Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes

S. Cotton, M. P. McHugh, R. Dewar, J. G. Haas, K. Templeton, Samuel C. Robson, Thomas R. Connor, Nicholas J. Loman, Tanya Golubchik, Rocio T. Martinez Nunez, David Bonsall, Andrew Rambaut, David K. Jackson, William L. Hamilton, Catherine Moore, Fiona Rogan, Derek J. Fairley, Husam Osman, David A. Simpson, James P. McKennaBen Temperton, Helen Adams, Marc Fuchs, Julia Miskelly, Thomas Davis, Anna Casey, Christopher R. Jones, Stephen Bridgett, Salman Goudarzi, Sophie Jones, Sarah Taylor, Tanya Curran, Tim Wyatt, Timofey Skvortsov, Declan T. Bradley, Jonathan Moore, Jack CD Lee, Zoltan Molnar, Kate Johnson, Leanne J. Murray, Darren R. Murray, Chris Baxter, Deborah Lavin, Arun Mariappan, Clara Radulescu, Aditi Singh, Miao Tang, Kathleen A. Williamson, Carol Scott, The COVID-19 Genomics UK (COG-UK) Consortium, Ken Smith

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: The first epidemic wave of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over one-third of care homes reported an outbreak, while there was limited testing of hospital patients discharged to care homes. Aim: To investigate patients discharged from hospitals as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. Methods: A clinical review was performed for all patients discharges from hospitals to care homes from 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease 2019 (COVID-19) test history, clinical assessment at discharge, whole-genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis using Cluster Investigation and Virus Epidemiological Tool software. Patient timelines were obtained using electronic hospital records. Findings: In total, 787 patients discharged from hospitals to care homes were identified. Of these, 776 (99%) were ruled out for subsequent introduction of SARS-CoV-2 into care homes. However, for 10 episodes, the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data were available. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission, leading to 10 positive cases in their care home. Conclusion: The majority of patients discharged from hospitals were ruled out for introduction of SARS-CoV-2 into care homes, highlighting the importance of screening all new admissions when faced with a novel emerging virus and no available vaccine.
Original languageEnglish
Pages (from-to)28-36
Number of pages9
JournalJournal of Hospital Infection
Volume135
Early online date29 Mar 2023
DOIs
Publication statusPublished - May 2023

Keywords

  • Care homes
  • Hospital discharge
  • Introduction
  • SARS-CoV-2

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