Genomic epidemiology of COVID-19 in care homes in the east of England.

COVID-19 poses a major challenge to care homes, as SARS-CoV-2 is readily transmitted and causes disproportionately severe disease in older people. Here, 1167 residents from 337 care homes were identified from a dataset of 6600 COVID-19 cases from the East of England. Older age and being a care home resident were associated with increased mortality. SARS-CoV-2 genomes were available for 700 residents from 292 care homes. By integrating genomic and temporal data, 409 viral clusters within the 292 homes were identified, indicating two different patterns - outbreaks among care home residents and independent introductions with limited onward transmission. Approximately 70% of residents in the genomic analysis were admitted to hospital during the study, providing extensive opportunities for transmission between care homes and hospitals. Limiting viral transmission within care homes should be a key target for infection control to reduce COVID-19 mortality in this population.
Competing Interests: WH, GT, ES, DA, CH, BW, LM, MH, AJ, MC, SP, LC, SC, FK, AY, GH, TF, MP, IG, YC, CB, SG, RA, EH, NB, MB, MS, DJ, IJ, AA, JS, CL, GD, SP, DK, IG No competing interests declared, MT I have received grant support from the Academy of Medical Sciences, the Health Foundation, and the NIHR Biomedical Research Centre. I have also received book royalties from Oxford University Press and honoraria from the Wellcome Sanger Institute
(© 2021, Hamilton et al.)