Efficacy of COVID-19 outbreak management in a skilled nursing facility based on serial testing for early detection and control
Pedro Manoel Marques Garibaldi, Natasha Nicos Ferreira, Glenda R. Moraes, José Carlos de Moura, Danillo Lucas Alves Espósito, Gustavo Jardim Volpe, Rodrigo T. Calado, Benedito Antônio Lopes da Fonseca, Marcos de Carvalho Borges
Abstract
SARS-CoV-2 has a high risk of outbreak in long-term skilled nursing facilities (SNF). Coronavirus disease (COVID-19) has high mortality rates among the elderly with chronic health conditions. Following identification of COVID-19 index case in a SNF, serial point-prevalence was implemented with reverse transcription-polymerase chain reaction (RT-PCR) and immunochromatographic assays. Active surveillance and early isolation of infected patients were implemented. Out of 23 SNF residents and 26 healthcare workers (HCW), 18 (78%) and 12 (46%) tested positive for SARS-CoV-2, respectively. High proportion (38%) of positive patients were asymptomatic and RT-PCR was positive up to six days before symptoms. Five (21.74%) residents were hospitalized with COVID-19, and 2 (9%) died; only 1 (4%) HCW needed to be hospitalized and no staff members died. Active surveillance helped COVID-19 control and management in a SNF. Testing symptomatic individuals only may fail to identify and isolate all persons contributing to transmission. In high-risk elderly, only symptoms screening may not be enough for outbreak control.