In March 2020, COVID-19 was spreading fast through Seattle's skilled nursing facilities, with high illness and death among older residents. When two residents of a Seattle independent and assisted living community were hospitalized with COVID-19, investigators tested everyone who lived and worked there. They found very few infections — and that asking people about symptoms would not have found them.
The community
The facility had 83 apartments — 45 independent living and 38 assisted living — along several hallways, with shared dining, library and activity areas. Residents could move around with little help; assisted-living residents got daily help with medicines and daily activities. Unlike in skilled nursing, residents do not live as close together and do not need skilled nursing care.
What was done
Between March 5 and 9, 2020, two residents were hospitalized with confirmed COVID-19. From March 6 the community:
- kept residents in their rooms, with no shared meals or activities;
- allowed no visitors;
- screened staff and sent home anyone with symptoms;
- stepped up cleaning of frequently touched surfaces and added hand hygiene stations in the hallways.
UW Medicine, Public Health – Seattle & King County and CDC tested all residents and staff on March 10 and 11, and all residents again seven days later.
What testing found
| Residents | Staff | |
|---|---|---|
| Tested | 80 (mean age 86; 77% women; 79% with at least one chronic condition) | 62 (mean age 40) |
| Positive, first round | 3 (3.8%) | 2 (3.2%) |
| Positive, second round | 1 more — negative the first time | not retested |
Three of the four infected residents had no symptoms when tested; the fourth reported a cough that had already cleared. The newly positive resident had no symptoms on either day. Both infected staff members reported symptoms such as headache, body aches or cough.
Meanwhile, symptoms were common among people who tested negative: 42 percent of residents and 25 percent of staff reported symptoms in the previous two weeks. As of March 31, all residents remained in isolation at the facility and were clinically stable.
Why so few cases
The contrast with Seattle nursing facilities was stark. Possible reasons include more distance between residents, less contact with health care providers than in skilled nursing, and strict isolation and protective measures started as soon as the first two cases were found.
The lesson
Symptom screening alone would have missed the infected residents while flagging many who were not infected. Social distancing, restricting visitors, testing residents and staff, keeping sick staff home, and stronger cleaning and hygiene — in line with CDC guidance for these communities — may prevent an outbreak.
Sources
Based on "Detection of SARS-CoV-2 Among Residents and Staff Members of an Independent and Assisted Living Community for Older Adults — Seattle, Washington, 2020," by Alison C. Roxby and colleagues (University of Washington, Public Health – Seattle & King County, CDC), Morbidity and Mortality Weekly Report (Early Release, April 3, 2020), Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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