Characterization of community‐wide transmission of SARS‐CoV‐2 in congregate living settings and local public health‐coordinated response during the initial phase of the COVID‐19 pandemic

Abstract

Background Clusters of COVID‐19 cases amplify the pandemic and are critical targets for intervention, but comprehensive cluster‐level data are not collected systematically by federal or most state public health entities. This analysis characterizes COVID‐19 clusters among vulnerable populations housed in congregate living settings across an entire community and describes early mitigation efforts. Methods The Cuyahoga County Board of Health identified and interviewed COVID‐19 cases and exposed contacts, assessing possible connections to congregate living facilities within its jurisdiction from March 7, 2020, to May 15, 2020, during the first phase of the pandemic, while state of Ohio stay‐at‐home orders were in effect. A multi‐disciplinary team‐based response network was mobilized to support active case finding and develop facility‐focused containment strategies. Results We identified a cascade of 45 COVID‐19 clusters across community facilities (corrections, nursing, assisted living, intermediate care, extended treatment, shelters, group homes). Attack rates were highest within small facilities ( P < .01) and large facilities requiring extensive support to implement effective containment measures. For 25 clusters, we identified an index case who frequently (88%) was a healthcare worker. Engagement of clinical, community, and government partners through public health coordination efforts created opportunities to rapidly develop and coordinate effective response strategies to support the facilities facing the dawning impact of the pandemic. Conclusions Active cluster investigations can uncover the dynamics of community transmission affecting both residents of congregate settings and their caregivers and help to target efforts toward populations with ongoing challenges in access to detection and control resources.

Antimicrobial Resistance in the COVID-19 Landscape: Is There an Opportunity for Anti-Infective Antibodies and Antimicrobial Peptides?

“…These measures may have contributed to a reduction in the opportunities for transmission of many pathogens beyond SARS-CoV-2 (74). On the other hand, transmission within a local household or facility may be amplifying (75). Generally, the situation of confinement, and the limitation in leaving home, could have contributed to a decrease in the number of medical visits and, therefore, to a decrease in antibiotic prescriptions (76) limiting the appearance of resistance microorganisms (Figure 4).…”

Establishment of primary health information in the COVID-19 outbreak: A cross-sectional study of population awareness of self-testing

“…Before implementing health self-monitoring behaviors, people would consider a combination of less expensive, better quality, and less time-consuming medical checkups. Therefore, it is necessary to improve the primary health care infrastructure to solve the problems of “expensive” and “difficult” access to health care, Especially during the COVID-19 pandemic, adequate health resources, and good medical conditions played an important role in guiding the population towards autonomous disease prevention counseling and health consultation [ 44 ].…”

Factors Influencing Elevated Mortality Rates of Patients with Schizophrenia Hospitalized with COVID

“…Possible explanations for the higher mortality rate specifically in congregate settings could include higher exposure to the virus when living in close quarters, limited ability for the congregate setting to isolate people who were positive for COVID, potential delay in treatment due to staff not being aware of the severity of symptoms or perhaps patient unawareness of the need for intervention. In one study, staff were also suspected to be the vector for introducing COVID-19 into the facility (Terebuh et al, 2021 ). Of note, in spite of the knowledge that people with schizophrenia were dying at higher rates than the general population and that the virus spread more quickly in congregate living situations, people in these two populations were not prioritized for receiving the vaccine.…”