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. 2020 Oct;68(10):2174-2178.
doi: 10.1111/jgs.16642. Epub 2020 Jun 13.

An Illustration of SARS-CoV-2 Dissemination Within a Skilled Nursing Facility Using Heat Maps

Carolyn Blackman  1   2 , Sharon Farber  1   2 , Richard A Feifer  1   2 , Vincent Mor  3   4 , Elizabeth M White  3
Affiliations

An Illustration of SARS-CoV-2 Dissemination Within a Skilled Nursing Facility Using Heat Maps

Carolyn Blackman et al. J Am Geriatr Soc. 2020 Oct.

Abstract

Objectives: To illustrate dissemination and asymptomatic transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a skilled nursing facility (SNF) outbreak.

Design: Case report.

Setting and participants: Residents of a 150-bed SNF.

Measurements: Heat maps generated by the SNF's infection prevention team to track staff and resident symptoms and SARS-CoV-2 test results to identify infection patterns.

Results: The SNF experienced a severe outbreak of SARS-CoV-2 early in the pandemic. The initial cluster of residents with symptoms and the first confirmed case occurred on the SNF's dementia care unit. The insufficient availability and prolonged turnaround time of testing for both residents and staff at the outset of the outbreak prevented timely and accurate identification and cohorting of cases. Despite extensive other infection control measures being in place, SARS-CoV-2 disseminated widely through the facility within 3 weeks of the first confirmed case, resulting in significant morbidity and mortality.

Conclusion: Early, rapid, universal SARS-CoV-2 testing of both SNF residents and staff at the outset of an outbreak and then repeatedly thereafter is critical to mitigate viral transmission. This will become even more important as states relax stay-at-home orders and SNF staff intermingle with communities that are increasingly mobile. Increased testing will inevitably result in more staff testing positive and having to self-quarantine at home, meaning that states must partner with SNFs and other long-term care providers to coordinate and support strategic staffing reserves that can supplement current frontline staff. J Am Geriatr Soc 68:2174-2178, 2020.

Keywords: COVID-19; SARS-CoV-2; infection control; nursing home; skilled nursing facility.

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Conflict of interest statement

Vincent Mor is Chair of the Scientific Advisory Committee at NaviHealth, Inc, former Chair of the Independent Quality Committee at HCR ManorCare, and former Director of PointRight, Inc, where he holds less than 1% equity. The other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
March 29 heat map. (Note: Image has been edited for clarity and deidentification.)
Figure 2
Figure 2
March 31 heat map. (Note: Image has been edited for clarity and deidentification.)
Figure 3
Figure 3
April 17 heat map. (Note: Image has been edited for clarity and deidentification.)
See this image and copyright information in PMC

References

    1. Kaiser Family Foundation . State reports of long‐term care facility cases and deaths related to COVID‐19. 2020. https://www.kff.org/health-costs/issue-brief/state-data-and-policy-actio.... Accessed May 12, 2020.
    1. Comas‐Herrera A, Zalakaín J, Litwin C, Hsu AT, Lane N, Fernández JL. Mortality associated with COVID‐19 outbreaks in care homes: early international evidence. 2020. https://ltccovid.org/wp-content/uploads/2020/05/Mortality-associated-wit.... Accessed May 7, 2020.

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