Variation in  SARS‐CoV ‐2 Prevalence in  US  Skilled Nursing Facilities

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Abstract

Objective

To identify county and facility factors associated with SARS‐CoV‐2 outbreaks in skilled nursing facilities (SNFs).

Desigsn

Cross‐sectional study linking county SARS‐CoV‐2 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post‐acute and long‐term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020.

Setting and Participants

The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non‐Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks.

Measurements

For Genesis and non‐Genesis SNFs: any outbreak (one or more residents testing positive for SARS‐CoV‐2). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, prevalence after universal testing.

Results

118 (34.6%) Genesis SNFs and 640 (21.2%) non‐Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% CI: 9.6, 57.7, P = .008) difference in the probability of an outbreak for Genesis and non‐Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI: 4.4, 20.8, P = .003) for Genesis SNFs. A 10 bed difference in facility size was associated with a 0.9 percentage point (95% CI: 0.6, 1.2; P < .001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five Star‐ratings or past infection control deficiency citations and probability or severity of outbreak.

Conclusions

Larger SNFs and SNFs in areas of high SARS‐CoV‐2 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications.

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Author and article information

Contributors

Elizabeth M. White:

ORCID: https://orcid.org/0000-0003-4175-8662

elizabeth_white@brown.edus

Journal

Journal ID (nlm-ta): J Am Geriatr Soc

Journal ID (iso-abbrev): J Am Geriatr Soc

Journal ID (doi): 10.1111/(ISSN)1532-5415

Journal ID (publisher-id): JGS

Title: Journal of the American Geriatrics Society

Publisher: John Wiley & Sons, Inc. (Hoboken, USA )

ISSN (Print): 0002-8614

ISSN (Electronic): 1532-5415

Publication date (Electronic): 16 July 2020

Electronic Location Identifier: 10.1111/jgs.16752

Affiliations

[ ¹ ] Department of Health Services, Policy, and Practices Brown University School of Public Health

[ ² ] Genesis HealthCare

[ ³ ] Genesis Physician Services

[ ⁴ ] Brown University Alpert Medical School, Division of Geriatrics and Palliative Medicines

[ ⁵ ] Florida Atlantic University Schmidt College of Medicine

[ ⁶ ] Providence Veterans Administration Medical Center Research Service

Author notes

[*] [* ]Address correspondence to Elizabeth M. White, Brown University School of Public Health, Center for Gerontology and Healthcare Research, Box G‐S121(6), 121 S. Main Street, Providence, RI 02912, Tel: 646‐379‐0710, E‐mail: elizabeth_white@ 123456brown.edus , Twitter: @betsy_white25

[†]

Dr. White and Mr. Kosar contributed equally to this article.

Author information

Elizabeth M. White https://orcid.org/0000-0003-4175-8662

Article

Publisher ID: JGS16752 Other ID: JAGS-1239-CI-Jun-20.R1

DOI: 10.1111/jgs.16752

PMC ID: 7404330

PubMed ID: 32674223

SO-VID: 478bf29b-07b5-4d60-a545-4013c7cf062b

License:

This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

History

Date received : 04 June 2020

Date revision received : 04 July 2020

Date accepted : 08 July 2020

Page count

Figures: 4, Tables: 1, Pages: 1, Words: 500

Custom metadata

source-schema-version-number 2.0

edited-state accepted-manuscript

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.6 mode:remove_FC converted:05.08.2020

ScienceOpen disciplines: Geriatric medicine

Data availability:

ScienceOpen disciplines: Geriatric medicine

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Variation in SARS‐CoV‐2 Prevalence in US Skilled Nursing Facilities

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