Mobile PCR-based surveillance for SARS-CoV-2 to reduce visiting restrictions in nursing homes during the COVID-19 pandemic: a pilot study

Jannik Stemler,Theresa Kramer,Harald Rau,Sofie Schumacher,Ulrike Wieland,Sally Pieper,Max Oberste,Florian Klein,Oliver A Cornely,Vassiliki Dimitriou,Rosanne Sprute,Clara Lehmann,Martin Hellmich,Ullrich Bethe,Georg Langebartels,Gerhard Wiesmüller

doi:10.1007/s15010-021-01716-4

Abstract

PurposeResidents in nursing homes for the elderly (NH) are at high risk for death from COVID-19. We investigated whether repeated non-mandatory RT-PCR SARS-CoV-2 surveillance of NH staff and visitors reduces COVID-19 incidence rates in NH residents and allows to reduce visiting restrictions.MethodsThis pilot study at the beginning of the COVID-19 pandemic compared a surveillance approach of regular, twice-weekly voluntary PCR testing of health-care workers (HCW) and visitors in interventional NH (INH) with a setting without regular testing in control NH (CNH). Residents were not tested routinely within this study. Testing was performed in a mobile testing site with same-day result reporting. SARS-CoV-2 incidence among residents in both INH and CNH was the primary endpoint; secondary endpoints being SARS-CoV-2 infection among visitors and HCW in INH.ResultsTwo INH and two CNH participated between October and December, 2020. At INH1, 787 tests of HCW and 350 tests of visitors were performed, accounting for 18.1% (n = 1930) of visits. At INH2, 78 tests of HCW and 372 tests of visitors were done, i.e., 30.5% (n = 1220) of visits. At the two INH 23 HCW and three visitors tested positive for SARS-CoV-2. COVID-19 outbreaks occurred among residents in INH1 (identified through study testing) and in CNH1. Utilization of voluntary testing was low.ConclusionIn a real-world setting without available rapid testing, voluntary RT-PCR SARS-CoV-2 testing of HCW and visitors does not prevent COVID-19 outbreaks in NH. Complete, non-selective testing for these groups should be instituted before visiting restrictions can be reduced.Trial registrationThe study has been registered at ClinicalTrials.gov with the identifier: NCT04933981.

Highlights

The COVID-19 pandemic continues to cause an unprecedented burden for health-care systems worldwide due to high levels of morbidity and mortality [1]
SARS-CoV-2 may be transmitted to NH residents via asymptomatic or oligosymptomatic infected health-care workers (HCW) and visitors [6]
At the beginning of the COVID-19 pandemic, when point-of-care rapid antigen tests (POCT) were not available, we hypothesized that offering repeated rapid turnaround PCR surveillance to NH staff and visitors may reduce incidence in NH residents and subsequently allows to reduce visiting restrictions. We addressed this hypothesis by accompanying a regional pilot study of a mobile testing site (MTS) in nursing homes

Summary

Introduction

The COVID-19 pandemic continues to cause an unprecedented burden for health-care systems worldwide due to high levels of morbidity and mortality [1]. Outbreaks in NH have led to a case fatality of up to 32% and a sixfold excess mortality compared with the pre-pandemic period [5]. SARS-CoV-2 may be transmitted to NH residents via asymptomatic or oligosymptomatic infected health-care workers (HCW) and visitors [6]. At the beginning of the COVID-19 pandemic, visits to NH were largely suspended in Germany with broad psychological and social constraints for NH residents [7]. PCR testing of HCW and visitors has been suggested a safe approach to prevent outbreaks in NH, because an asymptomatic person with a negative PCR test may not transmit SARS-CoV-2 for up to 72 h post-sampling [10, 11].

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Conclusion