Cross-Sectional Prevalence of SARS-CoV-2 Among Skilled Nursing Facility Employees and Residents Across Facilities in Seattle

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Skilled nursing facilities (SNFs) are high-risk settings for SARS-CoV-2 transmission. Infection rates among employees are infrequently described.

Objective

To describe SARS-CoV-2 rates among SNF employees and residents during a non-outbreak time period, we measured cross-sectional SARS-CoV-2 prevalence across multiple sites in the Seattle area.

Design

SARS-CoV-2 testing was performed for SNF employees and residents using quantitative real-time reverse transcription polymerase chain reaction. A subset of employees completed a sociodemographic and symptom questionnaire.

Participants

Between March 29 and May 13, 2020, we tested 1583 employees and 1208 residents at 16 SNFs for SARS-CoV-2.

Main Measure

SARS-CoV-2 testing results and symptom report among employees and residents.

Key Results

Eleven of the 16 SNFs had one or more resident or employee test positive. Overall, 46 (2.9%) employees had positive or inconclusive testing for SARS-CoV-2, and among those who completed surveys, most were asymptomatic and involved in direct patient care. The majority of employees tested were female (934, 73%), and most employees were Asian (392, 30%), Black (360, 28%), or white (360, 28%). Among the 1208 residents tested, 110 (9.1%) had positive or inconclusive results. There was no association between the presence of positive residents and positive employees within a SNF ( p = 0.62, McNemar’s test).

Conclusions

In the largest study of SNFs to date, SARS-CoV-2 infections were detected among both employees and residents. Employees testing positive were often asymptomatic and involved in direct patient care. Surveillance testing is needed for SNF employees and residents during the pandemic response.

Electronic supplementary material

The online version of this article (10.1007/s11606-020-06165-7) contains supplementary material, which is available to authorized users.

Related collections

Most cited references 10

Record: found
Abstract: found
Article: not found

Covid-19 in Critically Ill Patients in the Seattle Region — Case Series

Pavan K. Bhatraju, Bijan J Ghassemieh, Michelle Nichols … (2020)

Abstract Background Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020. Methods We identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up. Results We identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 days before admission. The most common symptoms were cough and shortness of breath; 50% of patients had fever on admission, and 58% had diabetes mellitus. All the patients were admitted for hypoxemic respiratory failure; 75% (18 patients) needed mechanical ventilation. Most of the patients (17) also had hypotension and needed vasopressors. No patient tested positive for influenza A, influenza B, or other respiratory viruses. Half the patients (12) died between ICU day 1 and day 18, including 4 patients who had a do-not-resuscitate order on admission. Of the 12 surviving patients, 5 were discharged home, 4 were discharged from the ICU but remained in the hospital, and 3 continued to receive mechanical ventilation in the ICU. Conclusions During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high. (Funded by the National Institutes of Health.)

0 comments Cited 1254 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

Melissa M. Arons, Kelly Hatfield, Sujan Reddy … (2020)

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can spread rapidly within skilled nursing facilities. After identification of a case of Covid-19 in a skilled nursing facility, we assessed transmission and evaluated the adequacy of symptom-based screening to identify infections in residents. Methods We conducted two serial point-prevalence surveys, 1 week apart, in which assenting residents of the facility underwent nasopharyngeal and oropharyngeal testing for SARS-CoV-2, including real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), viral culture, and sequencing. Symptoms that had been present during the preceding 14 days were recorded. Asymptomatic residents who tested positive were reassessed 7 days later. Residents with SARS-CoV-2 infection were categorized as symptomatic with typical symptoms (fever, cough, or shortness of breath), symptomatic with only atypical symptoms, presymptomatic, or asymptomatic. Results Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2. Among 76 residents who participated in point-prevalence surveys, 48 (63%) tested positive. Of these 48 residents, 27 (56%) were asymptomatic at the time of testing; 24 subsequently developed symptoms (median time to onset, 4 days). Samples from these 24 presymptomatic residents had a median rRT-PCR cycle threshold value of 23.1, and viable virus was recovered from 17 residents. As of April 3, of the 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit) and 15 had died (mortality, 26%). Of the 34 residents whose specimens were sequenced, 27 (79%) had sequences that fit into two clusters with a difference of one nucleotide. Conclusions Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.

0 comments Cited 1110 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

Temet M. McMichael, Dustin W Currie, Shauna Clark … (2020)

Abstract Background Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region. Methods After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health–Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control. Results As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County. Conclusions In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.

0 comments Cited 637 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Ana A. Weil:

ORCID: http://orcid.org/0000-0002-6170-4306

anaweil@uw.edu

Helen Y. Chu: helenchu@uw.edu

Journal

Journal ID (nlm-ta): J Gen Intern Med

Journal ID (iso-abbrev): J Gen Intern Med

Title: Journal of General Internal Medicine

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0884-8734

ISSN (Electronic): 1525-1497

Publication date (Electronic): 1 September 2020

Publication date PMC-release: 1 September 2020

Pages: 1-6

Affiliations

[1 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Medicine, Division of Allergy and Infectious Diseases, , University of Washington, ; Seattle, WA USA

[2 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Surgery, , University of Washington, ; Seattle, WA USA

[3 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Health Services, , University of Washington, ; Seattle, WA USA

[4 ]GRID grid.238801.0, ISNI 0000 0001 0435 8972, Public Health - Seattle & King County, ; King County, WA USA

[5 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Genome Sciences, , University of Washington, ; Seattle, WA USA

[6 ]Brotman Baty Institute for Precision Medicine, Seattle, WA USA

[7 ]GRID grid.270240.3, ISNI 0000 0001 2180 1622, Fred Hutchinson Cancer Research Center, ; Seattle, WA USA

[8 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Global Health, , University of Washington, ; Seattle, WA USA

Author information

Ana A. Weil http://orcid.org/0000-0002-6170-4306

Article

Publisher ID: 6165

DOI: 10.1007/s11606-020-06165-7

PMC ID: 7462112

PubMed ID: 32875494

SO-VID: ed5e2deb-6bf7-4d3c-bab8-59e929d6551c

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 5 August 2020

Date accepted : 14 August 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;

Cross-Sectional Prevalence of SARS-CoV-2 Among Skilled Nursing Facility Employees and Residents Across Facilities in Seattle

Read this article at

Abstract

Background

Objective

Design

Participants

Main Measure

Key Results

Conclusions

Electronic supplementary material

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 10

Covid-19 in Critically Ill Patients in the Seattle Region — Case Series

Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Comments

Comment on this article

Similar content 213

Cited by 6

Most referenced authors 474