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An outbreak of SARS-CoV-2 in a skilled nursing facility (SNF) can be devastating for residents and staff. Difficulty identifying asymptomatic and pre-symptomatic cases and lack of vaccination or treatment options make management challenging. We created, implemented and now present a guide to rapidly deploy point prevalence testing and three-tiered cohorting in a SNF to mitigate an outbreak. We outline key challenges to SNF cohorting.

Background/Objectives: Few studies present clinical management approaches and outcomes of coronavirus disease 2019 (COVID-19) outbreaks in skilled nursing facilities (SNFs). We describe outcomes of a clinical management pathway for a large COVID-19 outbreak in an urban SNF with predominantly racial minority (>90% black), medically complex, older residents.

has had an impact on nutrition at individual, community, national, and global levels. 1 COVID-19 has been associated with weight loss and also has been linked to cachexia and sarcopenia. 2 Anorexia was the most common symptom during COVID-19 infection among patients at an academic long-term chronic care facility, with 70.8% of residents developing anorexia during the illness course. 3 In addition to effects of the disease itself, there are potential unintended consequences of infection control measures. A study of residents in a nursing home without a COVID-19 outbreak in the month following implementation of restrictions on visitors and group dining designed to mitigate the spread of COVID-19 showed significant weight loss among residents. 4 We conducted a retrospective chart review assessing the outcome of a COVID-19 outbreak on resident weights in a >200-bed skilled nursing facility (SNF) in Chicago, IL. The medical charts of each resident in the facility between March 1, 2020, and May 31, 2020, were reviewed in the electronic medical record (EMR) (PointClickCare) at the SNF and the affiliated academic medical center (Epic, 2020 Epic Systems Corporation). Among the residents included in the sample (n ¼ 209), the average age was 75.3 years (SD ¼ 11.9 years); residents were predominantly Black (93.3%) and women (56.0%). Hypertension (89.5%) and cognitive impairment (67.9%) were the most common chronic conditions present, followed by cardiac disease (43.5%) and diabetes (39.2%).There was no significant difference in age, race, gender, or comorbidities between the COVID-positive (n ¼ 172) and COVID-negative groups (n ¼ 32). Prevalence testing was completed for all residents in the facility twice at 7-day intervals in addition to as-needed testing based on symptoms and exposure. 5 The results of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction

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