What is already known about this topic?: Symptom-based screening in skilled nursing facilities (SNFs) is inadequate to detect SARS-CoV-2 Transmission. Repeated point prevalence surveys can identify asymptomatic cases during outbreaks.

What is added by this report?: Repeated point prevalence surveys at 26 Detroit SNFs identified an attack rate of 44%; within 21 days of Diagnosis, 37% of infected patients were hospitalized and 24% died. Among 12 facilities participating in a second survey and receiving on-site infection Prevention and control (IPC) support, the percentage of newly identified cases decreased from 35% to 18%.

What are the implications for public health practice?: Repeated point prevalence surveys in SNFs can identify asymptomatic COVID-19 cases, inform cohorting and IPC practices, and guide prioritization of health department resources.

Skilled nursing facilities (SNFs) are focal points of the coronaVirus disease 2019 (COVID-19) pandemic, and asymptomatic infections with SARS-CoV-2, the Virus that causes COVID-19, among SNF residents and health care personnel have been described (1–3). Repeated point prevalence surveys (serial tTesting of all residents and health care personnel at a health care facility irrespective of symptoms) have been used to identify asymptomatic infections and have reduced SARS-CoV-2 Transmission during SNF outbreaks (1,3). During March 2020, the Detroit Health Department and area hospitals detected a sharp increase in COVID-19 diagnoses, hospitalizations, and associated deaths among SNF residents. The Detroit Health Department collaborated with local government, academic, and health care system partners and a CDC field team to rapidly expand SARS-CoV-2 tTesting and implement infection Prevention and control (IPC) activities in all Detroit-area SNFs. During March 7–May 8, among 2,773 residents of 26 Detroit SNFs, 1,207 laboratory-confirmed cases of COVID-19 were identified during three periods: before (March 7–April 7) and after two point prevalence surveys (April 8–25 and April 30–May 8): the overall attack rate was 44%. Within 21 days of receiving their first positive test results, 446 (37%) of 1,207 COVID-19 patients were hospitalized, and 287 (24%) died. Among facilities participating in both surveys (n = 12), the percentage of positive test results declined from 35% to 18%. Repeated point prevalence surveys in SNFs identified asymptomatic COVID-19 cases, informed cohorting and IPC practices aimed at reducing Transmission, and guided prioritization of health department resources for facilities experiencing high levels of SARS-CoV-2 Transmission. With the increased availability of SARS-CoV-2 tTesting, repeated point prevalence surveys and enhanced and expanded IPC support should be standard tools for interrupting and preventing COVID-19 outbreaks in SNFs.

Suggested citation for this article: Sanchez GV, Biedron C, Fink LR, et al. Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities — Detroit, Michigan, March–May 2020. MMWR Morb Mortal Wkly Rep. ePub: 1 July 2020.

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