This page summarizes a "Notes from the Field" report in CDC's MMWR by the West Virginia Bureau for Public Health and CDC, about testing in April and May 2020.
COVID-19 outbreaks in nursing homes can hit older adults hard. From March 17 to April 16, 2020, seven West Virginia nursing homes reported 307 cases among residents and staff, and four had outbreaks involving 20–40 residents. On April 17, the governor's Executive Order 27-20 directed the state Bureau for Public Health to test every resident and staff member of all 123 nursing homes, with or without symptoms.
How it worked
- From April 21, in-house staff, local health departments or the West Virginia National Guard collected nasopharyngeal or nasal swabs, tested by RT-PCR at a contracted private lab or other commercial labs.
- In homes with active outbreaks, everyone not already known positive was tested.
- An outbreak was two or more lab-confirmed cases among staff or residents within 14 days.
- Residents who tested positive were isolated in private rooms under transmission-based precautions. Staff who tested positive isolated at home, monitored by daily text message; negative staff who were close contacts quarantined at home for 14 days.
- Afterward, homes screened everyone daily, tested anyone with symptoms, and tested close contacts of new cases, including all residents cared for by the same worker. The state checked infection control through conference calls and twice-weekly line lists.
Results, April 21–May 8
| Measure | Result |
|---|---|
| Residents who declined testing | 115 of 9,026 (1.3%) |
| Staff who declined testing | 239 of 13,926 (1.7%) |
| Residents tested | 8,911 |
| Staff tested | 13,687 |
| Cases found | 42, in 28 homes (23%), none of which had had an earlier outbreak |
| Residents positive | 11 (0.1%) |
| Staff positive | 31 (0.2%) |
The 42 cases were 20 single cases in 20 homes and 22 cases in eight new outbreaks of two to six people each: 17 staff and five residents, of whom six staff and two residents had no symptoms.
Smaller outbreaks. In homes with outbreaks found by universal testing, 0.9% of residents and 1.9% of staff tested positive, far below earlier outbreaks detected through symptom screening (38.1% of residents and 16.3% of staff). Before universal testing, 32 COVID-19 deaths had been reported in nursing homes; none of the residents found through universal testing died.
In six of the eight new outbreaks, where positive residents were cohorted and positive staff kept off work, 28 days of daily screening (two incubation periods) found no further spread; the other two saw minimal spread.
What it meant
Finding infections without symptoms likely prevented larger outbreaks, gave a picture of COVID-19 prevalence in a high-risk population so resources could be directed, and let homes act quickly on infection control.
West Virginia then kept symptom screening, redefined a nursing home outbreak as a single case, and adopted testing of all residents and staff in response to any outbreak, weekly, until at least 14 days after the last positive result. From May 8 to July 26, 18 outbreaks were identified under these rules, 12 of them with five or fewer cases. Universal testing takes many resources, the authors concluded, but it proved essential to limiting spread in this vulnerable population.
Sources
- McBee SM, Thomasson ED, Scott MA, et al. "Notes from the Field: Universal Statewide Laboratory Testing for SARS-CoV-2 in Nursing Homes — West Virginia, April 21–May 8, 2020." MMWR 69(34). https://www.cdc.gov/mmwr/volumes/69/wr/mm6934a4.htm
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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