Can themes be identified in United Kingdom Health Security Agency records of general practice COVID-19 case investigations to support minimisation of SARS-CoV-2 transmission?

Problem

64 COVID-19 outbreaks/ clusters (multiple cases with/ without identified epidemiological links respectively) or single cases were reported to the UK Health Security Agency (UKHSA) from south-west England general practice (GP) settings to July 2022.Understanding how to minimise COVID-19 spread in healthcare settings serving community-dwelling populations is important both for health and wellbeing of staff and patients and for maintenance of local services.This study aimed to determine whether UKHSA records of investigations into COVID-19 cases reported by general practice could provide learning to minimise transmission of the causative virus, SARS-CoV-2.

Approach

Investigations of COVID-19 incidents are recorded on UKHSA’s in-house database. All 64 linked to GP settings in south-west England were exported securely to an Excel spreadsheet. Data was then extracted and content analysis used to report on confirmed cases, case contacts, potential routes of transmission and impacts on health/service provision.

Findings

Two reports without direct links to general practice were excluded from analysis. The remaining 62 records comprised 42 outbreaks (with 2-20 cases each), 10 clusters (2-5 cases) and 10 single cases.219 confirmed cases were identified in 42 outbreak records. 206 were staff cases, four their family members and nine were unidentified. Staff roles were not always provided but those most commonly indicated were administrative/reception staff (n=64), nurses (n=32) and GPs (n=29).No lapses in Infection Prevention and Control (IPC) measures were indicated in ten outbreaks and in six there was insufficient data for analysis. In 26 outbreaks however, at least one IPC weakness was identified, most commonly related to social distancing or staff movement between sites. Staff IPC compliance was higher when with patients than with colleagues. Weaknesses could involve practical issues e.g. shared room dimensions and laptop availability for home working. Sharing of staff across different sites, and reduced use of Personal Protective Equipment/social distancing during breaks were also indicated.No deaths and two hospitalisations were recorded. Site closures (≤14 days) occurred in four outbreaks, with reduced service provision at a further six sites and staffing adjustments identified at another two. This was due to case numbers and/or self-isolation requirements. One ‘cluster’ site was also closed due to staff self-isolations. Patients were infrequently considered case contacts due to good IPC compliance.

Consequences

UKHSA COVID-19 records hold data enabling analysis of cases, spread and IPC considerations in GP-linked COVID-19 incidents in south-west England. While good IPC was generally evident during staff-patient contact, local examination and strengthening of measures taken between staff may help contain COVID-19 cases, with potential impacts on both health and service provision. Further studies would be required to determine whether similar themes are common in other primary care health settings/regions, but local examination of possible issues identified in this study may nevertheless be helpful elsewhere.