Evolution and impact of COVID-19 outbreaks in care-homes: population analysis in 189 care-homes in one geographic region

Jennifer K Burton, Gwen Bayne, Christine Evans, Frederike Garbe, Dermot Gorman, Public Lothian, Duncan McCormick, Public Lothian, Janet Stevenson, Stefanie Swietlik, Kate E Templeton, Mette Tranter, Lorna Willocks, Bruce Guthrie

Research output: Contribution to journalArticlepeer-review


Background: COVID-19 has impacted on care-home residents internationally, but detailed information on outbreaks is lacking.

Methods: Analysis of testing, cases and deaths in all 189 care-homes with 5843 beds in a large Scottish Health Board up to 02/08/20.

Findings: 69 (36.5%) care-homes experienced a COVID-19 outbreak, 66 of which were care-homes for older people where care-home size was strongly associated with outbreaks (OR per 20-bed increase 3.35, 95%CI 1.99-5.63). There were 907 confirmed cases and 432 COVID-related deaths, 411 (95.1%) of which occurred in care-homes with an outbreak, 19 (4.4%) in hospital, and two in the 120 care-homes without a known outbreak. In outbreak care-homes, there were 77 non-COVID deaths additional to the historical average, and 11 such deaths in care-homes without an outbreak. There were 32 fewer non-COVID deaths of care-home residents in hospital than expected, consistent with some shift of deaths that would have occurred anyway from hospital to care home. A quarter of COVID-19 related cases and deaths occurred in five (2.6%) care-homes, and half in 13 (6.9%) care-homes.

Interpretation: COVID-19 impact was very large, but concentrated in care-homes with known outbreaks with wide variation in outbreak size. Impact therefore primarily appears to be a direct effect of COVID-19. A key implication is that there is a large pool of susceptible residents if community COVID-19 incidence increases again. Shielding residents from potential sources of infection and rapid action to minimise outbreak size where infection is introduced will be critical in any wave 2.
Original languageEnglish
JournalLancet Healthy Longevity
Issue number1
Publication statusPublished - 1 Oct 2020

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