[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]
Transmission of SARS-CoV-2 Involving Residents Receiving Dialysis in a Nursing Home — Maryland, April 2020
Early Release / August 11, 2020 / 69
Benjamin F. Bigelow1,*; Olive Tang, PhD1,*; Gregory R. Toci1; Norberth Stracker, MS1,2; Fatima Sheikh, MD1; Kara M. Jacobs Slifka, MD3; Shannon A. Novosad, MD3; John A. Jernigan, MD3; Sujan C. Reddy, MD3; Morgan J. Katz, MD1
Corresponding author: Benjamin F. Bigelow, firstname.lastname@example.org.
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; 2Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland; 3CDC 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.
* These authors contributed equally to this work.
Suggested citation for this article: Bigelow BF, Tang O, Toci GR, et al. Transmission of SARS-CoV-2 Involving Residents Receiving Dialysis in a Nursing Home — Maryland, April 2020. MMWR Morb Mortal Wkly Rep. ePub: 11 August 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6932e4
- What is already known about this topic?
- Residents of long-term care facilities have high COVID-19–associated morbidity and mortality. More information is needed about SARS-CoV-2 introduction and transmission in nursing homes.
- What is added by this report?
- Investigation of a COVID-19 outbreak in a Maryland nursing home identified a significantly higher prevalence among residents receiving dialysis (47%) than among those not receiving dialysis (16%); 72% were asymptomatic at the time of testing.
- What are the implications for public health practice?
- Nursing home residents undergoing dialysis might be at a higher risk for SARS-CoV-2 infection because of exposures to staff members and community dialysis patients. Attention to infection control practices and surveillance in nursing homes and dialysis centers is critical to preventing nursing home COVID-19 outbreaks.
SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly in nursing homes once it is introduced (1,2). To prevent outbreaks, more data are needed to identify sources of introduction and means of transmission within nursing homes. Nursing home residents who receive hemodialysis (dialysis) might be at higher risk for SARS-CoV-2 infections because of their frequent exposures outside the nursing home to both community dialysis patients and staff members at dialysis centers (3). Investigation of a COVID-19 outbreak in a Maryland nursing home (facility A) identified a higher prevalence of infection among residents undergoing dialysis (47%; 15 of 32) than among those not receiving dialysis (16%; 22 of 138) (p<0.001). Among residents with COVID-19, the 30-day hospitalization rate among those receiving dialysis (53%) was higher than that among residents not receiving dialysis (18%) (p = 0.03); the proportion of dialysis patients who died was 40% compared with those who did not receive dialysis (27%) (p = 0.42).Careful consideration of infection control practices throughout the dialysis process (e.g., transportation, time spent in waiting areas, spacing of machines, and cohorting), clear communication between nursing homes and dialysis centers, and coordination of testing practices between these sites are critical to preventing COVID-19 outbreaks in this medically vulnerable population.
Keywords: SARS-CoV-2; COVID-19; Institutional outbreaks; Maryland; USA.