{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T02:46:57Z","timestamp":1772160417022,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,2,6]],"date-time":"2021-02-06T00:00:00Z","timestamp":1612569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Influenza Resp Viruses"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The population of adult residential care homes has been shown to have high morbidity and mortality in relation to COVID\u201019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We examined 3115 hospital discharges to a national cohort of 1068 adult care homes and subsequent outbreaks of COVID\u201019 occurring between 22 February and 27 June 2020. A Cox proportional hazards regression model was used to assess the impact of time\u2010dependent exposure to hospital discharge on incidence of the first known outbreak, over a window of 7\u201021\u00a0days after discharge, and adjusted for care home characteristics, including size and type of provision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 330 homes experienced an outbreak, and 544 homes received a discharge over the study period. Exposure to hospital discharge was not associated with a significant increase in the risk of a new outbreak (hazard ratio 1.15, 95% CI 0.89, 1.47,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.29) after adjusting for care home characteristics. Care home size was the most significant predictor. Hazard ratios (95% CI) in comparison with homes of &lt;10 residents were as follows: 3.40 (1.99, 5.80) for 10\u201024 residents; 8.25 (4.93, 13.81) for 25\u201049 residents; and 17.35 (9.65, 31.19) for 50+ residents. When stratified for care home size, the outbreak rates were similar for periods when homes were exposed to a hospital discharge, in comparison with periods when homes were unexposed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our analyses showed that large homes were at considerably greater risk of outbreaks throughout the epidemic, and after adjusting for care home size, a discharge from hospital was not associated with a significant increase in risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/irv.12831","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T13:19:32Z","timestamp":1612790372000},"page":"371-380","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Risk factors for outbreaks of COVID\u201019 in care homes following hospital discharge: A national cohort analysis"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6112-7644","authenticated-orcid":false,"given":"Chris","family":"Emmerson","sequence":"first","affiliation":[{"name":"Public Health Wales Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9175-8287","authenticated-orcid":false,"given":"James P.","family":"Adamson","sequence":"additional","affiliation":[{"name":"Public Health Wales Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7456-6934","authenticated-orcid":false,"given":"Drew","family":"Turner","sequence":"additional","affiliation":[{"name":"Public Health Wales Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0710-0947","authenticated-orcid":false,"given":"Mike B.","family":"Gravenor","sequence":"additional","affiliation":[{"name":"Swansea University Medical School Swansea UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Salmon","sequence":"additional","affiliation":[{"name":"Public Health Wales Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Cottrell","sequence":"additional","affiliation":[{"name":"Public Health Wales Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Middleton","sequence":"additional","affiliation":[{"name":"Public Health Wales Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Buffy","family":"Thomas","sequence":"additional","affiliation":[{"name":"Public Health Wales Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6860-5394","authenticated-orcid":false,"given":"Brendan W.","family":"Mason","sequence":"additional","affiliation":[{"name":"Public Health Wales Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris J.","family":"Williams","sequence":"additional","affiliation":[{"name":"Public Health Wales Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,2,6]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"PHE Surveillance of influenza and other respiratory viruses in the UK Winter 2018 to 2019.https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/839350\/Surveillance_of_influenza_and_other_respiratory_viruses_in_the_UK_2018_to_2019\u2010FINAL.pdf"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.2648"},{"key":"e_1_2_12_4_1","unstructured":"Comas\u2010HerreraA ZalakainJ.Mortality associated with COVID\u201019 outbreaks in care homes: early international evidence 12 April 2020. Article in LTCcovid.org International Long\u2010Term Care Policy Network CPEC\u2010LSE.https:\/\/ltccovid.org\/wp\u2010content\/uploads\/2020\/04\/Mortality\u2010associated\u2010with\u2010COVID\u201012\u2010April\u20104.pdf"},{"key":"e_1_2_12_5_1","unstructured":"NERVTAG paper: Asymptomatic SARS\u2010CoV\u20102 infection.https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/893330\/S0358_Asymptomatic_SARS\u2010CoV\u20102_infection.pdf"},{"key":"e_1_2_12_6_1","unstructured":"Scientific Advisory Group for Emergencies.SPI\u2010M: Consensus statement on COVID\u201019\u201020 April 2020.2020.https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/888763\/S0201_SAGE27_200420_SPI\u2010M\u2010O_consensus_statement.pdf"},{"key":"e_1_2_12_7_1","article-title":"Introduction to and spread of COVID\u201019 in care homes in Norfolk, UK","author":"Brainard J","year":"2020","journal-title":"Medrvix"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-7568(20)30012-X"},{"key":"e_1_2_12_9_1","unstructured":"FergusonNM LaydonD Nedjati\u2010GilaniG. et al.Impact of non\u2010pharmaceutical interventions (NPIs) to reduce COVID\u201019 mortality and healthcare demand. Imperial College COVID\u201019 Response Team.2020.https:\/\/www.imperial.ac.uk\/media\/imperial\u2010college\/medicine\/sph\/ide\/gida\u2010fellowships\/Imperial\u2010College\u2010COVID19\u2010NPI\u2010modelling\u201016\u201003\u20102020.pdf"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m2375"},{"key":"e_1_2_12_11_1","unstructured":"Chronicle Live.Probe launched into whether hospital discharges caused Covid\u201019 outbreaks in Newcastle care homes.2020.https:\/\/www.chroniclelive.co.uk\/news\/north\u2010east\u2010news\/newcastle\u2010care\u2010homes\u2010hospital\u2010discharge\u201018412008"},{"key":"e_1_2_12_12_1","unstructured":"The Telegraph.Discharging coronavirus patients into care homes is 'madness' Government told.2020.https:\/\/www.telegraph.co.uk\/news\/2020\/04\/15\/discharging\u2010coronavirus\u2010patients\u2010care\u2010homes\u2010madness\u2010government\/"},{"key":"e_1_2_12_13_1","unstructured":"BBC.Coronavirus: What guidance did care homes get from the government?2020.https:\/\/www.bbc.co.uk\/news\/52674073"},{"key":"e_1_2_12_14_1","unstructured":"Sky News.Coronavirus: Discharged hospital patients may have seeded COVID\u201019 into care homes minister admits.2020.https:\/\/news.sky.com\/story\/coronavirus\u2010discharged\u2010hospital\u2010patients\u2010may\u2010have\u2010seeded\u2010covid\u201019\u2010into\u2010care\u2010homes\u2010minister\u2010admits\u201011991246"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m2334"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2020.05.073"},{"key":"e_1_2_12_17_1","unstructured":"Science Media Centre.Expert reaction to preprint paper on COVID\u201019 testing in four London care homes documenting clinical features and outcomes.2020.https:\/\/www.sciencemediacentre.org\/expert\u2010reaction\u2010to\u2010preprint\u2010paper\u2010on\u2010covid\u201019\u2010testing\u2010in\u2010four\u2010london\u2010care\u2010homes\u2010documenting\u2010clinical\u2010features\u2010and\u2010outcomes\/"},{"key":"e_1_2_12_18_1","doi-asserted-by":"crossref","unstructured":"Salcher\u2010KonradM JhassA NaciH TanM El\u2010TawilY Comas\u2010HerreraA.COVID\u201019 related mortality and spread of disease in long\u2010term care: a living systematic review of emerging evidence.medRxiv 2020.https:\/\/doi.org\/10.1101\/2020.06.09.20125237","DOI":"10.1101\/2020.06.09.20125237"},{"key":"e_1_2_12_19_1","unstructured":"Office for National Statistics.Impact of coronavirus in care homes in England: 26 May to 19 June 2020.https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/conditionsanddiseases\/articles\/impactofcoronavirusincarehomesinenglandvivaldi\/26mayto19june2020"},{"key":"e_1_2_12_20_1","doi-asserted-by":"crossref","unstructured":"Dutey\u2010MagniPF WilliamsH JhassA RaitG HemingwayH HaywardAC ShallcrossL.Covid\u201019 infection and attributable mortality in UK Long Term Care Facilities: Cohort study using active surveillance and electronic records (March\u2010June 2020).medRxiv 2020.https:\/\/doi.org\/10.1101\/2020.07.14.20152629","DOI":"10.1101\/2020.07.14.20152629"},{"key":"e_1_2_12_21_1","unstructured":"StatsWales 2020.Mid\u2010year population estimates by local health boards and age.2019.https:\/\/statswales.gov.wales\/Catalogue\/Population\u2010and\u2010Migration\/Population\/Estimates\/Local\u2010Health\u2010Boards\/populationestimates\u2010by\u2010lhb\u2010age"},{"key":"e_1_2_12_22_1","unstructured":"TherneauT.A Package for Survival Analysis in R. 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Welsh Government.https:\/\/gov.wales\/sites\/default\/files\/publications\/2020\u201010\/advice\u2010summary\u20102\u2010october\u20102020.pdf"}],"container-title":["Influenza and Other Respiratory Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/irv.12831","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/irv.12831","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/irv.12831","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T14:56:00Z","timestamp":1693580160000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/irv.12831"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,6]]},"references-count":25,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1111\/irv.12831"],"URL":"https:\/\/doi.org\/10.1111\/irv.12831","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1111\/IRV.12831\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/IRV.12831\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/IRV.12831\/v2\/response1","asserted-by":"object"}],"has-preprint":[{"id-type":"doi","id":"10.1101\/2020.08.24.20168955","asserted-by":"object"}]},"ISSN":["1750-2640","1750-2659"],"issn-type":[{"value":"1750-2640","type":"print"},{"value":"1750-2659","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,6]]},"assertion":[{"value":"2020-11-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}