Healthcare-associated COVID-19 in England: A national data linkage study

•This is the first national report of healthcare-associated COVID-19 in England.•Our study covered the first wave of the pandemic, from march to august 2020.•15% of SARS-CoV-2 infections in patients were hospital-onset healthcare-associated.•These represent less than 1% of the estimated 3 million COVID-19 cases in this period. Nosocomial transmission was an important aspect of SARS-CoV-1 and MERS-CoV outbreaks. Healthcare-associated SARS-CoV-2 infection has been reported in single and multi-site hospital-based studies in England, but not nationally. Admission records for all hospitals in England were linked to SARS-CoV-2 national test data for the period 01/03/2020 to 31/08/2020. Case definitions were: community-onset community-acquired, first positive test