Abstract
BackgroundOutbreaks of coronavirus disease 2019 (COVID-19) have been reported in nursing homes and assisted living facilities; however, the extent of asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this high-risk population remains unclear.MethodsWe conducted an investigation of the first known outbreak of SARS-CoV-2 at a skilled nursing facility (SNF) in Illinois on 15 March 2020 and followed residents for 30 days. We tested 126/127 residents for SARS-CoV-2 via reverse-transcription polymerase chain reaction and performed symptom assessments. We calculated the point prevalence of SARS-CoV-2 and assessed symptom onset over 30-day follow-up to determine: (1) the proportion of cases who were symptomatic, presymptomatic, and asymptomatic and (2) incidence of symptoms among those who tested negative. We used the Kaplan-Meier method to determine the 30-day probability of death for cases.ResultsOf 126 residents tested, 33 had confirmed SARS-CoV-2 on 15 March. Nineteen (58%) had symptoms at the time of testing, 1 (3%) developed symptoms over follow-up, and 13 (39%) remained asymptomatic. Thirty-five residents who tested negative on 15 March developed symptoms over follow-up; of these, 3 were re-tested and 2 were positive. The 30-day probability of death among cases was 29%.ConclusionsSNFs are particularly vulnerable to SARS-CoV-2, and residents are at risk of severe outcomes. Attention must be paid to preventing outbreaks in these and other congregate care settings. Widespread testing and infection control are key to help prevent COVID-19 morbidity and mortality in these high-risk populations.
Highlights
MethodsWe conducted an investigation of the first known outbreak of SARS-CoV-2 at a skilled nursing facility (SNF) in Illinois on 15 March 2020 and followed residents for 30 days
Outbreaks of coronavirus disease 2019 (COVID-19) have been reported in nursing homes and assisted living facilities; the extent of asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this high-risk population remains unclear
skilled nursing facility (SNF) are vulnerable to SARS-CoV-2, and residents are at risk of severe outcomes
Summary
We conducted an investigation of the first known outbreak of SARS-CoV-2 at a skilled nursing facility (SNF) in Illinois on 15 March 2020 and followed residents for 30 days. Facility A is a 150-bed SNF located in DuPage County, Illinois, that offers short- and long-term rehabilitation and hospice care. It is staffed by 1 medical director, 4 clinicians, and 2 nurse practitioners, and approximately 60 nurses, 10 housekeepers, and 35 additional full- and part-time staff. On 9 March 2020, a 67-year-old female resident of Facility A was noted to have fever and cough She was managed at the SARS-CoV-2 in a Skilled Nursing Facility cid 2020:XX (XX XXXX) 1 facility until she became hypoxic and had increasing shortness of breath necessitating transfer to a local hospital on 11 March.
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