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Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic

Joseph Hollinghurst, Laura North, Chris Emmerson, Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Chris Williams, Ronan Lyons Orcid Logo, Alan Hawkes, Ed Bennett Orcid Logo, Michael Gravenor Orcid Logo, Rich Fry Orcid Logo

Age and Ageing, Volume: 51, Issue: 5

Swansea University Authors: Joseph Hollinghurst, Laura North, Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Ronan Lyons Orcid Logo, Alan Hawkes, Ed Bennett Orcid Logo, Michael Gravenor Orcid Logo, Rich Fry Orcid Logo

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DOI (Published version): 10.1093/ageing/afac072

Abstract

BackgroundA defining feature of the COVID-19 pandemic in many countries was the tragic extent to which care home residents were affected, and the difficulty preventing introduction and subsequent spread of infection. Management of risk in care homes requires good evidence on the most important trans...

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Published in: Age and Ageing
ISSN: 0002-0729 1468-2834
Published: Oxford University Press (OUP) 2022
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URI: https://cronfa.swan.ac.uk/Record/cronfa59693
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Management of risk in care homes requires good evidence on the most important transmission pathways. One hypothesised route at the start of the pandemic, prior to widespread testing, was transfer of patients from hospitals, which were experiencing high levels of nosocomial events.MethodsWe tested the hypothesis that hospital discharge events increased the intensity of care home cases using a national individually linked health record cohort in Wales, UK. We monitored 186,772 hospital discharge events over the period March to July 2020, tracking individuals to 923 care homes and recording the daily case rate in the homes populated by 15,772 residents. We estimated the risk of an increase in cases rates following exposure to a hospital discharge using multi-level hierarchical logistic regression, and a novel stochastic Hawkes process outbreak model.FindingsIn regression analysis, after adjusting for care home size, we found no significant association between hospital discharge and subsequent increases in care home case numbers (odds ratio: 0.99, 95% CI 0.82, 1.90). Risk factors for increased cases included care home size, care home resident density, and provision of nursing care. Using our outbreak model, we found a significant effect of hospital discharge on the subsequent intensity of cases. However, the effect was small, and considerably less than the effect of care home size, suggesting the highest risk of introduction came from interaction with the community. We estimated approximately 1.8% of hospital discharged patients may have been infected.InterpretationThere is growing evidence in the UK that the risk of transfer of COVID-19 from the high-risk hospital setting to the high-risk care home setting during the early stages of the pandemic was relatively small. Although access to testing was limited to initial symptomatic cases in each care home at this time, our results suggest that reduced numbers of discharges, selection of patients, and action taken within care homes following transfer all may have contributed to mitigation. The precise key transmission routes from the community remain to be quantified.</abstract><type>Journal Article</type><journal>Age and Ageing</journal><volume>51</volume><journalNumber>5</journalNumber><paginationStart/><paginationEnd/><publisher>Oxford University Press (OUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0002-0729</issnPrint><issnElectronic>1468-2834</issnElectronic><keywords>Older people, Hawkes Process, Multi-level model, Linked Data, COVID-19, Hospital discharge, Care homes</keywords><publishedDay>1</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-05-01</publishedDate><doi>10.1093/ageing/afac072</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>This work was supported by the Medical Research Council [MR/V028367/1]; Health and Care Research Wales [Project: SCF-18-1504]; Health Data Research UK [HDR-9006] which receives its funding from the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust; and Administrative Data Research UK which is funded by the Economic and Social Research Council [grant ES/S007393/1]. E.B. acknowledges the support of the Supercomputing Wales programme, which is part-funded by the European Regional Development Fund (ERDF) via Welsh Government, and of the Science and Technologies Facilities Council Research Software Engineering Fellowship EP/V052489/1.</funders><projectreference/><lastEdited>2024-07-15T12:16:07.4828702</lastEdited><Created>2022-03-22T13:33:51.7502056</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Joseph</firstname><surname>Hollinghurst</surname><order>1</order></author><author><firstname>Laura</firstname><surname>North</surname><order>2</order></author><author><firstname>Chris</firstname><surname>Emmerson</surname><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>5</order></author><author><firstname>Chris</firstname><surname>Williams</surname><order>6</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>7</order></author><author><firstname>Alan</firstname><surname>Hawkes</surname><order>8</order></author><author><firstname>Ed</firstname><surname>Bennett</surname><orcid>0000-0002-1678-6701</orcid><order>9</order></author><author><firstname>Michael</firstname><surname>Gravenor</surname><orcid>0000-0003-0710-0947</orcid><order>10</order></author><author><firstname>Rich</firstname><surname>Fry</surname><orcid>0000-0002-7968-6679</orcid><order>11</order></author></authors><documents><document><filename>59693__24111__a84dc9e2c3ab42079d5d02415c2783da.pdf</filename><originalFilename>59693.pdf</originalFilename><uploaded>2022-05-17T15:24:03.1209217</uploaded><type>Output</type><contentLength>240122</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© The Author(s) 2022. 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spelling v2 59693 2022-03-22 Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic d7c51b69270b644a11b904629fe56ab0 Joseph Hollinghurst Joseph Hollinghurst true false a255822cf77a0184cb6922e9fbea39e9 Laura North Laura North true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 56dbf45233f1d80425924e81dc651635 Alan Hawkes Alan Hawkes true false e1a8e7927d2b093acdc54e74eac95e38 0000-0002-1678-6701 Ed Bennett Ed Bennett true false 70a544476ce62ba78502ce463c2500d6 0000-0003-0710-0947 Michael Gravenor Michael Gravenor true false d499b898d447b62c81b2c122598870e0 0000-0002-7968-6679 Rich Fry Rich Fry true false 2022-03-22 MEDS BackgroundA defining feature of the COVID-19 pandemic in many countries was the tragic extent to which care home residents were affected, and the difficulty preventing introduction and subsequent spread of infection. Management of risk in care homes requires good evidence on the most important transmission pathways. One hypothesised route at the start of the pandemic, prior to widespread testing, was transfer of patients from hospitals, which were experiencing high levels of nosocomial events.MethodsWe tested the hypothesis that hospital discharge events increased the intensity of care home cases using a national individually linked health record cohort in Wales, UK. We monitored 186,772 hospital discharge events over the period March to July 2020, tracking individuals to 923 care homes and recording the daily case rate in the homes populated by 15,772 residents. We estimated the risk of an increase in cases rates following exposure to a hospital discharge using multi-level hierarchical logistic regression, and a novel stochastic Hawkes process outbreak model.FindingsIn regression analysis, after adjusting for care home size, we found no significant association between hospital discharge and subsequent increases in care home case numbers (odds ratio: 0.99, 95% CI 0.82, 1.90). Risk factors for increased cases included care home size, care home resident density, and provision of nursing care. Using our outbreak model, we found a significant effect of hospital discharge on the subsequent intensity of cases. However, the effect was small, and considerably less than the effect of care home size, suggesting the highest risk of introduction came from interaction with the community. We estimated approximately 1.8% of hospital discharged patients may have been infected.InterpretationThere is growing evidence in the UK that the risk of transfer of COVID-19 from the high-risk hospital setting to the high-risk care home setting during the early stages of the pandemic was relatively small. Although access to testing was limited to initial symptomatic cases in each care home at this time, our results suggest that reduced numbers of discharges, selection of patients, and action taken within care homes following transfer all may have contributed to mitigation. The precise key transmission routes from the community remain to be quantified. Journal Article Age and Ageing 51 5 Oxford University Press (OUP) 0002-0729 1468-2834 Older people, Hawkes Process, Multi-level model, Linked Data, COVID-19, Hospital discharge, Care homes 1 5 2022 2022-05-01 10.1093/ageing/afac072 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) This work was supported by the Medical Research Council [MR/V028367/1]; Health and Care Research Wales [Project: SCF-18-1504]; Health Data Research UK [HDR-9006] which receives its funding from the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust; and Administrative Data Research UK which is funded by the Economic and Social Research Council [grant ES/S007393/1]. E.B. acknowledges the support of the Supercomputing Wales programme, which is part-funded by the European Regional Development Fund (ERDF) via Welsh Government, and of the Science and Technologies Facilities Council Research Software Engineering Fellowship EP/V052489/1. 2024-07-15T12:16:07.4828702 2022-03-22T13:33:51.7502056 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Joseph Hollinghurst 1 Laura North 2 Chris Emmerson 3 Ashley Akbari 0000-0003-0814-0801 4 Fatemeh Torabi 0000-0002-5853-4625 5 Chris Williams 6 Ronan Lyons 0000-0001-5225-000X 7 Alan Hawkes 8 Ed Bennett 0000-0002-1678-6701 9 Michael Gravenor 0000-0003-0710-0947 10 Rich Fry 0000-0002-7968-6679 11 59693__24111__a84dc9e2c3ab42079d5d02415c2783da.pdf 59693.pdf 2022-05-17T15:24:03.1209217 Output 240122 application/pdf Version of Record true © The Author(s) 2022. This is an Open Access article distributed under the terms of the Creative Commons Attribution License true eng http://creativecommons.org/licenses/by/4.0/
title Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic
spellingShingle Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic
Joseph Hollinghurst
Laura North
Ashley Akbari
Fatemeh Torabi
Ronan Lyons
Alan Hawkes
Ed Bennett
Michael Gravenor
Rich Fry
title_short Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic
title_full Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic
title_fullStr Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic
title_full_unstemmed Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic
title_sort Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic
author_id_str_mv d7c51b69270b644a11b904629fe56ab0
a255822cf77a0184cb6922e9fbea39e9
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83efcf2a9dfcf8b55586999d3d152ac6
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author_id_fullname_str_mv d7c51b69270b644a11b904629fe56ab0_***_Joseph Hollinghurst
a255822cf77a0184cb6922e9fbea39e9_***_Laura North
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
56dbf45233f1d80425924e81dc651635_***_Alan Hawkes
e1a8e7927d2b093acdc54e74eac95e38_***_Ed Bennett
70a544476ce62ba78502ce463c2500d6_***_Michael Gravenor
d499b898d447b62c81b2c122598870e0_***_Rich Fry
author Joseph Hollinghurst
Laura North
Ashley Akbari
Fatemeh Torabi
Ronan Lyons
Alan Hawkes
Ed Bennett
Michael Gravenor
Rich Fry
author2 Joseph Hollinghurst
Laura North
Chris Emmerson
Ashley Akbari
Fatemeh Torabi
Chris Williams
Ronan Lyons
Alan Hawkes
Ed Bennett
Michael Gravenor
Rich Fry
format Journal article
container_title Age and Ageing
container_volume 51
container_issue 5
publishDate 2022
institution Swansea University
issn 0002-0729
1468-2834
doi_str_mv 10.1093/ageing/afac072
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description BackgroundA defining feature of the COVID-19 pandemic in many countries was the tragic extent to which care home residents were affected, and the difficulty preventing introduction and subsequent spread of infection. Management of risk in care homes requires good evidence on the most important transmission pathways. One hypothesised route at the start of the pandemic, prior to widespread testing, was transfer of patients from hospitals, which were experiencing high levels of nosocomial events.MethodsWe tested the hypothesis that hospital discharge events increased the intensity of care home cases using a national individually linked health record cohort in Wales, UK. We monitored 186,772 hospital discharge events over the period March to July 2020, tracking individuals to 923 care homes and recording the daily case rate in the homes populated by 15,772 residents. We estimated the risk of an increase in cases rates following exposure to a hospital discharge using multi-level hierarchical logistic regression, and a novel stochastic Hawkes process outbreak model.FindingsIn regression analysis, after adjusting for care home size, we found no significant association between hospital discharge and subsequent increases in care home case numbers (odds ratio: 0.99, 95% CI 0.82, 1.90). Risk factors for increased cases included care home size, care home resident density, and provision of nursing care. Using our outbreak model, we found a significant effect of hospital discharge on the subsequent intensity of cases. However, the effect was small, and considerably less than the effect of care home size, suggesting the highest risk of introduction came from interaction with the community. We estimated approximately 1.8% of hospital discharged patients may have been infected.InterpretationThere is growing evidence in the UK that the risk of transfer of COVID-19 from the high-risk hospital setting to the high-risk care home setting during the early stages of the pandemic was relatively small. Although access to testing was limited to initial symptomatic cases in each care home at this time, our results suggest that reduced numbers of discharges, selection of patients, and action taken within care homes following transfer all may have contributed to mitigation. The precise key transmission routes from the community remain to be quantified.
published_date 2022-05-01T12:16:06Z
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