COVID-19 can cause significant mortality in the elderly in Long Term Care Facilities (LTCF). We describe four LTCF outbreaks where mass testing identified a high proportion of asymptomatic infections (4-41% in health care workers and 20-75% in residents), indicating that symptom-based screening alone is insufficient for monitoring for COVID-19 transmission.
Objective:
To describe epidemiologic and genomic characteristics of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large skilled nursing facility (SNF), and the strategies that controlled transmission.
Design, Setting, and Participants:
Cohort study during March 22–May 4, 2020 of all staff and residents at a 780-bed SNF in San Francisco, California.
Methods:
Contact tracing and symptom screening guided targeted testing of staff and residents; respiratory specimens were also collected through serial point prevalence surveys (PPS) in units with confirmed cases. Cases were confirmed by real-time reverse transcription–polymerase chain reaction testing for SARS-CoV-2; whole genome sequencing (WGS) characterized viral isolate lineages and relatedness. Infection prevention and control (IPC) interventions included restricting from work any staff who had close contact to a confirmed case; restricting movements between units; implementing surgical face masking facility-wide; and recommended PPE (isolation gown, gloves, N95 respirator and eye protection) for clinical interactions in units with confirmed cases.
Results:
Of 725 staff and residents tested through targeted testing and serial PPS, twenty-one (3%) were SARS-CoV-2-positive; sixteen (76%) staff and 5 (24%) residents. Fifteen (71%) were linked to a single unit. Targeted testing identified 17 (81%) cases; PPS identified 4 (19%). Most (71%) cases were identified prior to IPC intervention. WGS was performed on SARS-CoV-2 isolates from four staff and four residents; five were of Santa Clara County lineage and the three others were distinct lineages.
Conclusions:
Early implementation of targeted testing, serial PPS, and multimodal IPC interventions limited SARS-CoV-2 transmission within the SNF.
BACKGROUND COVID-19 has caused significant mortality worldwide. 1 Within the USA, marked geographic differences in incidence, hospitalization, and death have been reported. 2 Better characterization of populations at increased risk for death from COVID-19 is needed, including from long-term care facilities (LTCF). We describe the demographic and clinical characteristics of the first 50 fatalities with COVID-19 in San Francisco. METHODS All San Francisco residents who die with laboratoryconfirmed COVID-19 infection are reported to the San Francisco Department of Public Health (SFDPH). We reviewed case report forms, medical records, and death certificate data for demographics, clinical presentation, and hospital course when applicable. Cause of death was not considered to be due to COVID-19 if not listed as the underlying cause of death on both the death certificate and medical record. These activities were public health surveillance, and not research; therefore, institutional review board review was not obtained.
, COVID-19 can cause significant morbidity and mortality in persons 65 years and older residing in skilled nursing facilities (SNFs). 1-4 On March 5, 2020, after the first two epidemiologically distinct COVID-19 cases were confirmed in San Francisco, CA, the San Francisco Department of Public Health (SFDPH) implemented measures to limit community transmission and protect the most vulnerable populations. These included Health Officer Orders, issued on March 10, restricting entry of visitors and nonessential healthcare
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