Universal and Serial Laboratory Testing for SARS-CoV-2 at a Long-term Care Skilled Nursing Facility for Veterans — Los Angeles, California, 2020

Details

• Personal Author:
  Dora, Amy V. ; Winnett, Alexander ; Jatt, Lauren P. ; Davar, Kusha ; Watanabe, Mika ; Sohn, Linda ; Kern, Hannah S. ; Graber, Christopher J. ; Goetz, Matthew B.
• Corporate Authors:
  David Geffen School of Medicine. Division of Infectious Diseases. ; David Geffen School of Medicine. ; Greater Los Angeles Veterans Affairs Healthcare System (U.S.)Division of Geriatrics and Extended Care. ; Greater Los Angeles Veterans Affairs Healthcare System (U.S.)Division of Infectious Diseases.
• Description:
  What is already known about this topic?: Long-term care skilled nursing facilities (SNFs) are at high risk for COVID-19 outbreaks. Many SNF residents and staff members identified with COVID-19 are asymptomatic and presymptomatic.
  
  What is added by this report?: After identification of two cases of COVID-19 in an SNF in Los Angeles, universal, serial reverse transcription–polymerase chain reaction (RT-PCR) tTesting of residents and staff members aided in rapid identification of additional cases and isolation and cohorting of these residents and interruption of Transmission in the facility.
  
  What are the implications for public health practice?: Universal and serial RT-PCR tTesting in SNFs can identify cases during an outbreak, and rapid isolation and cohorting can help interrupt Transmission.
  
  On March 28, 2020, two residents of a long-term care skilled nursing facility (SNF) at the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS) had positive test results for SARS-CoV-2, the cause of coronaVirus disease 2019 (COVID-19), by reverse transcription–polymerase chain reaction (RT-PCR) tTesting of nasopharyngeal specimens collected on March 26 and March 27. During March 29–April 23, all SNF residents, regardless of symptoms, underwent serial (approximately weekly) nasopharyngeal SARS-CoV-2 RT-PCR tTesting, and positive results were communicated to the county health department. All SNF clinical and nonclinical staff members were also screened for SARS-CoV-2 by RT-PCR during March 29–April 10. Nineteen of 99 (19%) residents and eight of 136 (6%) staff members had positive test results for SARS-CoV-2 during March 28–April 10; no further resident cases were identified on subsequent tTesting on April 13, April 22, and April 23. Fourteen of the 19 residents with COVID-19 were asymptomatic at the time of tTesting. Among these residents, eight developed symptoms 1–5 days after specimen collection and were later classified as presymptomatic; one of these patients died. This report describes an outbreak of COVID-19 in an SNF, with case identification accomplished by implementing several rounds of RT-PCR tTesting, permitting rapid isolation of both symptomatic and asymptomatic residents with COVID-19. The outbreak was successfully contained following implementation of this strategy.
  
  Suggested citation for this article: Dora AV, Winnett A, Jatt LP, et al. Universal and Serial Laboratory Testing for SARS-CoV-2 at a Long-Term Care Skilled Nursing Facility for Veterans — Los Angeles, California, 2020. MMWR Morb Mortal Wkly Rep. ePub: 22 May 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6921e1
  
  mm6921e1-H.pdf
  
  
• Content Notes:
  RT-PCR Testing of Residents -- RT-PCR Testing of Staff Members -- Discussion -- Acknowledgments.
• Subjects:
  Aged Clinical Laboratory Techniques CoronaVirus Infections/Diagnosis COVID-19 COVID-19 Nucleic Acid Testing COVID-19 Testing Hospitals, Veterans Long-Term Care Pandemics Population Surveillance Reverse Transcriptase Polymerase Chain Reaction Skilled Nursing Facilities Veterans

  More +
• Source:
  MMWR: Morbidity and Mortality Weekly Report 2020; v. 69 Early Release
• Series:
  Weekly Report: Morbidity and Mortality Weekly Report (MMWR)
• ISSN:
  0149-2195 (print) ; 1545-861X (digital)
• Document Type:
  Journal Article
• Place as Subject:
  Los Angeles, CA
• Pages in Document:
  5 pdf pages
• Volume:
  69
• Collection(s):
  Morbidity and Mortality Weekly Report (MMWR)
• Main Document Checksum:
  urn:sha-512:f288c262e48369df6f12f2f35a2e6bd46829f16c0f0abc276614f4d93922591c95b69140deb61ab72642733c4be7df08b4ff8c0dbf8bfe3380cb755ecd3e84da
• Download URL:
  https://stacks.cdc.gov/view/cdc/88306/cdc_88306_DS1.pdf
• File Type:
  [PDF - 177.91 KB ]