Management of a large outbreak of COVID-19 at a British Army training centre: lessons for the future

Abstract

IntroductionThe COVID-19 pandemic has posed major challenges for infection control within training centres, both civilian and military. Here we present a narrative review of an outbreak that occurred at the Royal Military Academy Sandhurst (RMAS) in January–March 2021, in the context of the circulating, highly transmissible SARS-CoV-2 variant B.1.1.7.MethodsTesting for SARS-CoV-2 was performed using a combination of reverse transcriptase PCR and Lateral Flow Devices (LFDs). Testing and isolation procedures were conducted in line with a pre-established symptom stratification system. Genomic sequencing was performed on 10 sample isolates.ResultsBy the end of the outbreak, 185 cases (153 Officer Cadets, 32 permanent staff) had contracted confirmed COVID-19. This represented 15% of the total RMAS population. This resulted in 0 deaths and 0 hospitalisations, but due to necessary isolation procedures did represent an estimated 12 959 person-days of lost training. 9 of 10 (90%) of sequenced isolates had a reportable lineage. All of those reported were found to be the Alpha lineage B.1.1.7.ConclusionsWe discuss the key lessons learnt from the after-action review by the Incident Management Team. These include the importance of multidisciplinary working, the utility of sync matrices to monitor outbreaks in real time, issues around Officer Cadets reporting symptoms, timing of high-risk training activities, infrastructure and use of LFDs. COVID-19 represents a vital learning opportunity to minimise the impact of potential future pandemics, which may produce considerably higher morbidity and mortality in military populations.

Combining viral genomics and clinical data to assess risk factors for severe COVID-19 (mortality, ICU admission, or intubation) amongst hospital patients in a large acute UK NHS hospital Trust

“…Large-scale SARS-CoV-2 sequencing programs throughout the pandemic have allowed researchers to explore the role of viral genomics and different variants of the virus. However, whilst genomic epidemiology has been used in a number of studies to understand viral transmission in settings such as hospitals [14][15][16][17], long-term care facilities [18][19][20][21][22], and army barracks [23,24], well-powered studies of patient outcomes with high numbers of cases currently remain limited [25][26][27][28][29][30][31]. One of the largest studies looking at large-scale effects of viral genomics on patient outcomes are papers from the Hospital Onset COVID-19 Infections (HOCI) study in the UK [25,26,28].…”

Retrospective spatial analysis of cases of COVID-19 in a single military accommodation block corridor, RMAS, January–March 21

“…The paper from Routledge et al 1 described the management of an outbreak of COVID-19 at the Royal Military Academy Sandhurst in early 2021. A schematic map of positive cases on Victory College’s first floor was published, the figure noting that ‘ positive cases are clustered around shared facilities, rather than along the length of the corridor’ 1.…”

“…The paper from Routledge et al 1 described the management of an outbreak of COVID-19 at the Royal Military Academy Sandhurst in early 2021. A schematic map of positive cases on Victory College’s first floor was published, the figure noting that ‘ positive cases are clustered around shared facilities, rather than along the length of the corridor’ 1. Previously published studies on the transmission dynamics of COVID-19 in high-density settings have identified shared bathrooms2; stairwells as points of congregation3 and the relatedness of rooms based on airflow patterns as potential spatial factors in transmission.…”