#NYC #COVID19 resident #physician #exposure during exponential phase of pandemic (J Clin Invest., abstract)

[Source: Journal of Clinical Investigation, full page: (LINK). Abstract, edited.]

New York City COVID-19 resident physician exposure during exponential phase of pandemic

Mark P. Breazzano,1,2,3 Junchao Shen,4 Aliaa H. Abdelhakim,1,2,3 Lora R. Dagi Glass,1 Jason D. Horowitz,1 Sharon X. Xie,5 C. Gustavo de Moraes,1 Alice Chen-Plotkin,4 Royce W.S. Chen,1 and on behalf of the New York City Residency Program Directors COVID-19 Research Group6

First published May 28, 2020

 

Abstract

BACKGROUND.

From March 2, 2020, to April 12, 2020, New York City (NYC) experienced exponential growth of the COVID-19 pandemic due to novel coronavirus (SARS-CoV-2). Little is known regarding how physicians have been affected. We aimed to characterize the COVID-19 impact on NYC resident physicians.

METHODS.

IRB-exempt and expedited cross-sectional analysis through survey to NYC residency program directors April 3–12, 2020, encompassing events from March 2, 2020, to April 12, 2020.

RESULTS.

From an estimated 340 residency programs around NYC, recruitment yielded 91 responses, representing 24 specialties and 2306 residents. In 45.1% of programs, at least 1 resident with confirmed COVID-19 was reported. One hundred one resident physicians were confirmed COVID-19–positive, with an additional 163 residents presumed positive for COVID-19 based on symptoms but awaiting or unable to obtain testing. Two COVID-19–positive residents were hospitalized, with 1 in intensive care. Among specialties with more than 100 residents represented, negative binomial regression indicated that infection risk differed by specialty (P = 0.039). In 80% of programs, quarantining a resident was reported. Ninety of 91 programs reported reuse or extended mask use, and 43 programs reported that personal protective equipment (PPE) was suboptimal. Sixty-five programs (74.7%) redeployed residents elsewhere to support COVID-19 efforts.

CONCLUSION.

Many resident physicians around NYC have been affected by COVID-19 through direct infection, quarantine, or redeployment. Lack of access to testing and concern regarding suboptimal PPE are common among residency programs. Infection risk may differ by specialty.

FUNDING.

National Eye Institute Core Grant P30EY019007; Research to Prevent Blindness Unrestricted Grant; Parker Family Chair; University of Pennsylvania.

Keywords: SARS-CoV-2; COVID-19; Nosocomial Outbreaks; PPE; NYC; USA.

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#Serosurvey of #SARS-CoV-2 among #hospital #visitors in #China (Cell Res., summary)

[Source: Cell Research, full page: (LINK). Summary, edited.]

Serosurvey of SARS-CoV-2 among hospital visitors in China

Wenhua Liang, Yongping Lin, Jianping Bi, Jianfu Li, Ying Liang, Sook-San Wong, Mark Zanin, Zifeng Yang, Caichen Li, Ran Zhong, Guowu Jiang, Guang Han, Desheng Hu, Jianxing He & Nanshan Zhong

Cell Research (2020)

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Dear Editor, In China, the epidemic of COVID-19 has been temporarily brought under control due to strong measures, while there are few new cases except some imported ones (https://static.wecity.qq.com/wuhan-haiwai-pre/dist/index.html#/). The PCR-based test result combined with clinical symptoms has widely been used for the detection and confirmation of COVID-19.1 However, the prevalence of asymptomatic or subclinical SARS-CoV-2 infection in China remained unknown.

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Keywords: SARS-CoV-2; COVID-19; Serology; Seroprevalence; China; Nosocomial outbreaks.

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#Outcomes of #Universal #COVID19 #Testing Following Detection of Incident Cases in 11 Long-term #Care #Facilities (JAMA Intern Med., summary)

[Source: JAMA Internal Medicine, full page: (LINK). Summary, edited.]

Outcomes of Universal COVID-19 Testing Following Detection of Incident Cases in 11 Long-term Care Facilities

Benjamin F. Bigelow, BS1; Olive Tang, AB1; Bryan Barshick, MSN1;  Matthew Peters, MD2; Stephen D. Sisson, MD1; Kimberly S. Peairs, MD1; Morgan J. Katz, MD, MHS1

Author Affiliations: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; 2 Department of Cardiology, St Agnes Hospital, Baltimore, Maryland

JAMA Intern Med. Published online July 14, 2020. doi:10.1001/jamainternmed.2020.3738

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Residents in long-term care facilities are at particularly high risk of infection and poor outcomes associated with coronavirus disease 2019 (COVID-19).1,2 Early in the course of the pandemic, testing recommendations by the Centers for Disease Control advised testing residents and staff solely based on the presence of typical symptoms. Despite these efforts, there have been widespread outbreaks across long-term care facilities in the US, with high mortality rates.

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Keywords: SARS-CoV-2; COVID-19; Diagnostic tests; USA.

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Rapid implementation of #SARS-CoV-2 #sequencing to investigate cases of #healthcare associated #COVID19: a prospective #genomic #surveillance study (Lancet Infect Dis., abstract)

[Source: Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Rapid implementation of SARS-CoV-2 sequencing to investigate cases of health-care associated COVID-19: a prospective genomic surveillance study

Luke W Meredith, PhD *, †, William L Hamilton, PhD *, †, Ben Warne, MB Bchir, Charlotte J Houldcroft, PhD, Myra Hosmillo, PhD, Aminu S Jahun, PhD, Martin D Curran, PhD, Surendra Parmar, PhD, Laura G Caller, PhD, Sarah L Caddy, PhD, Fahad A Khokhar, BSc, Anna Yakovleva, BSc, Grant Hall, BS, Theresa Feltwell, Sally Forrest, BSc, Sushmita Sridhar, BS, Michael P Weekes, PhD, Prof Stephen Baker, PhD, Nicholas Brown, MD, Elinor Moore, MBBS, Ashley Popay, BSc, Iain Roddick, BSc, Mark Reacher, MD, Theodore Gouliouris, PhD, Prof Sharon J Peacock, FRCP, Prof Gordon Dougan, PhD, M Estée Török, FRCP  *, ‡, Prof Ian Goodfellow, PhD  *, ‡

Published: July 14, 2020 | DOI: https://doi.org/10.1016/S1473-3099(20)30562-4

 

Summary

Background

The burden and influence of health-care associated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections is unknown. We aimed to examine the use of rapid SARS-CoV-2 sequencing combined with detailed epidemiological analysis to investigate health-care associated SARS-CoV-2 infections and inform infection control measures.

Methods

In this prospective surveillance study, we set up rapid SARS-CoV-2 nanopore sequencing from PCR-positive diagnostic samples collected from our hospital (Cambridge, UK) and a random selection from hospitals in the East of England, enabling sample-to-sequence in less than 24 h. We established a weekly review and reporting system with integration of genomic and epidemiological data to investigate suspected health-care associated COVID-19 cases.

Findings

Between March 13 and April 24, 2020, we collected clinical data and samples from 5613 patients with COVID-19 from across the East of England. We sequenced 1000 samples producing 747 high-quality genomes. We combined epidemiological and genomic analysis of the 299 patients from our hospital and identified 35 clusters of identical viruses involving 159 patients. 92 (58%) of 159 patients had strong epidemiological links and 32 (20%) patients had plausible epidemiological links. These results were fed back to clinical, infection control, and hospital management teams, leading to infection-control interventions and informing patient safety reporting.

Interpretation

We established real-time genomic surveillance of SARS-CoV-2 in a UK hospital and showed the benefit of combined genomic and epidemiological analysis for the investigation of health-care associated COVID-19. This approach enabled us to detect cryptic transmission events and identify opportunities to target infection-control interventions to further reduce health-care associated infections. Our findings have important implications for national public health policy as they enable rapid tracking and investigation of infections in hospital and community settings.

Funding

COVID-19 Genomics UK funded by the Department of Health and Social Care, UK Research and Innovation, and the Wellcome Sanger Institute.

Keywords: SARS-CoV-2; COVID-19; Nosocomial outbreaks; Diagnostic tests; UK; Genetics.

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Pandemic #peak #SARS-CoV-2 infection and #seroconversion #rates in #London frontline #HCWs (Lancet, summary)

[Source: Lancet, full page: (LINK). Summary, edited.]

Pandemic peak SARS-CoV-2 infection and seroconversion rates in London frontline health-care workers

Catherine F Houlihan, Nina Vora, Thomas Byrne, Dan Lewer, Gavin Kelly, Judith Heaney, Sonia Gandhi, Moira J Spyer, Rupert Beale, Peter Cherepanov, David Moore, Richard Gilson, Steve Gamblin, George Kassiotis, Laura E McCoy, Charles Swanton on behalf of the Crick COVID-19 Consortium, Andrew Hayward, Eleni Nastouli, on behalf of the SAFER Investigators †

Published: July 09, 2020 | DOI: https://doi.org/10.1016/S0140-6736(20)31484-7

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Nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major public health concern. Health-care workers (HCWs) are at high risk of developing COVID-19, and may themselves contribute to transmission.1
To evaluate these risks, we enrolled 200 patient-facing HCWs between March 26 and April 8, 2020, in SARS-CoV-2 Acquisition in Frontline Healthcare Workers—Evaluation to inform Response (SAFER), a prospective cohort study in high-risk frontline HCWs in an acute National Health Service hospital trust in London. We collected nasopharyngeal swabs for RT-PCR twice per week, symptom data, and blood samples monthly for high-sensitivity serology assays (ELISA and flow cytometry for spike glycoprotein). Further methodology, study participant demographics, and the length of participation are described in the appendix.

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Keywords: SARS-CoV-2; COVID-19; Serology; Seroprevalence; Nosocomial Outbreaks; UK; HCWs.

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#COVID19 in #HCWs in three #hospitals in the south of the #Netherlands: a cross-sectional study (Lancet Infect Dis., abstract)

[Source: Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

COVID-19 in health-care workers in three hospitals in the south of the Netherlands: a cross-sectional study

Reina S Sikkema, DVM  †, Suzan D Pas, PhD †, David F Nieuwenhuijse, MSc, Áine O’Toole, MSc, Jaco Verweij, PhD, Anne van der Linden, BSc, Irina Chestakova, MSc, Claudia Schapendonk, BSc, Mark Pronk, BSc, Pascal Lexmond, BSc, Theo Bestebroer, BSc, Ronald J Overmars, MSc, Stefan van Nieuwkoop, BSc, Wouter van den Bijllaardt, MD, Robbert G Bentvelsen, MD, Miranda M L van Rijen, PhD, Anton G M Buiting, MD, Anne J G van Oudheusden, MSc, Bram M Diederen, MD, Anneke M C Bergmans, PhD, Annemiek van der Eijk, MD, Richard Molenkamp, PhD, Andrew Rambaut, PhD, Aura Timen, MD, Jan A J W Kluytmans, MD, Bas B Oude Munnink, PhD, Marjolein F Q Kluytmans van den Bergh, MD †, Marion P G Koopmans, PhD †

Open Access | Published: July 02, 2020 | DOI: https://doi.org/10.1016/S1473-3099(20)30527-2

 

Summary

Background

10 days after the first reported case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the Netherlands (on Feb 27, 2020), 55 (4%) of 1497 health-care workers in nine hospitals located in the south of the Netherlands had tested positive for SARS-CoV-2 RNA. We aimed to gain insight in possible sources of infection in health-care workers.

Methods

We did a cross-sectional study at three of the nine hospitals located in the south of the Netherlands. We screened health-care workers at the participating hospitals for SARS-CoV-2 infection, based on clinical symptoms (fever or mild respiratory symptoms) in the 10 days before screening. We obtained epidemiological data through structured interviews with health-care workers and combined this information with data from whole-genome sequencing of SARS-CoV-2 in clinical samples taken from health-care workers and patients. We did an in-depth analysis of sources and modes of transmission of SARS-CoV-2 in health-care workers and patients.

Findings

Between March 2 and March 12, 2020, 1796 (15%) of 12 022 health-care workers were screened, of whom 96 (5%) tested positive for SARS-CoV-2. We obtained complete and near-complete genome sequences from 50 health-care workers and ten patients. Most sequences were grouped in three clusters, with two clusters showing local circulation within the region. The noted patterns were consistent with multiple introductions into the hospitals through community-acquired infections and local amplification in the community.

Interpretation

Although direct transmission in the hospitals cannot be ruled out, our data do not support widespread nosocomial transmission as the source of infection in patients or health-care workers.

Funding

EU Horizon 2020 (RECoVer, VEO, and the European Joint Programme One Health METASTAVA), and the National Institute of Allergy and Infectious Diseases, National Institutes of Health.

Keywords: SARS-CoV-2; COVID-19; HCWs; Netherlands; Nosocomial outbreaks.

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#Screening for #SARS-CoV-2 Infection Within a #Psychiatric #Hospital and Considerations for Limiting #Transmission Within Residential Psychiatric Facilities — #Wyoming, 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Screening for SARS-CoV-2 Infection Within a Psychiatric Hospital and Considerations for Limiting Transmission Within Residential Psychiatric Facilities — Wyoming, 2020

Weekly / July 3, 2020 / 69(26);825–829

Anna W. Callaghan, MSc1; Anna N. Chard, PhD1,2; Patricia Arnold, MSN3; Cody Loveland, MPH4; Noah Hull, PhD4; Mona Saraiya, MD1; Sharon Saydah, PhD5; Wendy Dumont, MSN3; Laura G. Frakes3; Daniel Johnson, MSN3; ReaAnna Peltier3; Clayton Van Houten, MS4; A. Angelica Trujillo, MS1; Jazmyn Moore, MSc, MPH5; Dale A. Rose, PhD5; Margaret A. Honein, PhD5; David Carrington, MD3; Alexia Harrist, MD, PhD4; Susan L. Hills, MBBS1

Corresponding author: Anna W. Callaghan, ktv5@cdc.gov.

1CDC Wyoming COVID-19 Response Field Team; 2Epidemic Intelligence Service, CDC; 3Wyoming State Hospital, Evanston, Wyoming; 4Wyoming Department of Health; 5CDC COVID-19 Response Team.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Callaghan AW, Chard AN, Arnold P, et al. Screening for SARS-CoV-2 Infection Within a Psychiatric Hospital and Considerations for Limiting Transmission Within Residential Psychiatric Facilities — Wyoming, 2020. MMWR Morb Mortal Wkly Rep 2020;69:825–829. DOI: http://dx.doi.org/10.15585/mmwr.mm6926a4

 

Summary

  • What is already known about this topic?
    • SARS-CoV-2 can spread rapidly within residential, congregate settings. Psychiatric facilities are at risk for outbreaks because of patient transfers from other high-risk residential settings and face unique challenges in implementing standard infection prevention and control (IPC) measures because of complex patient needs.
  • What is added by this report?
    • After admitting two patients with SARS-CoV-2 infection, a psychiatric facility responded by implementing modified and expanded IPC procedures. A point prevalence survey found no evidence of further SARS-CoV-2 transmission within the facility.
  • What are the implications for public health practice?
    • Adaption of standard IPC strategies in psychiatric facilities to meet patient and facility needs might prevent SARS-CoV-2 transmission, and point prevalence surveys can be useful to assess the likely effectiveness of any adapted IPC measures.

 

Abstract

In the United States, approximately 180,000 patients receive mental health services each day at approximately 4,000 inpatient and residential psychiatric facilities (1). SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly within congregate residential settings (2–4), including psychiatric facilities. On April 13, 2020, two patients were transferred to Wyoming’s state psychiatric hospital from a private psychiatric hospital that had confirmed COVID-19 cases among its residents and staff members (5). Although both patients were asymptomatic at the time of transfer and one had a negative test result for SARS-CoV-2 at the originating facility, they were both isolated and received testing upon arrival at the state facility. On April 16, 2020, the test results indicated that both patients had SARS-CoV-2 infection. In response, the state hospital implemented expanded COVID-19 infection prevention and control (IPC) procedures (e.g., enhanced screening, testing, and management of new patient admissions) and adapted some standard IPC measures to facilitate implementation within the psychiatric patient population (e.g., use of modified face coverings). To assess the likely effectiveness of these procedures and determine SARS-CoV-2 infection prevalence among patients and health care personnel (HCP) (6) at the state hospital, a point prevalence survey was conducted. On May 1, 2020, 18 days after the patients’ arrival, 46 (61%) of 76 patients and 171 (61%) of 282 HCP had nasopharyngeal swabs collected and tested for SARS-CoV-2 RNA by reverse transcription–polymerase chain reaction. All patients and HCP who received testing had negative test results, suggesting that the hospital’s expanded IPC strategies might have been effective in preventing the introduction and spread of SARS-CoV-2 infection within the facility. In congregate residential settings, prompt identification of COVID-19 cases and application of strong IPC procedures are critical to ensuring the protection of other patients and staff members. Although standard guidance exists for other congregate facilities (7) and for HCP in general (8), modifications and nonstandard solutions might be needed to account for the specific needs of psychiatric facilities, their patients, and staff members.

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Keywords: SARS-CoV-2; COVID-19; Nosocomial Outbreaks; USA; Wyoming.

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#Nosocomial #transmission of #COVID19: a retrospective study of 66 #hospital-acquired cases in a #London teaching hospital (Clin Infect Dis., abstract9

[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]

Nosocomial transmission of COVID-19: a retrospective study of 66 hospital-acquired cases in a London teaching hospital

Hannah M Rickman, Tommy Rampling, Karen Shaw, Gema Martinez-Garcia, Leila Hail, Pietro Coen, Maryam Shahmanesh, Gee Yen Shin, Eleni Nastouli, Catherine F Houlihan

Clinical Infectious Diseases, ciaa816, https://doi.org/10.1093/cid/ciaa816

Published: 20 June 2020

 

Abstract

COVID-19 can cause deadly healthcare-associated outbreaks. In a major London teaching hospital, 66/435 (15%) of COVID-19 inpatient cases between 2 March and 12 April 2020 were definitely or probably hospital-acquired, through varied transmission routes. The case fatality was 36%. Nosocomial infection rates fell following comprehensive infection prevention and control measures.

Nosocomial, transmission, COVID-19, healthcare-associated infection, infection prevention and control

Issue Section: Brief Report

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Keywords: SARS-CoV-2; COVID-19; Nosocomial outbreaks; UK.

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#Coronavirus Disease 2019 (#COVID19) #Infection Among #HCWs and Implications for #Prevention #Measures in a Tertiary #Hospital in #Wuhan, #China (JAMA Netw Open, abstract)

[Source: JAMA Network Open, full page: (LINK). Abstract, edited.]

Coronavirus Disease 2019 (COVID-2019) Infection Among Health Care Workers and Implications for Prevention Measures in a Tertiary Hospital in Wuhan, China

Xiaoquan Lai, MD1; Minghuan Wang, MD, PhD2; Chuan Qin, MD, PhD2; et al. Li Tan, MD, PhD1; Lusen Ran, MD2; Daiqi Chen, BM2; Han Zhang, MD, PhD2; Ke Shang, MD, PhD2; Chen Xia, MS3; Shaokang Wang, MS3; Shabei Xu, MD, PhD2; Wei Wang, MD, PhD2

Author Affiliations: 1 Department of Hospital Infection Management, Tongji Medical  College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China; 2 Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China; 3 Beijing Infervision Technology, Beijing, China

JAMA Netw Open. 2020;3(5):e209666. doi:10.1001/jamanetworkopen.2020.9666

 

Key Points

  • Question  – What are the exposure details and clinical characteristics of health care workers with coronavirus disease (COVID-19) in Wuhan, China?
  • Findings  – In this single-center case series including 9684 health care workers, 110 of whom had COVID-19, a higher rate of infection was found among those working in the low-contagion area during the early stage of the disease outbreak, especially among nurses younger than 45 years. Most health care workers with COVID-19 had nonsevere disease, with an asymptomatic carrier prevalence of 0.9% and a mortality rate of 0.9%.
  • Meaning  – In this study, most infections among health care workers occurred during the early stage of the COVID-19 outbreak and in low-contagion areas; routine screening may be helpful in identifying asymptomatic carriers.

 

Abstract

Importance  

Health care workers (HCWs) have high infection risk owing to treating patients with coronavirus disease 2019 (COVID-19). However, research on their infection risk and clinical characteristics is limited.

Objectives  

To explore infection risk and clinical characteristics of HCWs with COVID-19 and to discuss possible prevention measures.

Design, Setting, and Participants  

This single-center case series included 9684 HCWs in Tongji Hospital, Wuhan, China. Data were collected from January 1 to February 9, 2020.

Exposures  

Confirmed COVID-19.

Main Outcomes and Measures  

Exposure, epidemiological, and demographic information was collected by a structured questionnaire. Clinical, laboratory, and radiologic information was collected from electronic medical records. A total of 335 medical staff were randomly sampled to estimate the prevalence of subclinical infection among a high-risk, asymptomatic population. Samples from surfaces in health care settings were also collected.

Results  

Overall, 110 of 9684 HCWs in Tongji Hospital tested positive for COVID-19, with an infection rate of 1.1%. Of them, 70 (71.8%) were women, and they had a median (interquartile range) age of 36.5 (30.0-47.0) years. Seventeen (15.5%) worked in fever clinics or wards, indicating an infection rate of 0.5% (17 of 3110) among first-line HCWs. A total of 93 of 6574 non–first-line HCWs (1.4%) were infected. Non–first-line nurses younger than 45 years were more likely to be infected compared with first-line physicians aged 45 years or older (incident rate ratio, 16.1; 95% CI, 7.1-36.3; P < .001). The prevalence of subclinical infection was 0.74% (1 of 135) among asymptomatic first-line HCWs and 1.0% (2 of 200) among non–first-line HCWs. No environmental surfaces tested positive. Overall, 93 of 110 HCWs (84.5%) with COVID-19 had nonsevere disease, while 1 (0.9%) died. The 5 most common symptoms were fever (67 [60.9%]), myalgia or fatigue (66 [60.0%]), cough (62 [56.4%]), sore throat (55 [50.0%]), and muscle ache (50 [45.5%]). Contact with indexed patients (65 [59.1%]) and colleagues with infection (12 [10.9%]) as well as community-acquired infection (14 [12.7%]) were the main routes of exposure for HCWs.

Conclusions and Relevance  

In this case series, most infections among HCWs occurred during the early stage of disease outbreak. That non–first-line HCWs had a higher infection rate than first-line HCWs differed from observation of previous viral disease epidemics. Rapid identification of staff with potential infection and routine screening among asymptomatic staff could help protect HCWs.

Keywords: SARS-CoV-2; COVID-19; Nosocomial outbreaks; HCWs; Hubei; China.

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#Epidemiology of #Covid19 in a Long-Term Care #Facility in King County, #Washington (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

Temet M. McMichael, Ph.D., Dustin W. Currie, Ph.D., Shauna Clark, R.N., Sargis Pogosjans, M.P.H., Meagan Kay, D.V.M., Noah G. Schwartz, M.D., James Lewis, M.D., Atar Baer, Ph.D., Vance Kawakami, D.V.M., Margaret D. Lukoff, M.D., Jessica Ferro, M.P.H., Claire Brostrom-Smith, M.S.N., et al., for the Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team*

Abstract

BACKGROUND

Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region.

METHODS

After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health–Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.

RESULTS

As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County.

CONCLUSIONS

In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.

Keywords: SARS-CoV-2; COVID-19; Nosocomial Outbreaks; USA.

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