Hybrid simulation modelling of networks of heterogeneous care homes and the inter-facility spread of Covid-19 by sharing staff

Although system dynamics [SD] and agent-based modelling [ABM] have individually served as effective tools to understand the Covid-19 dynamics, combining these methods in a hybrid simulation model can help address Covid-19 questions and study systems and settings that are difficult to study with a single approach. To examine the spread and outbreak of Covid-19 across multiple care homes via bank/agency staff and evaluate the effectiveness of interventions targeting this group, we develop an integrated hybrid simulation model combining the advantages of SD and ABM. We also demonstrate how we use several approaches adapted from both SD and ABM practices to build confidence in this model in response to the lack of systematic approaches to validate hybrid models. Our modelling results show that the risk of infection for residents in care homes using bank/agency staff was significantly higher than those not using bank/agency staff (Relative risk [RR] 2.65, 95% CI 2.57–2.72). Bank/agency staff working across several care homes had a higher risk of infection compared with permanent staff working in a single care home (RR 1.55, 95%CI 1.52–1.58). The RR of infection for residents is negatively correlated to bank/agency staff’s adherence to weekly PCR testing. Within a network of heterogeneous care homes, using bank/agency staff had the most impact on care homes with lower intra-facility transmission risks, higher staff-to-resident ratio, and smaller size. Forming bubbles of care homes had no or limited impact on the spread of Covid-19. This modelling study has implications for policy makers considering developing effective interventions targeting staff working across care homes during the ongoing and future pandemics. Author summary We developed an integrated hybrid simulation model to evaluate the impact of bank/agency staff on the spread of Covid-19 across a network of heterogeneous care homes and the effectiveness of interventions targeting these staff. The study methods advance infectious disease hybrid simulation modelling, and in particular, we demonstrate approaches for validation and confidence building of hybrid models; an under-researched area. Our model findings fill a research gap with policy implications for care homes, which are heavily reliant on bank/agency staff due to shortages of staff. Our findings align well with existing observational study evidence, including that that using bank/agency staff increases the risk of infection for residents and that bank/agency staff have a greater risk of infection compared with permanent staff working in single care homes. Using bank/agency staff has the greatest impact on infections in care homes with lower intra-facility transmission risks, higher staff-to-resident ratio, and smaller size. Testing bank/agency staff is particularly important while forming smaller bubbles of care homes and restricting staff to only work within a bubble has limited impact on the spread of Covid-19. The model is being used to assist decision-makers from the Department of Health and Social Care in the UK.