Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility
List of authors.
Melissa M. Arons, R.N., Kelly M. Hatfield, M.S.P.H., Sujan C. Reddy, M.D., Anne Kimball, M.D., Allison James, Ph.D., Jesica R. Jacobs, Ph.D., Joanne Taylor, Ph.D., Kevin Spicer, M.D., Ana C. Bardossy, M.D., Lisa P. Oakley, Ph.D., Sukarma Tanwar, M.Med., Jonathan W. Dyal, M.D., et al., for the Public Health–Seattle and King County and CDC COVID-19 Investigation Team*
Abstract
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.
