Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility
By Melissa M. Arons, Kelly M. Hatfield, Sujan C. Reddy, Anne A. Kimball, Allison E James, Jesica R Jacobs, Joanne Taylor, K. Spicer, A. Bardossy, Lisa P Oakley and 26 more. New England Journal of Medicine, 2020
1,951 citations recorded by the source corpus.
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. Results Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2. Among 76 residents who participated in point-prevalence surveys, 48 (63%) tested positive. Of these 48 residents, 27 (56%) were asymptomatic at the time of testing; 24 subsequently developed symptoms (median time to onset, 4 days). Samples from these 24 presymptomatic residents had a median rRT-PCR cycle threshold value of 23.1, and viable virus was recovered from 17 residents. As of April 3, of the 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit) and 15 had died (mortality, 26%). Of the 34 residents whose specimens were sequenced, 27 (79%) had sequences that fit into two clusters with a difference of one nucleotide. Conclusions Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.
Subfields: Infectious Diseases, Pulmonary and Respiratory Medicine
View Paper: https://www.semanticscholar.org/paper/efc047183288a0c36d67675ae6d30a0ed36a968a
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In Infectious Diseases
Citations in the corpus
- Asymptomatic Transmission, the Achilles’ Heel of Current Strategies to Control Covid-19 (2020, methodology): “5 Residents of the facility were then offered two facility-wide point-prevalence screenings for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) of nasopharyngeal swabs on March 13 and March 19-20, along with collection of information on symptoms the residents recall”
- Airborne transmission of respiratory viruses (2021, background): “A high proportion of individuals infected with SARS-CoV-2 have no symptoms at the time of testing (167, 168).”
- Mechanisms of SARS-CoV-2 Transmission and Pathogenesis (2020, positive): “Furthermore, there is now evidence for nonsymptomatic/presymptomatic spread of SARS-CoV-2, which is in contrast to the transmission dynamics of SARS-CoV [50].”