key: cord-0893069-28lda13g
authors: McBee, Shannon M.; Thomasson, Erica D.; Scott, Melissa A.; Reed, Christy L.; Epstein, Lauren; Atkins, Amy; Slemp, Catherine C.
title: Notes from the Field: Universal Statewide Laboratory Testing for SARS-CoV-2 in Nursing Homes — West Virginia, April 21–May 8, 2020
date: 2020-08-28
journal: MMWR Morb Mortal Wkly Rep
DOI: 10.15585/mmwr.mm6934a4
sha: be0bf94a9edaefd065c06e573092f83ad538335c
doc_id: 893069
cord_uid: 28lda13g

nan

screened staff members and residents daily and tested anyone with signs or symptoms of COVID-19. If additional cases were identified, testing was also performed for close contacts of patients, including all residents cared for by the same health care worker. WVBPH monitored nursing homes' adherence to infection prevention and control measures through conference calls, and facilities twice weekly submitted line lists of residents and staff members who were symptomatic or who had a positive SARS-CoV-2 test result.

During April 21-May 8, universal testing was conducted in all 123 West Virginia nursing homes. Receiving testing was declined by 1.3% (115 of 9,026) of residents and 1.7% (239 of 13,926) of staff members. Among the 8,911 residents and 13,687 staff members who were tested, 42 COVID-19 cases were identified in 28 (23%) nursing homes, none of which had previously experienced an outbreak. The 42 cases occurred in 11 residents (0.1% of residents tested) and 31 staff members (0.2% of tested staff members). The 42 identified cases represented 20 single cases from 20 facilities and 22 outbreak-associated cases, representing new outbreaks (ranging in size from two to six persons) in eight facilities (Table) . The prevalence of positive SARS-CoV-2 test results was lower in nursing homes with COVID-19 outbreaks during universal testing (0.9% of residents and 1.9% of staff members) than it was during earlier outbreaks when testing was triggered by daily symptom-based resident screening (38.1%) and preshift employee screening (16.3%). Before universal testing, 32 COVID-19-associated nursing home deaths had been reported; however, no deaths occurred among residents with COVID-19 who were identified during universal testing.

In six of the eight nursing homes with newly identified COVID-19 outbreaks where cohorting of residents with positive SARS-CoV-2 test results and exclusion of staff members with positive test results were implemented, daily follow-up symptom screening of all residents and staff members for 28 days (the upper bound of two incubation periods) found that further transmission did not occur. Two facilities experienced minimal transmission beyond the initial cases detected during universal testing.

Universal testing identified eight outbreaks with 17 staff members and five residents who tested positive for SARS-CoV-2, including six staff members and two residents who were asymptomatic (Table) . The testing likely prevented the occurrence of ongoing transmission and larger outbreaks, had the asymptomatic infections gone undetected. Proactive universal testing prevented additional infections, as illustrated by the lower percentages of residents and staff members with positive test results in outbreaks identified through universal testing compared with those identified through symptom screening. Universal testing helped estimate the prevalence of COVID-19 in a population at increased risk for serious COVID-19 outcomes (1) so that public health resources could be allocated to prevent further spread (2) . Statewide universal testing enabled rapid implementation of infection prevention and control measures that likely prevented the occurrence of larger outbreaks. Since completing universal screening, West Virginia has maintained symptom screening in nursing homes, revised its outbreak case definition to constitute a single case in a nursing home, and adopted universal testing of all residents and staff members in response to an outbreak with weekly testing for a period of at least 14 days since the most recent positive result.

For the period May 8-July 26, following completion of universal testing and under the new procedures, 18 COVID-19 outbreaks were identified in West Virginia nursing homes, 12 of which involved five or fewer cases. Although universal testing is resource-intensive, it has proven essential to limiting COVID-19 transmission in nursing homes and has reduced the impact of the pandemic on this vulnerable population in West Virginia.

Public Health -Seattle & King County, EvergreenHealth, and CDC COVID-19 Investigation Team. COVID-19 in a long-term care facility

Universal and serial laboratory testing for SARS-CoV-2 at a long-term care skilled nursing facility for veterans

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.