tetano
Editor, Senior Moderator
JAMA Intern Med
. 2020 May 21.
doi: 10.1001/jamainternmed.2020.2233. Online ahead of print.
Outbreak Investigation of COVID-19 Among Residents and Staff of an Independent and Assisted Living Community for Older Adults in Seattle, Washington
Alison C Roxby[SUP] 1 2 [/SUP], Alexander L Greninger[SUP] 3 [/SUP], Kelly M Hatfield[SUP] 4 [/SUP], John B Lynch[SUP] 1 [/SUP], Timothy H Dellit[SUP] 1 [/SUP], Allison James[SUP] 4 [/SUP], Joanne Taylor[SUP] 4 [/SUP], Libby C Page[SUP] 5 [/SUP], Anne Kimball[SUP] 4 [/SUP], Melissa Arons[SUP] 4 [/SUP], Albert Munanga[SUP] 6 7 [/SUP], Nimalie Stone[SUP] 4 [/SUP], John A Jernigan[SUP] 4 [/SUP], Sujan C Reddy[SUP] 4 [/SUP], James Lewis[SUP] 5 [/SUP], Seth A Cohen[SUP] 1 [/SUP], Keith R Jerome[SUP] 3 8 [/SUP], Jeffrey S Duchin[SUP] 1 5 [/SUP], Santiago Neme[SUP] 1 [/SUP]
Affiliations
Abstract
Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused epidemic spread of coronavirus disease 2019 (COVID-19) in the Seattle, Washington, metropolitan area, with morbidity and mortality concentrated among residents of skilled nursing facilities. The prevalence of COVID-19 among older adults in independent/assisted living is not understood.
Objectives: To conduct surveillance for SARS-CoV-2 and describe symptoms of COVID-19 among residents and staff of an independent/assisted living community.
Design, setting, and participants: In March 2020, public health surveillance of staff and residents was conducted on site at an assisted and independent living residence for older adults in Seattle, Washington, after exposure to 2 residents who were hospitalized with COVID-19.
Exposures: Surveillance for SARS-CoV-2 infection in a congregate setting implementing social isolation and infection prevention protocols.
Main outcomes and measures: SARS-CoV-2 real-time polymerase chain reaction was performed on nasopharyngeal swabs from residents and staff; a symptom questionnaire was completed assessing fever, cough, and other symptoms for the preceding 14 days. Residents were retested for SARS-CoV-2 7 days after initial screening.
Results: Testing was performed on 80 residents; 62 were women (77%), with mean age of 86 (range, 69-102) years. SARS-CoV-2 was detected in 3 of 80 residents (3.8%); none felt ill, 1 male resident reported resolved cough and 1 loose stool during the preceding 14 days. Virus was also detected in 2 of 62 staff (3.2%); both were symptomatic. One week later, resident SARS-CoV-2 testing was repeated and 1 new infection detected (asymptomatic). All residents remained in isolation and were clinically stable 14 days after the second test.
Conclusions and relevance: Detection of SARS-CoV-2 in asymptomatic residents highlights challenges in protecting older adults living in congregate settings. In this study, symptom screening failed to identify residents with infections and all 4 residents with SARS-CoV-2 remained asymptomatic after 14 days. Although 1 asymptomatic infection was found on retesting, a widespread facility outbreak was avoided. Compared with skilled nursing settings, in assisted/independent living communities, early surveillance to identify asymptomatic persons among residents and staff, in combination with adherence to recommended preventive strategies, may reduce viral spread.
. 2020 May 21.
doi: 10.1001/jamainternmed.2020.2233. Online ahead of print.
Outbreak Investigation of COVID-19 Among Residents and Staff of an Independent and Assisted Living Community for Older Adults in Seattle, Washington
Alison C Roxby[SUP] 1 2 [/SUP], Alexander L Greninger[SUP] 3 [/SUP], Kelly M Hatfield[SUP] 4 [/SUP], John B Lynch[SUP] 1 [/SUP], Timothy H Dellit[SUP] 1 [/SUP], Allison James[SUP] 4 [/SUP], Joanne Taylor[SUP] 4 [/SUP], Libby C Page[SUP] 5 [/SUP], Anne Kimball[SUP] 4 [/SUP], Melissa Arons[SUP] 4 [/SUP], Albert Munanga[SUP] 6 7 [/SUP], Nimalie Stone[SUP] 4 [/SUP], John A Jernigan[SUP] 4 [/SUP], Sujan C Reddy[SUP] 4 [/SUP], James Lewis[SUP] 5 [/SUP], Seth A Cohen[SUP] 1 [/SUP], Keith R Jerome[SUP] 3 8 [/SUP], Jeffrey S Duchin[SUP] 1 5 [/SUP], Santiago Neme[SUP] 1 [/SUP]
Affiliations
- PMID: 32437547
- DOI: 10.1001/jamainternmed.2020.2233
Abstract
Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused epidemic spread of coronavirus disease 2019 (COVID-19) in the Seattle, Washington, metropolitan area, with morbidity and mortality concentrated among residents of skilled nursing facilities. The prevalence of COVID-19 among older adults in independent/assisted living is not understood.
Objectives: To conduct surveillance for SARS-CoV-2 and describe symptoms of COVID-19 among residents and staff of an independent/assisted living community.
Design, setting, and participants: In March 2020, public health surveillance of staff and residents was conducted on site at an assisted and independent living residence for older adults in Seattle, Washington, after exposure to 2 residents who were hospitalized with COVID-19.
Exposures: Surveillance for SARS-CoV-2 infection in a congregate setting implementing social isolation and infection prevention protocols.
Main outcomes and measures: SARS-CoV-2 real-time polymerase chain reaction was performed on nasopharyngeal swabs from residents and staff; a symptom questionnaire was completed assessing fever, cough, and other symptoms for the preceding 14 days. Residents were retested for SARS-CoV-2 7 days after initial screening.
Results: Testing was performed on 80 residents; 62 were women (77%), with mean age of 86 (range, 69-102) years. SARS-CoV-2 was detected in 3 of 80 residents (3.8%); none felt ill, 1 male resident reported resolved cough and 1 loose stool during the preceding 14 days. Virus was also detected in 2 of 62 staff (3.2%); both were symptomatic. One week later, resident SARS-CoV-2 testing was repeated and 1 new infection detected (asymptomatic). All residents remained in isolation and were clinically stable 14 days after the second test.
Conclusions and relevance: Detection of SARS-CoV-2 in asymptomatic residents highlights challenges in protecting older adults living in congregate settings. In this study, symptom screening failed to identify residents with infections and all 4 residents with SARS-CoV-2 remained asymptomatic after 14 days. Although 1 asymptomatic infection was found on retesting, a widespread facility outbreak was avoided. Compared with skilled nursing settings, in assisted/independent living communities, early surveillance to identify asymptomatic persons among residents and staff, in combination with adherence to recommended preventive strategies, may reduce viral spread.