#REAL LIFE CASES OF SEQUENTIAL TESTING SERIAL#
During the first round of serial testing, 23 (43%) of 53 tested residents had positive SARS-CoV-2 RT-PCR test results ( Figure 1) 11 refused testing. Facility A conducted three rounds of testing during April 30–May 18. Before serial testing (April 17–29), COVID-19 was laboratory-confirmed in 14 (18%) symptomatic residents. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.**Īs of April 14, the census at facility A included 78 residents, with 156 HCP. Descriptive analyses were conducted using R (version 3.6.1 The R Foundation). Phylogenetic relationships, including distinct clustering of viral whole genome sequences, were inferred based on nucleotide differences via IQ-TREE, using general time reversible substitution models ( 9) as a part of the Nextstrain workflow ( 10). Whole genome sequencing was conducted by MDH-PHL on available ¶ specimens using previously described methods ( 8). Residents with positive SARS-CoV-2 test results were moved to a COVID-19 care unit within each facility, and HCP with positive test results were excluded from work for at least 10 days ( 7). MDH and CDC provided frequent onsite IPC assessment to both facilities, including review of cohorting, hand hygiene practices, and use of PPE. Data on symptoms, demographic characteristics, and HCP work assignment were collected from resident charts, MDH COVID-19 case interviews, and SNF administrator interviews. § Symptomatic residents and HCP were tested outside of scheduled serial testing.
Starting in mid-March, HCP were screened daily for COVID-19–compatible symptoms, and symptomatic HCP were sent home per MDH and CDC guidance. Residents and HCP with positive test results were excluded from future serial testing. HCP were offered testing services at the facility during serial testing of residents as well as whenever it was convenient to account for work schedules. After a first round of testing on April 30 and May 7 in facilities A and B, respectively, serial testing was conducted in residents every 7–10 days. During April 30–June 12, nasal, nasopharyngeal, or oral swabs were collected from residents and HCP and were tested to detect SARS-CoV-2 nucleic acid by RT-PCR, which was conducted at MDH Public Health Laboratory (MDH-PHL) and multiple commercial laboratories ( 6). Paul metropolitan area contacted MDH after identifying multiple confirmed resident and HCP COVID-19 cases. In light of the release of CDC interim guidance on May 1 ( 6), and in an effort to improve IPC and implement facility-wide SARS-CoV-2 testing, two SNFs located in the Minneapolis-St. Interim guidance for HCP mask use and SNF visitor restriction was implemented statewide by Mahowever, during April, an increase in COVID-19 diagnoses and deaths among SNF residents in Minnesota occurred. As part of comprehensive COVID-19 preparation and response, including early identification of cases, SNFs should conduct serial testing of residents and HCP, maximize HCP testing participation, ensure availability of personal protective equipment (PPE), and enhance IPC practices † ( 4– 5). Residents and HCP working in SNFs are at risk for infection with SARS-CoV-2. Genetic sequencing demonstrated that SARS-CoV-2 viral genomes from HCP and resident specimens were clustered by facility, suggesting facility-based transmission. Continued SARS-CoV-2 transmission was potentially facilitated by lapses in infection prevention and control (IPC) practices, up to 12-day delays in receiving HCP test results (53%) at one facility, and incomplete HCP participation (71%).
Among 259 tested residents, and 341 tested HCP, 64% and 33%, respectively, had positive reverse transcription–polymerase chain reaction (RT-PCR) SARS-CoV-2 test results. During April–June 2020, the Minnesota Department of Health (MDH), with CDC assistance, conducted weekly serial testing at two SNFs experiencing COVID-19 outbreaks.
Facility-wide, serial testing in SNFs has been used to identify residents with asymptomatic and presymptomatic SARS-CoV-2 infection to inform mitigation efforts, including cohorting of residents with positive test results and exclusion of infected HCP from the workplace ( 2, 3). In Minnesota, SNF-associated cases accounted for 3,950 (8%) of 48,711 COVID-19 cases reported through J35% of SNF-associated cases involved health care personnel (HCP*), including six deaths. SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly in high-risk congregate settings such as skilled nursing facilities (SNFs) ( 1).
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