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.

Original languageEnglish
Article numbere64618
Number of pages31
Publication statusPublished - 2 Mar 2021


  • Aged, 80 and over
  • COVID-19/epidemiology
  • Disease Outbreaks
  • England/epidemiology
  • Female
  • Humans
  • Infectious Disease Transmission, Patient-to-Professional
  • Infectious Disease Transmission, Professional-to-Patient
  • Male
  • Nursing Homes
  • Polymorphism, Single Nucleotide
  • SARS-CoV-2/genetics
  • Sequence Analysis
  • Time Factors


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