Assessing the role of care homes as community reservoirs, and potential sentinel sites for the enhanced surveillance of infectious disease.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has had a devastating effect on adults living in long term care: it's estimated that this population accounted for at least 40% of COVID-19 related deaths in the UK during the first 3 months of the pandemic. COVID-19, like many other infectious diseases, can spread silently - particularly among older people who are often infectious without displaying any symptoms. In care homes, this results in explosive outbreaks which are difficult to control. In order to detect infectious organisms before they cause outbreaks, it's important to understand where the pathogens accumulate and how they are distributed. Since viruses and bacteria can be found on surfaces, in the air and in waste water, sampling the environment will provide clues about how they spread so effectively in care homes. This study will investigate how the SARS-CoV-2 virus spreads around care homes during outbreaks. We will take regular environmental samples alongside diagnostic tests for staff and residents, and epidemiological information about the setting and its population. Using the findings from this study we will build a mathematical model to assess the best way to monitor care homes for the emergence of infectious diseases.