[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]
Facility-Wide Testing for SARS-CoV-2 in Nursing Homes — Seven U.S. Jurisdictions, March–June 2020
Early Release / August 11, 2020 / 69
Kelly M. Hatfield, MSPH1; Sujan C. Reddy, MD1; Kaitlin Forsberg, MPH1; Lauren Korhonen, MSPH1; Kelley Garner, MPH2; Trent Gulley, MPH2; Allison James, DVM, PhD2; Naveen Patil, MD2; Carla Bezold, ScD3; Najibah Rehman, MD3; Marla Sievers, MPH4; Benjamin Schram, MPH5; Tracy K. Miller, PhD5; Molly Howell, MPH5; Claire Youngblood, MA6; Hannah Ruegner, MPH6; Rachel Radcliffe, DVM6; Allyn Nakashima, MD7; Michael Torre, PhD7; Kayla Donohue, MPH8; Paul Meddaugh, MS8; Mallory Staskus, MS8; Brandon Attell, MA1; Caitlin Biedron, MD1; Peter Boersma, MPH1; Lauren Epstein, MD1; Denise Hughes1; Meghan Lyman, MD1; Leigh E. Preston, DrPH1; Guillermo V. Sanchez, MSHS, MPH1; Sukarma Tanwar, MMed1; Nicola D. Thompson, PhD1; Snigdha Vallabhaneni, MD1; Amber Vasquez, MD1; John A. Jernigan, MD1
Corresponding author: Kelly M. Hatfield, email@example.com.
1CDC COVID-19 Response Team; 2Arkansas Department of Health; 3Detroit Health Department, Detroit, Michigan; 4New Mexico Department of Health; 5North Dakota Department of Health; 6South Carolina Department of Health and Environmental Control; 7Utah Department of Health; 8Vermont Department of Health.
All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Kayla Donohue reports full-time employment at United Way of Northwest Vermont with temporary assignment to COVID-19 response at the Vermont Department of Health, which supported her work related to this publication. No other potential conflicts of interest were disclosed.
Suggested citation for this article: Hatfield KM, Reddy SC, Forsberg K, et al. Facility-Wide Testing for SARS-CoV-2 in Nursing Homes — Seven U.S. Jurisdictions, March–June 2020. MMWR Morb Mortal Wkly Rep. ePub: 11 August 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6932e5
- What is already known about this topic?
- Facility-wide testing of health care personnel and nursing home residents for SARS-CoV-2 can inform strategies to prevent transmission.
- What is added by this report?
- In two health department jurisdictions, testing in facilities without a previous COVID-19 case identified a prevalence of 0.4%. Five health department jurisdictions that targeted facility-wide testing after identification of a case found a prevalence of 12%; for each additional day before completion of initial facility-wide testing, an estimated 1.3 additional cases were identified.
- What are the implications for public health practice?
- Performing facility-wide testing rapidly following identification of a case in a nursing home might facilitate control of transmission among residents and health care personnel. Strategies are needed to optimize facility-wide testing in nursing homes without a reported case.
Undetected infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) contributes to transmission in nursing homes, settings where large outbreaks with high resident mortality have occurred (1,2). Facility-wide testing of residents and health care personnel (HCP) can identify asymptomatic and presymptomatic infections and facilitate infection prevention and control interventions (3–5). Seven state or local health departments conducted initial facility-wide testing of residents and staff members in 288 nursing homes during March 24–June 14, 2020. Two of the seven health departments conducted testing in 195 nursing homes as part of facility-wide testing all nursing homes in their state, which were in low-incidence areas (i.e., the median preceding 14-day cumulative incidence in the surrounding county for each jurisdiction was 19 and 38 cases per 100,000 persons); 125 of the 195 nursing homes had not reported any COVID-19 cases before the testing. Ninety-five of 22,977 (0.4%) persons tested in 29 (23%) of these 125 facilities had positive SARS-CoV-2 test results. The other five health departments targeted facility-wide testing to 93 nursing homes, where 13,443 persons were tested, and 1,619 (12%) had positive SARS-CoV-2 test results. In regression analyses among 88 of these nursing homes with a documented case before facility-wide testing occurred, each additional day between identification of the first case and completion of facility-wide testing was associated with identification of 1.3 additional cases. Among 62 facilities that could differentiate results by resident and HCP status, an estimated 1.3 HCP cases were identified for every three resident cases. Performing facility-wide testing immediately after identification of a case commonly identifies additional unrecognized cases and, therefore, might maximize the benefits of infection prevention and control interventions. In contrast, facility-wide testing in low-incidence areas without a case has a lower proportion of test positivity; strategies are needed to further optimize testing in these settings.
Keywords: SARS-CoV-2; COVID-19; Diagnostic tests; Institutional outbreaks; USA.