{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:01:59Z","timestamp":1787068919511,"version":"build-2736575974"},"reference-count":23,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This cross-sectional study investigated how care home size influences COVID-19 transmission dynamics, focusing on outbreaks in England during the second wave of COVID-19 (Wave 2; December 2020 to March 2021) and the Omicron wave (December 2021 to February 2022). Using data from the UK Health Security Agency and the Care Quality Commission, positive SARS-CoV-2 test results were matched to care home registration and occupancy data, examining outbreak trajectories in homes of varying sizes and resident age groups. The study included over 90,000 positive cases across the two waves. Small care homes (SCHs, with 10 or fewer beds), predominantly housing younger adults, showed significantly higher early positivity rates: 42% of residents were positive at outbreak detection, rising to 61% by day 7. In contrast, larger homes had early positivity rates of only 3\u20136%. These findings suggest that SCHs, often designed for communal living, facilitate rapid within-home transmission similar to household settings. The study concludes that outbreak control strategies in SCHs should differ from those in larger care homes, emphasizing proportionate, individualized approaches that consider resident vulnerability and minimize disruption to social support systems. These results have broader implications for managing future infectious disease outbreaks and support the development of tailored guidance based on care home size and resident demographics.<\/jats:p>","DOI":"10.1017\/s0950268825100757","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T05:00:26Z","timestamp":1765342826000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["COVID-19 outbreaks in care homes: How does size influence transmission dynamics? A cross-sectional study with implications for outbreak management in small care homes"],"prefix":"10.1017","volume":"154","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5574-6788","authenticated-orcid":false,"given":"Catherine","family":"Carey","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c9amonn","family":"O\u2019Moore","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Huyton","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Willner","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Fernandes","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9595-3212","authenticated-orcid":false,"given":"Will","family":"Morton","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martyn","family":"Regan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackie","family":"Cassell","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"S0950268825100757_r12","year":"2022"},{"key":"S0950268825100757_r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2020.100533"},{"key":"S0950268825100757_r5","volume-title":"Registration under the Health and Social Care Act 2008. The Scope of Registration","year":"2022"},{"key":"S0950268825100757_r21","doi-asserted-by":"publisher","DOI":"10.1186\/2193-1801-2-222"},{"key":"S0950268825100757_r15","year":"2019"},{"key":"S0950268825100757_r23","unstructured":"[23] Health Research Authority (2013) Is my study research? London: HRA. https:\/\/www.hra-decisiontools.org.uk\/research\/ (accessed 10 September 2025)."},{"key":"S0950268825100757_r6","volume-title":"Guidance on Regulated Activities for Providers of Supported Living and Extra Care Housing","year":"2015"},{"key":"S0950268825100757_r20","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afab054"},{"key":"S0950268825100757_r19","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afq029"},{"key":"S0950268825100757_r3","unstructured":"[3] Office for National Statistics. Older people living in care homes in 2021 and changes since 2011. Office for National Statistics (2021) https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/ageing\/articles\/olderpeoplelivingincarehomesin2021andchangessince2011\/2023-10-09 (accessed 7 April 2025)."},{"key":"S0950268825100757_r2","article-title":"COVID-19 risk factors among 14,786 care home residents: An observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays and vaccination status in Wales (UK) between 1 September 2020 and 1 May 2021","volume":"51","author":"Hollinghurst","year":"2022","journal-title":"Age and Ageing"},{"key":"S0950268825100757_r4","unstructured":"[4] World Health Organization (2025) A decision framework for effective, equitable and context-specific public health and social measures during public health emergencies: Decision Navigator. Geneva: WHO https:\/\/www.who.int\/publications\/i\/item\/9789240108611 (accessed 23 September 2025)."},{"key":"S0950268825100757_r11","unstructured":"[11] Department of Health and Social Care (2021) Adult Social Care Infection Control and Testing Fund (ICTF). GOV.UK https:\/\/www.gov.uk\/government\/publications\/adult-social-care-infection-control-fund (accessed 10 September 2025)."},{"key":"S0950268825100757_r17","article-title":"Changes in COVID-19 outbreak severity and duration in long-term care facilities following vaccine introduction, England, November 2020 to June 2021","volume":"26","author":"Giddings","year":"2021","journal-title":"Euro Surveillance"},{"key":"S0950268825100757_r16","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-7568(22)00147-7"},{"key":"S0950268825100757_r14","year":"2020"},{"key":"S0950268825100757_r7","volume-title":"Glossary of Terms","year":"2025"},{"key":"S0950268825100757_r1","unstructured":"[1] Chief Medical Officer, Chief Scientific Adviser. (2022) Technical report on the COVID-19 pandemic in the UK. In: Department of Health and Social Care, editor. A technical report for future UK chief medical officers, government chief scientific advisers, National Medical Directors and public health leaders in a pandemic. Chapter 8.2: Care homes. London: His Majesty\u2019s Government."},{"key":"S0950268825100757_r13","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-022-01009-8"},{"key":"S0950268825100757_r10","unstructured":"[10] NHS England, Department of Health and Social Care (2022) Capacity Tracker reports: Utilisation by region and location https:\/\/capacitytracker.com\/reports\/utilisation-report\/by-region-and-location (accessed 10 September 2025)."},{"key":"S0950268825100757_r22","year":"2022"},{"key":"S0950268825100757_r8","volume-title":"UKHSA Epidemiology Cell (EpiCell) Line List for Positive COVID-19 Tests","year":"2022"},{"key":"S0950268825100757_r9","volume-title":"Using CQC Data","year":"2022"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268825100757","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T07:13:06Z","timestamp":1784272386000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268825100757\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,10]]},"references-count":23,"alternative-id":["S0950268825100757"],"URL":"https:\/\/doi.org\/10.1017\/s0950268825100757","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,10]]},"assertion":[{"value":"\u00a9 Crown Copyright - UK Health Security Agency, 2025. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e8"}}