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

Details

• Alternative Title:
  N Engl J Med
• Personal Author:
  Arons, Melissa M. ; Hatfield, Kelly M. ; Reddy, Sujan C. ; Kimball, Anne ; James, Allison ; Jacobs, Jesica R. ; Taylor, Joanne ; Spicer, Kevin ; Bardossy, Ana C. ; Oakley, Lisa P. ; Tanwar, Sukarma ; Dyal, Jonathan W. ; Harney, Josh ; Chisty, Zeshan ; Bell, Jeneita M. ; Methner, Mark ; Paul, Prabasaj ; Carlson, Christina M. ; McLaughlin, Heather P. ; Thornburg, Natalie ; Tong, Suxiang ; Tamin, Azaibi ; Tao, Ying ; Uehara, Anna ; Harcourt, Jennifer ; Clark, Shauna ; Brostrom-Smith, Claire ; Page, Libby C. ; Kay, Meagan ; Lewis, James ; Montgomery, Patty ; Stone, Nimalie D. ; Clark, Thomas A. ; Honein, Margaret A. ; Duchin, Jeffrey S. ; Jernigan, John A.
• 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.
  
  
• Subjects:
  Aged Aged, 80 And Over Asymptomatic Diseases Betacoronavirus Comorbidity Coronavirus Infections Cough COVID-19 Disease Transmission, Infectious Dyspnea Female Fever Genome, Viral Humans Infection Control Male Original Article Pandemics Pneumonia, Viral Prevalence Real-Time Polymerase Chain Reaction SARS-CoV-2 Skilled Nursing Facilities Viral Load Washington

  More +
• Source:
  N Engl J Med. 2020;
• Pubmed ID:
  32329971
• Pubmed Central ID:
  PMC7200056
• Document Type:
  Journal Article
• Collection(s):
  Stephen B. Thacker CDC Library
• Main Document Checksum:
  urn:sha256:32c146873b8e7efedee036c9aeb6066964508f35335ed98015d954e1752344d2
• Download URL:
  https://stacks.cdc.gov/view/cdc/87734/cdc_87734_DS1.pdf
• File Type:
  [PDF - 497.61 KB ]