key: cord-0855124-sv7xs20m authors: Park, Shin Young; Choi, Gawon; Lee, Hyeyoung; Kim, Na-young; Lee, Seon-young; Kim, Kyungnam; Shin, Soyoung; Jang, Eunsu; Moon, YoungSin; Oh, KwangHwan; Choi, JaeRin; Lee, Sangeun; Kim, Young-Man; Kim, Jieun; Yi, Seonju; Gwack, Jin; Park, Ok; Park, Young Joon title: Early Intervention Reduces the Spread of COVID-19 in Long-Term Care Facilities in the Republic of Korea date: 2020-08-03 journal: Osong Public Health Res Perspect DOI: 10.24171/j.phrp.2020.11.4.16 sha: 3f0008ad25f5a2b7b9e42b74fae72207d5e26c02 doc_id: 855124 cord_uid: sv7xs20m This study describes the epidemiological characteristics of coronavirus disease 2019 (COVID-19) based on reported cases from long-term care facilities. As of April 20(th), 2020, 3 long-term care facilities in a metropolitan area of South Korea had reported cases of COVID-19. These facilities’ employees were presumed to be the sources of infection. There were 2 nursing hospitals that did not report any additional cases. One nursing home had a total of 25 cases, with an attack rate of 51.4% (95% CI 35.6–67.0), and a fatality rate of 38.9% (95% CI 20.3–61.4) among residents. The results from this study suggest that early detection and maintenance of infection control minimizes the risk of rapid transmission. The first Korean patient confirmed as infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was reported on 20 th January 2020. This novel virus first appeared in China on the 8 th December 2019. As of the 20 th April 2020, the total COVID-19 cases in Korea were 10,674 [1] . Of these, 1,372 were confirmed cases from metropolitan areas of Seoul, Gyeonggi-do, and Incheon, and represented 12.9% of all COVID-19 cases. Among the confirmed cases, 44.8% of them were related to congregated settings, and 25.1% of these were related to health and long-term care facilities (LTCFs). LTCF residents who have pre-existing comorbidities are more susceptible to coronavirus disease 2019 (COVID-19) infection and spread. Moreover, adults older than 65 years reportedly have a higher fatality rate than children or young adults [2] . From the 20 th January to the 20 th April 2020, 3 [1] . An "index case" was defined as the first documented laboratory-confirmed case, or the first documented patient included in an epidemiologic investigation within a cluster. A "source case" was defined as a patient who gave rise to an outbreak [3] . Contacts who were in high risk groups (household contacts, healthcare personnel) were routinely tested, whereas non-high-risk groups were only tested if they had COVID-19 symptoms including a fever and respiratory symptoms. Nonhigh-risk, asymptomatic contacts were mandated to selfquarantine for 14 days (from the last day of encountering the index case) and were placed under active surveillance. This investigation was a part of the public health response and was not subject to institutional review board approval therefore, written informed consent from individuals was not required. The LTCF A index case (female, aged 46) was a caregiver who was confirmed COVID-19 positive on the 12 th March. During the outbreak at building X, contact tracing began on the 9 th March, and an outbreak at a church was confirmed on the There were no additional COVID-19 confirmed cases at this facility (Table 1) . The LTCF B index case (female, aged 50) was a hospital nurse who attended the same church as the caregiver from LTCF A, and was under home-quarantine from the 11 th March due to All were negative, and there have been no additional confirmed COVID-19 patients from LTCF B. The LTCF C index case (female, aged 85), was a resident on March until the 8 th April 2020 (Figure 1 ). States, there has been an outbreak of 167 COVID-19 cases that were linked to a LTCF employee who was the index case [6] . It appeared that the higher attack rate and fatality rate in LTCF C was a result of delayed identification of the index case ( Figure 2 ). In LTCFs A and B, screening was performed within 3 days of the employees' exposure to COVID-19, with the former index case presenting as asymptomatic, and only attending her LTCF for 1 day. In the case of LTCF C, the employee worked for 4 days before quarantine. Even if the physical therapist was not the source, the detection of the index case was delayed because the RT-PCR was performed 3 days after the onset of symptoms. In addition, in situations where there is a high possibility of infection due to prolonged exposure, individual distributed deployment should be considered rather than cohort isolation. Yet, transferring process in an outbreak setting is often complex and difficult due to limited hospital beds and resources. A plan should be placed ahead to secure healthcare facilities or alternate care sites with adequate staffing and to transfer the contacts from LTCF to designated facilities. [3, 7] . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 surveillance of LTCFs, tests were conducted on 6,544 people including employees, caregivers, and new inpatients at 46 nursing hospitals in the metropolitan areas of Seoul, Gyeonggido from the 17 th to 27 th April, all of which were negative [9] . Once COVID-19 had been introduced into LTCFs, rapid transmission was a significant risk therefore, a strategy was needed to minimize the risk. Strict monitoring was reinforced for employees and patients for infection control guideline adherence, visitor restriction, and the restriction of admitted patients from going out, monitoring for fever and/or respiratory symptoms, and COVID-19 screening for symptomatic individuals. It was essential that symptomatic individuals were tested for COVID-19 and excluded from the workplace until symptoms reduced without medication [10] . In conclusion, early detection was the most important outbreak control method used in LTCFs. The authors have no conflicts of interest to declare. Epidemiology and Case Management Team, Korea Centers for Disease Control and Prevention. Early epidemiological and clinical characteristics of 28 cases of coronavirus disease in South Korea COVID-19)-United States COVID-19 Response and Management Guidelines Coronavirus disease outbreak in call center Contact transmission of COVID-19 in South Korea: Novel investigation techniques for tracing contacts Epidemiology of Covid-19 in a long-term care facility in King County, Washington Strategies to Mitigate Healthcare Personnel Staffing Shortages Criteria for Return to Work for Healthcare Personnel with Suspected or Confirmed COVID-19 (Interim Guidance) Press Release: Regular Briefing of Central Disaster and Safety Countermeasure Headquarters on COVID-19 Press Release: Regular Briefing of Central Disaster and Safety Countermeasure Headquarters on COVID-19 We thank the relevant ministries, including the Ministry of Interior and Safety, Si/Do and Si/Gun/Gu, medical staff in health centers and medical facilities for their effort in responding to COVID-19 outbreaks.