Control of a COVID-19 outbreak in a nursing home by general screening and cohort isolation in Germany, March to May 2020

Abstract

Elderly care facilities have become a major focus of coronavirus disease (COVID-19) control. Here, we describe an outbreak of COVID-19 in a nursing home in Germany from 8 March to 4 May 2020 (58 days), and the effect of an intervention of general screening and cohort isolation. COVID-19 cases among residents and staff were recorded on a daily basis from the first positive SARS-CoV-2 test from a resident on 8 March 2020, until 4 May 2020 when the last staff member was classified COVID-19 negative. Eighty of 160 residents (50%) and 37 of 135 staff members (27%) tested positive for SARS-CoV-2. Twenty-seven of the 80 residents were asymptomatic but tested positive during the first general screening. Cohort isolation of SARS-CoV-2 positive residents by reorganising the facility proved to be a major effort. After the intervention, four further asymptomatic residents tested positive in follow-up screenings within a period of 6 days, and were possibly infected prior to the intervention. Thereafter, no further infections were recorded among residents. The described outbreak was controlled by implementing general screening and rigorous cohort isolation, providing a blueprint for similar facilities.

Clinical performance evaluation of SARS-CoV-2 rapid antigen testing in point of care usage in comparison to RT-qPCR

“…In contrast, viral load at the beginning of a SARS-CoV-2 infection is low, and rapidly increases after the test is performed. Unless these individuals are identified by a parallel RT-qPCR, a false negative RDT may cause and fuel outbreaks [23] . Additionally, incorrect swabbing may strongly decrease in-vitro viral load in the sample and falsely suggest a lower viral load according to a preprint analysis [24] .…”

Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses

“…Given the variable time latencies between testing and results [24], and the need to repeat testing in many instances, isolation and cohorting strategies were implemented in nursing homes to divide the residents into defined groups based on COVID-19 status. Many studies reported the common practice of cohorting positive cases within a separate COVID-19 unit [47][48][49]. It was recommended that specific staff members be allocated to these units to reduce dissemination and allow for more focused care [50].…”

COVID-19 Prevention and Control Measures in Workplace Settings: A Rapid Review and Meta-Analysis

“…Following duplicate removal, title and abstract screening, and full-text screening, 61 met all inclusion criteria and were included in the review (Figure 1). Included studies (k = 61) varied in study design, comprising 6 cross-sectional studies [21][22][23][24][25][26], 7 case-control series [27,28], 22 prospective cohort studies , 1 longitudinal cohort study [51], 7 retrospective cohort studies [52][53][54][55][56][57][58], 7 prospective observational studies (i.e., observing the number of new cases in a facility after the implementation of IPC measures) [59][60][61][62][63][64][65], 1 retrospective observational study [66], 3 outbreak investigation reports [67][68][69], 1 post hoc analysis [70], 1 sequential follow-up study [71], 1 short-term prospective survey [72], 2 surveillance studies [73,74], and 7 mathematical modelling studies [75][76][77][78][79][80][81]. All studies were conducted before COVID-19 vaccinations became available in December 2020.…”

“…Fifteen studies were performed in the United States (USA) [28,36,38,41,45,49,51,52,55,69,72,[78][79][80][81]. Other included studies were performed in India [32], France [72], Canada [29,63], Italy [22,42,44,57,60,62,74], the United King-dom (UK) [35,40,50,53,58,65,75,76], Belgium [21,39], Korea [30,31,54,56], Taiwan [73], Germany [33,37,59,67,68,71] China [48], Finland [25], Spain [26], Japan …”