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.