homes reporting low numbers of cases of COVID-19. DesignA cross-sectional study of care homes, ascertaining perceived disease burden using interviews with care home managers and SARS-CoV-2 RNA detection in residents and staff using nose and throat swabbing. Setting15 Care homes in Essex, United Kingdom, all of which had reported either zero or one case of COVID-19 to the Health Protection Team. Participants912 residents and staff of care homes were tested. Residents were eligible to be tested regardless of symptoms. Main outcome measureDetection of SARS-CoV-2 in residents and staff. ResultsIn the 15 care homes studied, SARS-CoV-2 was detected in 23 (5.2%) of 441 residents. Of these 23, 21/23 (91%) were asymptomatic as reported by the care home managers. SARS-CoV-2 was detected in 8/471 (1.7%) of staff. This differs from that in residents (p=0.003). ConclusionsThe studys findings suggest that symptoms, as reported by care home managers, are an insensitive method of defining the extent of SARS-CoV-2 infection in nursing homes. Viral detection from residents is more common than from staff. Microbiological screening is a more sensitive method for defining the extent of SARS-CoV-2 in care homes than managerial reporting of resident symptoms.