Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities — Detroit, Michigan, March–May 2020

Details

• Personal Author:
  Sanchez, Guillermo V. ; Biedron, Caitlin ; Fink, Lauren R. ; Hatfield, Kelly M. ; Polistico, Jordan Micah F. ; Meyer, Monica P. ; Noe, Rebecca S. ; Copen, Casey E. ; Lyons, Amanda K. ; Gonzalez, Gonzalo ; Kiama, Keith ; Lebednick, Mark ; Czander, Bonnie K. ; Agbonze, Amen ; Surma, Aimee R. ; Sandhu, Avnish ; Mika, Valerie H. ; Prentiss, Tyler ; Zervos, John ; Dalal, Donia A. ; Vasquez, Amber M. ; Reddy, Sujan C. ; Jernigan, John ; Kilgore, Paul E. ; Zervos, Marcus J. ; Chopra, Teena ; Bezold, Carla P. ; Rehman, Najibah K.
• Corporate Authors:
  CDC COVID-19 Response Team. ; Detroit (Mich.). Department of Health. ; Detroit Medical Center. ; Wayne State University. ; Henry Ford Health System.
• Description:
  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.
  
  mm6927e1-H.pdf
  
  mm6927e1.htm?s_cid=mm6927e1_w
  
  
• Content Notes:
  Demographic and Baseline Health Characteristics -- Reported Symptoms -- Exposures -- Discussion -- Acknowledgments -- Table 1 -- Table 2 -- Table 3.
• Subjects:
  Aged Aged, 80 And Over BetacoronaVirus Clinical Laboratory Techniques CoronaVirus Infections COVID-19 Disease Outbreaks Long-Term Care Pandemics Pneumonia, Viral Skilled Nursing Facilities

  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:
  Detroit, MI
• Pages in Document:
  5 pdf pages
• Volume:
  69
• Collection(s):
  Morbidity and Mortality Weekly Report (MMWR)
• Main Document Checksum:
  urn:sha-512:7a1f2009208a326eb7f411d3b61df296af86418bcc3134218721dc2b0c92c878ce9b2f26696340fdf51902cd49fb9f81802cf65716c8673b032dd6485f8f6e9d
• Download URL:
  https://stacks.cdc.gov/view/cdc/90046/cdc_90046_DS1.pdf
• File Type:
  [PDF - 155.58 KB ]