Cross-Sectional Prevalence of SARS-CoV-2 Among Skilled Nursing Facility Employees and Residents Across Facilities in Sea
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Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; 2Department of Surgery, University of Washington, Seattle, WA, USA; 3Department of Health Services, University of Washington, Seattle, WA, USA; 4Public Health - Seattle & King County, King County, WA, USA; 5Department of Genome Sciences, University of Washington, Seattle, WA, USA; 6Brotman Baty Institute for Precision Medicine, Seattle, WA, USA; 7Fred Hutchinson Cancer Research Center, Seattle, WA, USA; 8Department of Global Health, University of Washington, Seattle, WA, USA.
BACKGROUND: Skilled nursing facilities (SNFs) are highrisk settings for SARS-CoV-2 transmission. Infection rates among employees are infrequently described. OBJECTIVE: To describe SARS-CoV-2 rates among SNF employees and residents during a non-outbreak time period, we measured cross-sectional SARS-CoV-2 prevalence across multiple sites in the Seattle area. DESIGN: SARS-CoV-2 testing was performed for SNF employees and residents using quantitative real-time reverse transcription polymerase chain reaction. A subset of employees completed a sociodemographic and symptom questionnaire. PARTICIPANTS: Between March 29 and May 13, 2020, we tested 1583 employees and 1208 residents at 16 SNFs for SARS-CoV-2. MAIN MEASURE: SARS-CoV-2 testing results and symptom report among employees and residents. KEY RESULTS: Eleven of the 16 SNFs had one or more resident or employee test positive. Overall, 46 (2.9%) employees had positive or inconclusive testing for SARSCoV-2, and among those who completed surveys, most were asymptomatic and involved in direct patient care. The majority of employees tested were female (934, 73%), and most employees were Asian (392, 30%), Black (360, 28%), or white (360, 28%). Among the 1208 residents tested, 110 (9.1%) had positive or inconclusive results. There was no association between the presence of positive residents and positive employees within a SNF (p = 0.62, McNemar’s test). CONCLUSIONS: In the largest study of SNFs to date, SARS-CoV-2 infections were detected among both employees and residents. Employees testing positive were Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06165-7) contains supplementary material, which is available to authorized users. Received August 5, 2020 Accepted August 14, 2020
often asymptomatic and involved in direct patient care. Surveillance testing is needed for SNF employees and residents during the pandemic response. KEY WORDS: SARS-CoV-2; skilled nursing facility. J Gen Intern Med DOI: 10.1007/s11606-020-06165-7 © The Author(s) 2020
INTRODUCTION
Skilled nursing facilities (SNFs) are high-risk settings for rapid spread of SARS-CoV-2 infection because they are congregate settings that frequently house a vulnerable patient population with multiple co-morbidities.1, 2 Many outbreaks in long-term care facilities have been described, often with high mortality rates in residents.3 Symptom screening alone for COVID-19 has been s
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