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Global infection and mortality rates from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are disproportionately high in certain populations, including amongst older people. Care home residents are frequently exposed to infection due to contact with staff and other residents, and are highly susceptible to infection due to their age and co-morbidity. In England, official statistics suggest that at least 25% of all deaths in care home residents since the start of pandemic are linked to coronavirus disease 2019 (COVID-19), but limited testing for SARS-CoV-2 early in the pandemic means estimates of the true burden of disease are lacking. Additionally, little is known about patterns of transmission between care homes, the community and hospitals, or the relationship between infection and immunity in care home staff and residents. The VIVALDI study plans to address these questions. VIVALDI is a prospective cohort study aiming to recruit 6,500 staff and 5000 residents from 105 care homes across England. Successive rounds of testing for infection will be performed over a period of 12 months. Nasopharyngeal swabs will detect evidence of viral RNA and therefore active infection (accompanied by collection of data on symptoms), whereas blood tests will detect antibodies and evidence of cellular immunity to SARS-CoV-2. Whole genome sequencing of viral isolates to investigate pathways of transmission of infection is planned in collaboration with the COVID-19 Genomics UK Consortium. Qualitative interviews with care home staff will investigate the impact of the pandemic on ways of working and how test results influence infection control practices and behaviours. Data from residents and staff will be linked to national datasets on hospital admissions, antibody and PCR test results, mortality and care home characteristics. Data generated will support national public health efforts to prevent transmission of COVID-19 and protect care home staff and residents from infection. Protocol registration: ISRCTN14447421 05/06/2020

Background: Most antibiotic prescribing occurs in primary care, largely in children under 5 years old, and often inappropriately. This study investigated knowledge, attitudes and behaviours (KABs) towards common childhood infections, antibiotic use and antimicrobial resistance (AMR), among parents of children under 5 years old. The concept of individual sacrifice (forgoing antibiotics—a selective pressure for AMR) to mitigate future societal risk of AMR and how the COVID-19 pandemic shaped views were explored. Methods: This qualitative study included three, one-hour, virtual focus groups with mothers from parenting networks across inner-city London and semi-rural England, held mid-pandemic (2020) . All had ≥1 child The Framework Method of analysis was used. Parents' KABs towards antibiotic use/AMR formed the primary outcome, with emphases on their sense of personal agency towards mitigating the threat of AMR for society, plus how the pandemic influenced views on infection prevention and care. Results: Fourteen mothers (groups of six, four, four) participated, with mixed ethnicities, education and employment status. Parent perceptions of their individual child's immediate need for antibiotics outweighed concerns for any possible future threat of AMR to society. Four key themes were identified: uncertainty around symptoms; impact of socio-cultural background on KAB; poor understanding of how antibiotics/AMR work; and opportunities within the doctor–patient dialogue to shape mindset around AMR. The pandemic influenced views across themes. Conclusion: Parents prioritising their child's perceived, immediate, individual 'need' for antibiotics over any future impact of AMR on society highlights a continuing need to engage parents in how to mitigate AMR through appropriate antibiotic use, reducing threat to both their child and others. Framing point-of-care dialogue around antibiotic use/AMR in the present (versus future), drawing on pandemic insights and tailoring according to nuanced socio-cultural influences, may encourage a greater sense of personal agency towards taking action to mitigate antibiotic resistance.