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

Details

• Personal Author:
  Arons MM ; Bardossy AC ; Bell JM ; Brostrom-Smith C ; Carlson CM ; Chisty Z ; Clark S ; Clark TA ; Duchin JS ; Dyal JW ; Harcourt J ; Harney, Joshua M. ; Hatfield KM ; Honein MA ; Jacobs JR ; James A ; Jernigan JA ; Kay M ; Kimball A ; Lewis J ; McLaughlin HP ; Methner, Mark M. ; Montgomery P ; Oakley LP ; Page LC ; Paul P ; Reddy SC ; Spicer K ; Stone ND ; Tamin A ; Tanwar S ; Tao Y ; Taylor J ; Thornburg N ; Tong S ; Uehara A
• Corporate Authors:
  Seattle-King County Dept. of Public Health ; CDC COVID-19 Investigation Team
• Description:
  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. [Description provided by NIOSH]
• Subjects:
  Age Factors Communicable Diseases Health Care Facilities Workforce And Services Health Personnel Laboratories Occupational Health Personal Protective Equipment Preventive Medicine Public Health Safety Viral Diseases

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• Keywords:
  Age Factors Disease Control Disease Transmission Health Care Facilities Health Care Workers Humans Infection Control Infectious Diseases Laboratory Testing Medical Screening Nursing Personal Protective Equipment PPE Preventive Measures Protective Measures Public Health Recommendations Viral Diseases Viral Infections

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• ISSN:
  0028-4793
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; Ohio ; OSHA Region 10 ; OSHA Region 4 ; OSHA Region 5 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DFSE - Division of Field Studies and Engineering
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  382
• Issue:
  22
• NIOSHTIC Number:
  nn:20059677
• Citation:
  N Engl J Med 2020 May; 382(22):2081-2090
• Contact Point Address:
  Dr. J.A. Jernigan, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop A-31, Atlanta, GA 30333
• Email:
  jqj9@cdc.gov
• Federal Fiscal Year:
  2020
• NORA Priority Area:
  Services
• Peer Reviewed:
  True
• Source Full Name:
  New England Journal of Medicine
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:b85b8dbcd73236696ee97e3da9f1c426ca960c1d5cc070f78c66fba700c467c2cf891cfbe0e7f56f0397302e8c261a2f240eebb1938e0971fcc3520a1f32b2f0
• Download URL:
  https://stacks.cdc.gov/view/cdc/223826/cdc_223826_DS1.pdf
• File Type:
  [PDF - 476.36 KB ]