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, we report on 6,600 COVID-19 cases from the East of England, 1,167 of which were identified as residents from 337 care homes.

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 we defined 409 viral clusters within the 292 homes, 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 period, providing extensive opportunities for transmission between care homes and hospitals.

Limiting viral transmission between care home residents should be a key target for infection control to reduce COVID-19 mortality in this population.