Applying Genomic Epidemiology to Characterize a COVID-19 Outbreak in a Developmentally Disabled Adult Group Home Setting, Arizona.

Hayley D Yaglom,Jolene R Bowers,Matthew Maurer,Chris French,Darrin Lemmer,Marette Gebhardt,Daniel E Jasso-Selles,Mary Ellen Ormsby,Megan L Folkerts,David M Engelthaler,Ashlyn Pfeiffer

doi:10.3389/fpubh.2021.668214

Abstract

Individuals living in congregate settings, including those in group homes, have been disproportionately impacted by COVID-19 and may be at increased risk of exposure or infection due to underlying illness. In mid-May 2020, local public health officials responded to an outbreak of COVID-19 among staff and residents associated with a multi-residential group home that provides care for adults with intellectual and developmental disabilities. Samples were collected at 16 of the homes. In four of the homes all the residents tested positive, and in the remaining 12 houses where samples were collected, all residents tested negative. Of the 152 individuals tested, 15/58 (25.9%) residents and 27/94 (28.7%) staff were positive for SARS-CoV-2, including eight hospitalizations and four deaths. Phylogenetic analysis of genomes from this outbreak in the context of genomes from Northern Arizona shows that very few mutations separate the samples from this outbreak. A potential transmission network was developed to illustrate person-place epidemiologic linkages and further demonstrates the dynamic connections between staff and residents with respect to each group home location. Epidemiologic and genomic evidence correlate, and suggest that asymptomatic infected staff likely introduced and spread COVID-19 in this setting. Implementation of public health prevention measures alongside rapid genomic analysis can help guide policy development and guide management efforts to prevent and mitigate future outbreaks.

Highlights

The COVID-19 pandemic has dramatically impacted individuals in many different congregate settings, including long-term care facilities, homeless shelters, and group homes
On May 15th 2020, public health officials were notified of positive COVID-19 cases associated with a multi-residence group home that provides services for people with intellectual or developmental disabilities (IDD)
None of the residents experienced the hallmark signs of COVID-19; staff reported that several infected residents were hypoxic and lethargic

Summary

Introduction

The COVID-19 pandemic has dramatically impacted individuals in many different congregate settings, including long-term care facilities, homeless shelters, and group homes. Adults with intellectual or developmental disabilities (IDD) are three times more likely to suffer from underlying medical conditions, such as heart disease, diabetes, and respiratory illnesses, that are known COVID-19 risk factors, than those without IDD [1,2,3,4] It is typical for people with IDD to have multiple chronic health conditions, which paired with metabolic and nutritional disorders, elevate the risk of experiencing more severe outcomes of COVID-19. New York health officials have reported infection rates in group homes to be five times higher than the general population [7] Despite these numbers, which are likely an underestimation of the true burden on this population, limited scientific reports have highlighted outbreaks in group homes throughout the United States that care for individuals with IDD

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