In the spring of 2020, long-term care residents made up less than 1 percent of Fulton County, Georgia's population but more than half of its COVID-19 deaths. The county tested entire facilities — residents and staff — and the timing of that testing made a striking difference.
Two groups of facilities
At first, with scarce test kits and staff, the Fulton County Board of Health tested only facilities that already had a confirmed case, found by testing someone with symptoms. From April 29, with help from the National Guard, it also tested facilities with no known infection. Each facility had a single testing day between March 31 and May 18, followed by four weeks of symptom screening.
| Response group (tested after a first case) | Preventive group (tested before any known case) | |
|---|---|---|
| Facilities | 15 | 13 |
| Residents infected at initial testing | 28.0% | 0.5% |
| Staff infected at initial testing | 7.4% | 1.0% |
| Residents infected after 4 weeks | 42.4% | 1.5% |
| Staff infected after 4 weeks | 11.8% | 1.7% |
In the response group, the virus had clearly spread before anyone knew. But even in the preventive group, eight of the 13 facilities found at least one infection on testing day — early enough to act.
The toll
Across 28 facilities, 5,671 people were tested — 2,868 residents and 2,803 staff. In all, 985 tested positive (25.8 percent of residents, 8.7 percent of staff). Of them, 164 were hospitalized and 113 died. Nearly all the deaths, 109 of 113, were in the response-group facilities; only one staff member died. Among infected residents, the share hospitalized or dying was similar in both groups — the difference was in how many were infected at all.
Why early testing helped
Knowing about infections early let facilities tighten infection prevention and control, rather than rely on symptom screening, which misses people without symptoms. By the time of the report, the Centers for Medicare & Medicaid Services required long-term care facilities to test residents and staff routinely, with results within 48 hours, at a frequency set by community positivity.
Caveats
The preventive-group facilities may simply have been at lower risk, though outbreaks kept appearing in previously unaffected facilities through August 2020. CDC's infection control guidance came out on May 8, after some response facilities were tested. The facilities were not a random sample (though they included 48.3 percent of the county's licensed facilities), and later infections without symptoms went uncounted.
Sources
Based on "Preventing COVID-19 Outbreaks in Long-Term Care Facilities Through Preemptive Testing of Residents and Staff Members — Fulton County, Georgia, March–May 2020," by Carson T. Telford and colleagues (Fulton County Board of Health, Emory University, Georgia Department of Public Health), Morbidity and Mortality Weekly Report, 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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