Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility
Abstract Background Outbreaks of coronavirus disease 2019 (COVID-19) have been reported in nursing homes and assisted living facilities; however, the extent of asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this high-risk population remains...
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| Veröffentlicht in: | Clinical infectious diseases 2020-12, Vol.71 (11), p.2920-2926 |
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| creator | Patel, Mahesh C Chaisson, Lelia H Borgetti, Scott Burdsall, Deborah Chugh, Rashmi K Hoff, Christopher R Murphy, Elizabeth B Murskyj, Emily A Wilson, Shannon Ramos, Joe Akker, Lynn Bryars, Debra Thomas-Smith, Evonda Bleasdale, Susan C Ezike, Ngozi O |
| description | Abstract
Background
Outbreaks of coronavirus disease 2019 (COVID-19) have been reported in nursing homes and assisted living facilities; however, the extent of asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this high-risk population remains unclear.
Methods
We conducted an investigation of the first known outbreak of SARS-CoV-2 at a skilled nursing facility (SNF) in Illinois on 15 March 2020 and followed residents for 30 days. We tested 126/127 residents for SARS-CoV-2 via reverse-transcription polymerase chain reaction and performed symptom assessments. We calculated the point prevalence of SARS-CoV-2 and assessed symptom onset over 30-day follow-up to determine: (1) the proportion of cases who were symptomatic, presymptomatic, and asymptomatic and (2) incidence of symptoms among those who tested negative. We used the Kaplan-Meier method to determine the 30-day probability of death for cases.
Results
Of 126 residents tested, 33 had confirmed SARS-CoV-2 on 15 March. Nineteen (58%) had symptoms at the time of testing, 1 (3%) developed symptoms over follow-up, and 13 (39%) remained asymptomatic. Thirty-five residents who tested negative on 15 March developed symptoms over follow-up; of these, 3 were re-tested and 2 were positive. The 30-day probability of death among cases was 29%.
Conclusions
SNFs are particularly vulnerable to SARS-CoV-2, and residents are at risk of severe outcomes. Attention must be paid to preventing outbreaks in these and other congregate care settings. Widespread testing and infection control are key to help prevent COVID-19 morbidity and mortality in these high-risk populations.
In an investigation of the first known outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a skilled nursing facility in Illinois, we found that 39% of confirmed cases remained asymptomatic, and the 30-day probability of death was 29%. |
| doi_str_mv | 10.1093/cid/ciaa763 |
| format | Article |
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Background
Outbreaks of coronavirus disease 2019 (COVID-19) have been reported in nursing homes and assisted living facilities; however, the extent of asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this high-risk population remains unclear.
Methods
We conducted an investigation of the first known outbreak of SARS-CoV-2 at a skilled nursing facility (SNF) in Illinois on 15 March 2020 and followed residents for 30 days. We tested 126/127 residents for SARS-CoV-2 via reverse-transcription polymerase chain reaction and performed symptom assessments. We calculated the point prevalence of SARS-CoV-2 and assessed symptom onset over 30-day follow-up to determine: (1) the proportion of cases who were symptomatic, presymptomatic, and asymptomatic and (2) incidence of symptoms among those who tested negative. We used the Kaplan-Meier method to determine the 30-day probability of death for cases.
Results
Of 126 residents tested, 33 had confirmed SARS-CoV-2 on 15 March. Nineteen (58%) had symptoms at the time of testing, 1 (3%) developed symptoms over follow-up, and 13 (39%) remained asymptomatic. Thirty-five residents who tested negative on 15 March developed symptoms over follow-up; of these, 3 were re-tested and 2 were positive. The 30-day probability of death among cases was 29%.
Conclusions
SNFs are particularly vulnerable to SARS-CoV-2, and residents are at risk of severe outcomes. Attention must be paid to preventing outbreaks in these and other congregate care settings. Widespread testing and infection control are key to help prevent COVID-19 morbidity and mortality in these high-risk populations.
In an investigation of the first known outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a skilled nursing facility in Illinois, we found that 39% of confirmed cases remained asymptomatic, and the 30-day probability of death was 29%.</description><identifier>ISSN: 1058-4838</identifier><identifier>ISSN: 1537-6591</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciaa763</identifier><identifier>PMID: 32548628</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>COVID-19 ; Disease Outbreaks ; Humans ; Illinois - epidemiology ; Major ; SARS-CoV-2 ; Skilled Nursing Facilities</subject><ispartof>Clinical infectious diseases, 2020-12, Vol.71 (11), p.2920-2926</ispartof><rights>The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c478t-f65326b59e59864df053cd7302e07f73dd166536bb1686c836dec496b87a95ef3</citedby><cites>FETCH-LOGICAL-c478t-f65326b59e59864df053cd7302e07f73dd166536bb1686c836dec496b87a95ef3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32548628$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patel, Mahesh C</creatorcontrib><creatorcontrib>Chaisson, Lelia H</creatorcontrib><creatorcontrib>Borgetti, Scott</creatorcontrib><creatorcontrib>Burdsall, Deborah</creatorcontrib><creatorcontrib>Chugh, Rashmi K</creatorcontrib><creatorcontrib>Hoff, Christopher R</creatorcontrib><creatorcontrib>Murphy, Elizabeth B</creatorcontrib><creatorcontrib>Murskyj, Emily A</creatorcontrib><creatorcontrib>Wilson, Shannon</creatorcontrib><creatorcontrib>Ramos, Joe</creatorcontrib><creatorcontrib>Akker, Lynn</creatorcontrib><creatorcontrib>Bryars, Debra</creatorcontrib><creatorcontrib>Thomas-Smith, Evonda</creatorcontrib><creatorcontrib>Bleasdale, Susan C</creatorcontrib><creatorcontrib>Ezike, Ngozi O</creatorcontrib><title>Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Background
Outbreaks of coronavirus disease 2019 (COVID-19) have been reported in nursing homes and assisted living facilities; however, the extent of asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this high-risk population remains unclear.
Methods
We conducted an investigation of the first known outbreak of SARS-CoV-2 at a skilled nursing facility (SNF) in Illinois on 15 March 2020 and followed residents for 30 days. We tested 126/127 residents for SARS-CoV-2 via reverse-transcription polymerase chain reaction and performed symptom assessments. We calculated the point prevalence of SARS-CoV-2 and assessed symptom onset over 30-day follow-up to determine: (1) the proportion of cases who were symptomatic, presymptomatic, and asymptomatic and (2) incidence of symptoms among those who tested negative. We used the Kaplan-Meier method to determine the 30-day probability of death for cases.
Results
Of 126 residents tested, 33 had confirmed SARS-CoV-2 on 15 March. Nineteen (58%) had symptoms at the time of testing, 1 (3%) developed symptoms over follow-up, and 13 (39%) remained asymptomatic. Thirty-five residents who tested negative on 15 March developed symptoms over follow-up; of these, 3 were re-tested and 2 were positive. The 30-day probability of death among cases was 29%.
Conclusions
SNFs are particularly vulnerable to SARS-CoV-2, and residents are at risk of severe outcomes. Attention must be paid to preventing outbreaks in these and other congregate care settings. Widespread testing and infection control are key to help prevent COVID-19 morbidity and mortality in these high-risk populations.
In an investigation of the first known outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a skilled nursing facility in Illinois, we found that 39% of confirmed cases remained asymptomatic, and the 30-day probability of death was 29%.</description><subject>COVID-19</subject><subject>Disease Outbreaks</subject><subject>Humans</subject><subject>Illinois - epidemiology</subject><subject>Major</subject><subject>SARS-CoV-2</subject><subject>Skilled Nursing Facilities</subject><issn>1058-4838</issn><issn>1537-6591</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9rFDEYhoNYbK2evEtOIsjUZPJzLsKytXahuuBqryGTZNbYmck2ybTsf9-suy168RAS-J73TcIDwBuMzjBqyEfjbVlaC06egRPMiKg4a_DzckZMVlQSeQxepvQbIYwlYi_AMakZlbyWJ-B-lrbDJodBZ2_gavZ9Vc3DdVXDxdg5k30YoR4tnC-vF-cVbuDXELPufd7C8yn6cV2mcDnlNjp9UzJ3LmW_1n9yvkTh6sb3vbPw2xTTDr_Qxu_ir8BRp_vkXh_2U_Dz4vOP-WV1tfyymM-uKkOFzFXHGal5yxrHGsmp7RAjxgqCaodEJ4i1mBeEty3mkhtJuHWGNryVQjfMdeQUfNr3bqZ2cNa4MUfdq030g45bFbRX_05G_0utw50ShAguaSl4fyiI4XYq31ODT8b1vR5dmJKqKaa0eKh36Ic9amJIKbru6RqM1E6VKqrUQVWh3_79sif20U0B3u2BMG3-2_QA7Nydtw</recordid><startdate>20201231</startdate><enddate>20201231</enddate><creator>Patel, Mahesh C</creator><creator>Chaisson, Lelia H</creator><creator>Borgetti, Scott</creator><creator>Burdsall, Deborah</creator><creator>Chugh, Rashmi K</creator><creator>Hoff, Christopher R</creator><creator>Murphy, Elizabeth B</creator><creator>Murskyj, Emily A</creator><creator>Wilson, Shannon</creator><creator>Ramos, Joe</creator><creator>Akker, Lynn</creator><creator>Bryars, Debra</creator><creator>Thomas-Smith, Evonda</creator><creator>Bleasdale, Susan C</creator><creator>Ezike, Ngozi O</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20201231</creationdate><title>Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility</title><author>Patel, Mahesh C ; Chaisson, Lelia H ; Borgetti, Scott ; Burdsall, Deborah ; Chugh, Rashmi K ; Hoff, Christopher R ; Murphy, Elizabeth B ; Murskyj, Emily A ; Wilson, Shannon ; Ramos, Joe ; Akker, Lynn ; Bryars, Debra ; Thomas-Smith, Evonda ; Bleasdale, Susan C ; Ezike, Ngozi O</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c478t-f65326b59e59864df053cd7302e07f73dd166536bb1686c836dec496b87a95ef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>COVID-19</topic><topic>Disease Outbreaks</topic><topic>Humans</topic><topic>Illinois - epidemiology</topic><topic>Major</topic><topic>SARS-CoV-2</topic><topic>Skilled Nursing Facilities</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patel, Mahesh C</creatorcontrib><creatorcontrib>Chaisson, Lelia H</creatorcontrib><creatorcontrib>Borgetti, Scott</creatorcontrib><creatorcontrib>Burdsall, Deborah</creatorcontrib><creatorcontrib>Chugh, Rashmi K</creatorcontrib><creatorcontrib>Hoff, Christopher R</creatorcontrib><creatorcontrib>Murphy, Elizabeth B</creatorcontrib><creatorcontrib>Murskyj, Emily A</creatorcontrib><creatorcontrib>Wilson, Shannon</creatorcontrib><creatorcontrib>Ramos, Joe</creatorcontrib><creatorcontrib>Akker, Lynn</creatorcontrib><creatorcontrib>Bryars, Debra</creatorcontrib><creatorcontrib>Thomas-Smith, Evonda</creatorcontrib><creatorcontrib>Bleasdale, Susan C</creatorcontrib><creatorcontrib>Ezike, Ngozi O</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patel, Mahesh C</au><au>Chaisson, Lelia H</au><au>Borgetti, Scott</au><au>Burdsall, Deborah</au><au>Chugh, Rashmi K</au><au>Hoff, Christopher R</au><au>Murphy, Elizabeth B</au><au>Murskyj, Emily A</au><au>Wilson, Shannon</au><au>Ramos, Joe</au><au>Akker, Lynn</au><au>Bryars, Debra</au><au>Thomas-Smith, Evonda</au><au>Bleasdale, Susan C</au><au>Ezike, Ngozi O</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2020-12-31</date><risdate>2020</risdate><volume>71</volume><issue>11</issue><spage>2920</spage><epage>2926</epage><pages>2920-2926</pages><issn>1058-4838</issn><issn>1537-6591</issn><eissn>1537-6591</eissn><abstract>Abstract
Background
Outbreaks of coronavirus disease 2019 (COVID-19) have been reported in nursing homes and assisted living facilities; however, the extent of asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this high-risk population remains unclear.
Methods
We conducted an investigation of the first known outbreak of SARS-CoV-2 at a skilled nursing facility (SNF) in Illinois on 15 March 2020 and followed residents for 30 days. We tested 126/127 residents for SARS-CoV-2 via reverse-transcription polymerase chain reaction and performed symptom assessments. We calculated the point prevalence of SARS-CoV-2 and assessed symptom onset over 30-day follow-up to determine: (1) the proportion of cases who were symptomatic, presymptomatic, and asymptomatic and (2) incidence of symptoms among those who tested negative. We used the Kaplan-Meier method to determine the 30-day probability of death for cases.
Results
Of 126 residents tested, 33 had confirmed SARS-CoV-2 on 15 March. Nineteen (58%) had symptoms at the time of testing, 1 (3%) developed symptoms over follow-up, and 13 (39%) remained asymptomatic. Thirty-five residents who tested negative on 15 March developed symptoms over follow-up; of these, 3 were re-tested and 2 were positive. The 30-day probability of death among cases was 29%.
Conclusions
SNFs are particularly vulnerable to SARS-CoV-2, and residents are at risk of severe outcomes. Attention must be paid to preventing outbreaks in these and other congregate care settings. Widespread testing and infection control are key to help prevent COVID-19 morbidity and mortality in these high-risk populations.
In an investigation of the first known outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a skilled nursing facility in Illinois, we found that 39% of confirmed cases remained asymptomatic, and the 30-day probability of death was 29%.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>32548628</pmid><doi>10.1093/cid/ciaa763</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical infectious diseases, 2020-12, Vol.71 (11), p.2920-2926 |
| issn | 1058-4838 1537-6591 1537-6591 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | COVID-19 Disease Outbreaks Humans Illinois - epidemiology Major SARS-CoV-2 Skilled Nursing Facilities |
| title | Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility |
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