Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

Temet M McMichael, Dustin W Currie, Shauna Clark, Sargis Pogosjans, Meagan Kay, Noah G Schwartz, James Lewis, Atar Baer, Vance Kawakami, Margaret D Lukoff, Jessica Ferro, Claire Brostrom-Smith, Thomas D Rea, Michael R Sayre, Francis X Riedo, Denny Russell, Brian Hiatt, Patricia Montgomery, Agam K Rao, Eric J Chow, Farrell Tobolowsky, Michael J Hughes, Ana C Bardossy, Lisa P Oakley, Jesica R Jacobs, Nimalie D Stone, Sujan C Reddy, John A Jernigan, Margaret A Honein, Thomas A Clark, Jeffrey S Duchin, Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team, Meaghan S Fagalde, Jennifer L Lenahan, Emily B Maier, Julia E Hood, Kaitlyn J Sykes, Grace Hatt, Holly J Whitney, Melinda Huntington-Frazier, Elysia Gonzales, Laura A Mummert, Hal Garcia Smith, Steve Stearns, Eileen Benoliel, Shelly McKeirnan, Jennifer L Morgan, Daniel Smith, Michaela Hope, Noel Hatley, Joanie D Lambert, Alexandra R Topper, Sunghoi Mccarroll, Leslie M Barnard, Leilani Schwarcz, Jamie M Emert, Christopher Drucker, Sally Guan, Kosuke Kume, Karen Rodriquez, Tracie Jacinto, Nicole Yarid, Betty Y Yang, Catherine R Counts, David L Murphy, Eric Yim, Sandra Kreider, Dawn Barr, Nancy Wilde, Courtney Dorman, Airin Lam, Jeanette Harris, Hollianne Bruce, Christopher Spitters, Rachael Zacks, Jonathan Dyal, Christina M Carlson, Barbara Cooper, Michelle Banks, Heather P McLaughlin, S Arunmozhi Balajee, Christine Olson, Suzanne Zane, Hammad Ali, Jessica Healy, Kristine Schmit, Kevin Spicer, Zeshan Chisty, Sukarma Tanwar, Joanne Taylor, Leisha D Nolen, Jeneita Bell, Kelly Hatfield, Melissa Arons, Anne Kimball, Allison James, Mark Methner, Joshua M Harney, Temet M McMichael, Dustin W Currie, Shauna Clark, Sargis Pogosjans, Meagan Kay, Noah G Schwartz, James Lewis, Atar Baer, Vance Kawakami, Margaret D Lukoff, Jessica Ferro, Claire Brostrom-Smith, Thomas D Rea, Michael R Sayre, Francis X Riedo, Denny Russell, Brian Hiatt, Patricia Montgomery, Agam K Rao, Eric J Chow, Farrell Tobolowsky, Michael J Hughes, Ana C Bardossy, Lisa P Oakley, Jesica R Jacobs, Nimalie D Stone, Sujan C Reddy, John A Jernigan, Margaret A Honein, Thomas A Clark, Jeffrey S Duchin, Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team, Meaghan S Fagalde, Jennifer L Lenahan, Emily B Maier, Julia E Hood, Kaitlyn J Sykes, Grace Hatt, Holly J Whitney, Melinda Huntington-Frazier, Elysia Gonzales, Laura A Mummert, Hal Garcia Smith, Steve Stearns, Eileen Benoliel, Shelly McKeirnan, Jennifer L Morgan, Daniel Smith, Michaela Hope, Noel Hatley, Joanie D Lambert, Alexandra R Topper, Sunghoi Mccarroll, Leslie M Barnard, Leilani Schwarcz, Jamie M Emert, Christopher Drucker, Sally Guan, Kosuke Kume, Karen Rodriquez, Tracie Jacinto, Nicole Yarid, Betty Y Yang, Catherine R Counts, David L Murphy, Eric Yim, Sandra Kreider, Dawn Barr, Nancy Wilde, Courtney Dorman, Airin Lam, Jeanette Harris, Hollianne Bruce, Christopher Spitters, Rachael Zacks, Jonathan Dyal, Christina M Carlson, Barbara Cooper, Michelle Banks, Heather P McLaughlin, S Arunmozhi Balajee, Christine Olson, Suzanne Zane, Hammad Ali, Jessica Healy, Kristine Schmit, Kevin Spicer, Zeshan Chisty, Sukarma Tanwar, Joanne Taylor, Leisha D Nolen, Jeneita Bell, Kelly Hatfield, Melissa Arons, Anne Kimball, Allison James, Mark Methner, Joshua M Harney

Abstract

Background: Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region.

Methods: After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health-Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.

Results: As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County.

Conclusions: In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.

Copyright © 2020 Massachusetts Medical Society.

Figures

Figure 1. Confirmed Cases of Covid-19 Linked…
Figure 1. Confirmed Cases of Covid-19 Linked to Facility A.
Shown are cases of Covid-19 in Washington that had been epidemiologically linked to Facility A as of March 18, 2020.
Figure 2. Timeline Showing Long-Term Care Facilities…
Figure 2. Timeline Showing Long-Term Care Facilities in King County with One or More Confirmed Cases of COVID-19.
The first nine long-term care facilities (e.g., nursing homes or assisted living facilities) in King County with one or more confirmed cases of Covid-19 are shown according to the date of the first confirmed case. Facilities are those identified as of March 9, 2020. The direction of potential introduction of Covid-19 from one facility to another is unknown.

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Source: PubMed

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