Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility.
Aged
Aged, 80 and over
Asymptomatic Diseases
Betacoronavirus
/ genetics
COVID-19
Comorbidity
Coronavirus Infections
/ complications
Cough
/ etiology
Disease Transmission, Infectious
/ prevention & control
Dyspnea
/ etiology
Female
Fever
/ etiology
Genome, Viral
Humans
Infection Control
/ methods
Male
Pandemics
Pneumonia, Viral
/ complications
Prevalence
Real-Time Polymerase Chain Reaction
SARS-CoV-2
Skilled Nursing Facilities
Viral Load
Washington
/ epidemiology
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
28 05 2020
28 05 2020
Historique:
pubmed:
25
4
2020
medline:
2
6
2020
entrez:
25
4
2020
Statut:
ppublish
Résumé
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can spread rapidly within skilled nursing facilities. After identification of a case of Covid-19 in a skilled nursing facility, we assessed transmission and evaluated the adequacy of symptom-based screening to identify infections in residents. We conducted two serial point-prevalence surveys, 1 week apart, in which assenting residents of the facility underwent nasopharyngeal and oropharyngeal testing for SARS-CoV-2, including real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), viral culture, and sequencing. Symptoms that had been present during the preceding 14 days were recorded. Asymptomatic residents who tested positive were reassessed 7 days later. Residents with SARS-CoV-2 infection were categorized as symptomatic with typical symptoms (fever, cough, or shortness of breath), symptomatic with only atypical symptoms, presymptomatic, or asymptomatic. Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2. Among 76 residents who participated in point-prevalence surveys, 48 (63%) tested positive. Of these 48 residents, 27 (56%) were asymptomatic at the time of testing; 24 subsequently developed symptoms (median time to onset, 4 days). Samples from these 24 presymptomatic residents had a median rRT-PCR cycle threshold value of 23.1, and viable virus was recovered from 17 residents. As of April 3, of the 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit) and 15 had died (mortality, 26%). Of the 34 residents whose specimens were sequenced, 27 (79%) had sequences that fit into two clusters with a difference of one nucleotide. Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.
Sections du résumé
BACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can spread rapidly within skilled nursing facilities. After identification of a case of Covid-19 in a skilled nursing facility, we assessed transmission and evaluated the adequacy of symptom-based screening to identify infections in residents.
METHODS
We conducted two serial point-prevalence surveys, 1 week apart, in which assenting residents of the facility underwent nasopharyngeal and oropharyngeal testing for SARS-CoV-2, including real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), viral culture, and sequencing. Symptoms that had been present during the preceding 14 days were recorded. Asymptomatic residents who tested positive were reassessed 7 days later. Residents with SARS-CoV-2 infection were categorized as symptomatic with typical symptoms (fever, cough, or shortness of breath), symptomatic with only atypical symptoms, presymptomatic, or asymptomatic.
RESULTS
Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2. Among 76 residents who participated in point-prevalence surveys, 48 (63%) tested positive. Of these 48 residents, 27 (56%) were asymptomatic at the time of testing; 24 subsequently developed symptoms (median time to onset, 4 days). Samples from these 24 presymptomatic residents had a median rRT-PCR cycle threshold value of 23.1, and viable virus was recovered from 17 residents. As of April 3, of the 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit) and 15 had died (mortality, 26%). Of the 34 residents whose specimens were sequenced, 27 (79%) had sequences that fit into two clusters with a difference of one nucleotide.
CONCLUSIONS
Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.
Identifiants
pubmed: 32329971
doi: 10.1056/NEJMoa2008457
pmc: PMC7200056
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2081-2090Investigateurs
Atar Baer
(A)
Leslie M Barnard
(LM)
Eileen Benoliel
(E)
Meaghan S Fagalde
(MS)
Jessica Ferro
(J)
Hal Garcia-Smith
(H)
Elysia Gonzales
(E)
Noel Hatley
(N)
Grace Hatt
(G)
Michaela Hope
(M)
Melinda Huntington-Frazier
(M)
Vance Kawakami
(V)
Jennifer L Lenahan
(JL)
Margaret D Lukoff
(MD)
Emily B Maier
(EB)
Shelly McKeirnan
(S)
Jennifer L Morgan
(JL)
Laura A Mummert
(LA)
Sargis Pogosjans
(S)
Leilani Schwarcz
(L)
Daniel Smith
(D)
Steven Stearns
(S)
Kaitlyn J Sykes
(KJ)
Holly Whitney
(H)
Michelle Banks
(M)
Arun Balajee
(A)
Eric J Chow
(EJ)
Barbara Cooper
(B)
Dustin W Currie
(DW)
Jessica Healy
(J)
Michael Hughes
(M)
Temet M McMichael
(TM)
Leisha Nolen
(L)
Christine Olson
(C)
Agam K Rao
(AK)
Kristine Schmit
(K)
Noah G Schwartz
(NG)
Farrell Tobolowsky
(F)
Rachael Zacks
(R)
Suzanne Zane
(S)
Jing Zhang
(J)
Krista Queen
(K)
Clinton R Paden
(CR)
Brett Whitaker
(B)
Steve Lindstrom
(S)
Denny Russell
(D)
Brian Hiatt
(B)
Jessica Gant
(J)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 Massachusetts Medical Society.
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