Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities - Detroit, Michigan, March-May 2020

Abstract

Skilled nursing facilities (SNFs) are focal points of the coronavirus disease 2019 (COVID-19) pandemic, and asymptomatic infections with SARS-CoV-2, the virus that causes COVID-19, among SNF residents and health care personnel have been described (1-3). Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) have been used to identify asymptomatic infections and have reduced SARS-CoV-2 transmission during SNF outbreaks (1,3). During March 2020, the Detroit Health Department and area hospitals detected a sharp increase in COVID-19 diagnoses, hospitalizations, and associated deaths among SNF residents. The Detroit Health Department collaborated with local government, academic, and health care system partners and a CDC field team to rapidly expand SARS-CoV-2 testing and implement infection prevention and control (IPC) activities in all Detroit-area SNFs. During March 7-May 8, among 2,773 residents of 26 Detroit SNFs, 1,207 laboratory-confirmed cases of COVID-19 were identified during three periods: before (March 7-April 7) and after two point prevalence surveys (April 8-25 and April 30-May 8): the overall attack rate was 44%. Within 21 days of receiving their first positive test results, 446 (37%) of 1,207 COVID-19 patients were hospitalized, and 287 (24%) died. Among facilities participating in both surveys (n = 12), the percentage of positive test results declined from 35% to 18%. Repeated point prevalence surveys in SNFs identified asymptomatic COVID-19 cases, informed cohorting and IPC practices aimed at reducing transmission, and guided prioritization of health department resources for facilities experiencing high levels of SARS-CoV-2 transmission. With the increased availability of SARS-CoV-2 testing, repeated point prevalence surveys and enhanced and expanded IPC support should be standard tools for interrupting and preventing COVID-19 outbreaks in SNFs.

FIGURE

Skilled nursing facility residents with confirmed COVID-19 diagnosed by May 8, 2020, (A) by date of first positive SARS-CoV-2 test result (n = 1,190); (B) date of hospital admission (n = 331)^†,^§; and (C) date of death (n = 282)^§,^¶ — 26 facilities,** Detroit, March 7–May 29, 2020 Abbreviation: COVID-19 = coronavirus disease 2019. * Seventeen dates of first positive test results are not known. † Five residents had multiple admissions; 120 had unknown hospitalization dates. ^§ Hospitalization and mortality data were current as of May 29, 2020. Hospitalizations with admission dates documented as 2 days before, through 21 days after the specimen collection date for a positive SARS-CoV-2 test were counted; deaths within 21 days of positive specimen collection date were counted. ¶ Five dates of death are not known. ** Data from all 26 facilities are displayed; only 12 facilities were tested during the second survey. COVID-19 testing data are not shown after May 8.