Mass testing for discovery and control of COVID-19 outbreaks in adult social care: an observational study and cost-effectiveness analysis of 14 805 care homes in England
Introduction We retrospectively evaluated the impact of COVID-19 testing among residents and staff in social care homes in England.Methods We obtained 80 million reported PCR and lateral flow device (LFD) test results, from 14 805 care homes (residents and staff) in England, conducted between Octobe...
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BMJ Publishing Group
2025-05-01
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| author | Ben Lambert Sassy Molyneux Susan Hopkins Tom Fowler Prabin Dahal Kasia Stepniewska Sheetal Silal Sabine Dittrich Sunil Pokharel Siyu Chen Bo Gao Ricardo Aguas Marta Wanat Lisa White Rima Shretta Wirichada Pan-Ngum Ainura Moldokmatova Caroline Franco Sompob Saralamba Jared Norman Rachel Hounsell Reshania Naidoo Merryn Voysey Liberty Cantrell Sophie Dickinson Billie Andersen-Waine Angus Ferguson-Lewis Ma’ayan Amswych Anastasiia Polner Claire Keene Emily Rowe Kweku Bimpong Muhammad Kasim Randolph Ngwafor Anye Richard Creswell Sumali Bajaj Tracy Evans Sarah Pinto-Duschinsky Gulsen Yenidogan Joseph Tsui Lok Hei Olumide Kolade Adam Bodley Umar Mahmood Ben Lambert Melinda Mills Katarzyna Przybylska Joseph Tsui |
| author_facet | Ben Lambert Sassy Molyneux Susan Hopkins Tom Fowler Prabin Dahal Kasia Stepniewska Sheetal Silal Sabine Dittrich Sunil Pokharel Siyu Chen Bo Gao Ricardo Aguas Marta Wanat Lisa White Rima Shretta Wirichada Pan-Ngum Ainura Moldokmatova Caroline Franco Sompob Saralamba Jared Norman Rachel Hounsell Reshania Naidoo Merryn Voysey Liberty Cantrell Sophie Dickinson Billie Andersen-Waine Angus Ferguson-Lewis Ma’ayan Amswych Anastasiia Polner Claire Keene Emily Rowe Kweku Bimpong Muhammad Kasim Randolph Ngwafor Anye Richard Creswell Sumali Bajaj Tracy Evans Sarah Pinto-Duschinsky Gulsen Yenidogan Joseph Tsui Lok Hei Olumide Kolade Adam Bodley Umar Mahmood Ben Lambert Melinda Mills Katarzyna Przybylska Joseph Tsui |
| author_sort | Ben Lambert |
| collection | DOAJ |
| description | Introduction We retrospectively evaluated the impact of COVID-19 testing among residents and staff in social care homes in England.Methods We obtained 80 million reported PCR and lateral flow device (LFD) test results, from 14 805 care homes (residents and staff) in England, conducted between October 2020 and March 2022. These testing data were then linked to care home characteristics, test costs and 24 500 COVID-19-related deaths of residents. We decomposed the mechanism of outbreak mitigation into outbreak discovery and outbreak control and used Poisson regressions to investigate how reported testing intensity was associated with the size of outbreak discovered and to uncover its association with outbreak control. We used negative binomial regressions to determine the factors influencing COVID-19-related deaths subsequent to outbreaks. We performed a cost-effectiveness analysis of the impact of testing on preventing COVID-19-related deaths of residents.Results Reported testing intensity generally reflected changes in testing policy over time, although there was considerable heterogeneity among care homes. Client type was the strongest determinant of whether COVID-19-related deaths in residents occurred subsequent to testing positive. Higher staff-to-resident ratios were associated with larger outbreak sizes but rapid outbreak control and a decreased risk of COVID-19-related deaths. Assuming our regression estimates represent causal effects, care home testing in England was cost-effective at preventing COVID-19-related deaths among residents during the pandemic and approximately 3.5 times more cost-effective prior to the vaccine rollout.Conclusions PCR and LFD testing was likely an impactful intervention for detecting and controlling COVID-19 outbreaks in care homes in England and cost-effective for preventing COVID-19-related deaths among residents. In future pandemics, testing must be prioritised for care homes, especially if severe illness and death particularly affect older people or individuals with characteristics similar to care home residents, and an efficacious vaccine is unavailable. |
| format | Article |
| id | doaj-art-deceab71e8f5445292ad0cd684e52c1c |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Public Health |
| spelling | doaj-art-deceab71e8f5445292ad0cd684e52c1c2025-08-20T03:31:11ZengBMJ Publishing GroupBMJ Public Health2753-42942025-05-013110.1136/bmjph-2024-001376Mass testing for discovery and control of COVID-19 outbreaks in adult social care: an observational study and cost-effectiveness analysis of 14 805 care homes in EnglandBen Lambert0Sassy MolyneuxSusan Hopkins1Tom Fowler2Prabin Dahal3Kasia Stepniewska4Sheetal SilalSabine DittrichSunil PokharelSiyu Chen5Bo GaoRicardo AguasMarta WanatLisa White6Rima Shretta7Wirichada Pan-NgumAinura MoldokmatovaCaroline FrancoSompob SaralambaJared NormanRachel Hounsell8Reshania Naidoo9Merryn Voysey10Liberty Cantrell11Sophie DickinsonBillie Andersen-WaineAngus Ferguson-LewisMa’ayan Amswych12Anastasiia PolnerClaire KeeneEmily RoweKweku BimpongMuhammad KasimRandolph Ngwafor AnyeRichard Creswell13Sumali Bajaj14Tracy EvansSarah Pinto-DuschinskyGulsen YenidoganJoseph Tsui Lok Hei15Olumide Kolade16Adam BodleyUmar Mahmood Ben LambertMelinda MillsKatarzyna PrzybylskaJoseph Tsui10 Department of Statistics; Pandemic Sciences Institute, University of Oxford, Oxford, UK7 UK Health Security Agency, London, UK2 UK Health Security Agency, London, UK4 Nuffield Department of Medicine, University of Oxford, Oxford, UK9 University of Oxford, Oxford, UK1 Princeton University High Meadows Environmental Institute, Princeton, New Jersey, USA6 Department of Biology, University of Oxford, Oxford, UK4 Nuffield Department of Medicine, University of Oxford, Oxford, UK4 Nuffield Department of Medicine, University of Oxford, Oxford, UK4 Nuffield Department of Medicine, University of Oxford, Oxford, UK5 Department of Paediatrics, University of Oxford, Oxford, UK5 Department of Paediatrics, University of Oxford, Oxford, UK8 Ernst & Young, London, UK3 Department of Computer Science, University of Oxford, Oxford, UK6 Department of Biology, University of Oxford, Oxford, UK6 Department of Biology, University of Oxford, Oxford, UK7 UK Health Security Agency, London, UKIntroduction We retrospectively evaluated the impact of COVID-19 testing among residents and staff in social care homes in England.Methods We obtained 80 million reported PCR and lateral flow device (LFD) test results, from 14 805 care homes (residents and staff) in England, conducted between October 2020 and March 2022. These testing data were then linked to care home characteristics, test costs and 24 500 COVID-19-related deaths of residents. We decomposed the mechanism of outbreak mitigation into outbreak discovery and outbreak control and used Poisson regressions to investigate how reported testing intensity was associated with the size of outbreak discovered and to uncover its association with outbreak control. We used negative binomial regressions to determine the factors influencing COVID-19-related deaths subsequent to outbreaks. We performed a cost-effectiveness analysis of the impact of testing on preventing COVID-19-related deaths of residents.Results Reported testing intensity generally reflected changes in testing policy over time, although there was considerable heterogeneity among care homes. Client type was the strongest determinant of whether COVID-19-related deaths in residents occurred subsequent to testing positive. Higher staff-to-resident ratios were associated with larger outbreak sizes but rapid outbreak control and a decreased risk of COVID-19-related deaths. Assuming our regression estimates represent causal effects, care home testing in England was cost-effective at preventing COVID-19-related deaths among residents during the pandemic and approximately 3.5 times more cost-effective prior to the vaccine rollout.Conclusions PCR and LFD testing was likely an impactful intervention for detecting and controlling COVID-19 outbreaks in care homes in England and cost-effective for preventing COVID-19-related deaths among residents. In future pandemics, testing must be prioritised for care homes, especially if severe illness and death particularly affect older people or individuals with characteristics similar to care home residents, and an efficacious vaccine is unavailable.https://bmjpublichealth.bmj.com/content/3/1/e001376.full |
| spellingShingle | Ben Lambert Sassy Molyneux Susan Hopkins Tom Fowler Prabin Dahal Kasia Stepniewska Sheetal Silal Sabine Dittrich Sunil Pokharel Siyu Chen Bo Gao Ricardo Aguas Marta Wanat Lisa White Rima Shretta Wirichada Pan-Ngum Ainura Moldokmatova Caroline Franco Sompob Saralamba Jared Norman Rachel Hounsell Reshania Naidoo Merryn Voysey Liberty Cantrell Sophie Dickinson Billie Andersen-Waine Angus Ferguson-Lewis Ma’ayan Amswych Anastasiia Polner Claire Keene Emily Rowe Kweku Bimpong Muhammad Kasim Randolph Ngwafor Anye Richard Creswell Sumali Bajaj Tracy Evans Sarah Pinto-Duschinsky Gulsen Yenidogan Joseph Tsui Lok Hei Olumide Kolade Adam Bodley Umar Mahmood Ben Lambert Melinda Mills Katarzyna Przybylska Joseph Tsui Mass testing for discovery and control of COVID-19 outbreaks in adult social care: an observational study and cost-effectiveness analysis of 14 805 care homes in England BMJ Public Health |
| title | Mass testing for discovery and control of COVID-19 outbreaks in adult social care: an observational study and cost-effectiveness analysis of 14 805 care homes in England |
| title_full | Mass testing for discovery and control of COVID-19 outbreaks in adult social care: an observational study and cost-effectiveness analysis of 14 805 care homes in England |
| title_fullStr | Mass testing for discovery and control of COVID-19 outbreaks in adult social care: an observational study and cost-effectiveness analysis of 14 805 care homes in England |
| title_full_unstemmed | Mass testing for discovery and control of COVID-19 outbreaks in adult social care: an observational study and cost-effectiveness analysis of 14 805 care homes in England |
| title_short | Mass testing for discovery and control of COVID-19 outbreaks in adult social care: an observational study and cost-effectiveness analysis of 14 805 care homes in England |
| title_sort | mass testing for discovery and control of covid 19 outbreaks in adult social care an observational study and cost effectiveness analysis of 14 805 care homes in england |
| url | https://bmjpublichealth.bmj.com/content/3/1/e001376.full |
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