Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility
Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility
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DOI：
10.1093/cid/ciaa763
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发表时间：
2020-12-01
影响因子：
11.8
通讯作者：
Ezike, Ngozi O.
中科院分区：
文献类型：
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作者：
Patel, Mahesh C.;Chaisson, Lelia H.;Ezike, Ngozi O.
背景据报道，养老院和辅助生活设施中爆发了2019年冠状病毒病（COVID-19）;然而，这一高危人群中无症状和症状前严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的程度仍不清楚。我们于2020年3月15日在伊利诺伊州的一家专业护理机构（SNF）对首次已知的SARS-CoV-2疫情进行了调查，并对居民进行了30天的随访。我们通过逆转录聚合酶链反应检测了126/127名居民的SARS-CoV-2，并进行了症状评估。我们计算了SARS-CoV-2的点患病率，并在30天的随访中评估了症状发作，以确定：（1）有症状、症状前和无症状病例的比例，以及（2）检测阴性者中的症状发生率。我们使用Kaplan-Meier方法来确定病例的30天死亡概率。在接受检测的126名居民中，有33人在3月15日确认了SARS-CoV-2。19例（58%）在检测时出现症状，1例（3%）在随访期间出现症状，13例（39%）无症状。3月15日检测呈阴性的35名居民在随访期间出现症状;其中3人重新检测，2人呈阳性。病例中30天死亡概率为29%。SNF特别容易受到SARS-CoV-2的影响，居民面临严重后果的风险。必须注意防止在这些和其他集体护理环境中爆发。广泛的检测和感染控制是帮助预防这些高风险人群中COVID-19发病率和死亡率的关键。
Background. Outbreaks of coronavirus disease 2019 (COVID-19) have been reported in nursing homes and assisted living facilities; however, the extent of asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this high-risk population remains unclear.Methods. We conducted an investigation of the first known outbreak of SARS-CoV-2 at a skilled nursing facility (SNF) in Illinois on 15 March 2020 and followed residents for 30 days. We tested 126/127 residents for SARS-CoV-2 via reverse-transcription polymerase chain reaction and performed symptom assessments. We calculated the point prevalence of SARS-CoV-2 and assessed symptom onset over 30-day follow-up to determine: (1) the proportion of cases who were symptomatic, presymptomatic, and asymptomatic and (2) incidence of symptoms among those who tested negative. We used the Kaplan-Meier method to determine the 30-day probability of death for cases.Results. Of 126 residents tested, 33 had confirmed SARS-CoV-2 on 15 March. Nineteen (58%) had symptoms at the time of testing, 1 (3%) developed symptoms over follow-up, and 13 (39%) remained asymptomatic. Thirty-five residents who tested negative on 15 March developed symptoms over follow-up; of these, 3 were re-tested and 2 were positive. The 30-day probability of death among cases was 29%.Conclusions. SNFs are particularly vulnerable to SARS-CoV-2, and residents are at risk of severe outcomes. Attention must be paid to preventing outbreaks in these and other congregate care settings. Widespread testing and infection control are key to help prevent COVID-19 morbidity and mortality in these high-risk populations.