Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

doi:10.1056/NEJMoa2005412

Case Reports

. 2020 May 21;382(21):2005-2011.

doi: 10.1056/NEJMoa2005412. Epub 2020 Mar 27.

Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

Temet M McMichael¹, Dustin W Currie¹, Shauna Clark¹, Sargis Pogosjans¹, Meagan Kay¹, Noah G Schwartz¹, James Lewis¹, Atar Baer¹, Vance Kawakami¹, Margaret D Lukoff¹, Jessica Ferro¹, Claire Brostrom-Smith¹, Thomas D Rea¹, Michael R Sayre¹, Francis X Riedo¹, Denny Russell¹, Brian Hiatt¹, Patricia Montgomery¹, Agam K Rao¹, Eric J Chow¹, Farrell Tobolowsky¹, Michael J Hughes¹, Ana C Bardossy¹, Lisa P Oakley¹, Jesica R Jacobs¹, Nimalie D Stone¹, Sujan C Reddy¹, John A Jernigan¹, Margaret A Honein¹, Thomas A Clark¹, Jeffrey S Duchin¹; Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team

Collaborators, Affiliations

Collaborators

Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team:
Meaghan S Fagalde, Jennifer L Lenahan, Emily B Maier, Julia E Hood, Kaitlyn J Sykes, Grace Hatt, Holly J Whitney, Melinda Huntington-Frazier, Elysia Gonzales, Laura A Mummert, Hal Garcia Smith, Steve Stearns, Eileen Benoliel, Shelly McKeirnan, Jennifer L Morgan, Daniel Smith, Michaela Hope, Noel Hatley, Joanie D Lambert, Alexandra R Topper, Sunghoi Mccarroll, Leslie M Barnard, Leilani Schwarcz, Jamie M Emert, Christopher Drucker, Sally Guan, Kosuke Kume, Karen Rodriquez, Tracie Jacinto, Nicole Yarid, Betty Y Yang, Catherine R Counts, David L Murphy, Eric Yim, Sandra Kreider, Dawn Barr, Nancy Wilde, Courtney Dorman, Airin Lam, Jeanette Harris, Hollianne Bruce, Christopher Spitters, Rachael Zacks, Jonathan Dyal, Christina M Carlson, Barbara Cooper, Michelle Banks, Heather P McLaughlin, S Arunmozhi Balajee, Christine Olson, Suzanne Zane, Hammad Ali, Jessica Healy, Kristine Schmit, Kevin Spicer, Zeshan Chisty, Sukarma Tanwar, Joanne Taylor, Leisha D Nolen, Jeneita Bell, Kelly Hatfield, Melissa Arons, Anne Kimball, Allison James, Mark Methner, Joshua M Harney

Affiliation

¹ From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.

PMID: 32220208
PMCID: PMC7121761
DOI: 10.1056/NEJMoa2005412

Case Reports

Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

Temet M McMichael et al. N Engl J Med. 2020.

. 2020 May 21;382(21):2005-2011.

doi: 10.1056/NEJMoa2005412. Epub 2020 Mar 27.

Authors

Collaborators

Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team:
Meaghan S Fagalde, Jennifer L Lenahan, Emily B Maier, Julia E Hood, Kaitlyn J Sykes, Grace Hatt, Holly J Whitney, Melinda Huntington-Frazier, Elysia Gonzales, Laura A Mummert, Hal Garcia Smith, Steve Stearns, Eileen Benoliel, Shelly McKeirnan, Jennifer L Morgan, Daniel Smith, Michaela Hope, Noel Hatley, Joanie D Lambert, Alexandra R Topper, Sunghoi Mccarroll, Leslie M Barnard, Leilani Schwarcz, Jamie M Emert, Christopher Drucker, Sally Guan, Kosuke Kume, Karen Rodriquez, Tracie Jacinto, Nicole Yarid, Betty Y Yang, Catherine R Counts, David L Murphy, Eric Yim, Sandra Kreider, Dawn Barr, Nancy Wilde, Courtney Dorman, Airin Lam, Jeanette Harris, Hollianne Bruce, Christopher Spitters, Rachael Zacks, Jonathan Dyal, Christina M Carlson, Barbara Cooper, Michelle Banks, Heather P McLaughlin, S Arunmozhi Balajee, Christine Olson, Suzanne Zane, Hammad Ali, Jessica Healy, Kristine Schmit, Kevin Spicer, Zeshan Chisty, Sukarma Tanwar, Joanne Taylor, Leisha D Nolen, Jeneita Bell, Kelly Hatfield, Melissa Arons, Anne Kimball, Allison James, Mark Methner, Joshua M Harney

Affiliation

¹ From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.

PMID: 32220208
PMCID: PMC7121761
DOI: 10.1056/NEJMoa2005412

Abstract

Background: Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region.

Methods: After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health-Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.

Results: As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County.

Conclusions: In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.

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Figures

**Figure 1. Confirmed Cases of Covid-19 Linked to Facility A.**
Shown are cases of Covid-19 in Washington that had been epidemiologically linked to Facility A as of March 18, 2020.

**Figure 2. Timeline Showing Long-Term Care Facilities in King County with One or More Confirmed Cases of COVID-19.**
The first nine long-term care facilities (e.g., nursing homes or assisted living facilities) in King County with one or more confirmed cases of Covid-19 are shown according to the date of the first confirmed case. Facilities are those identified as of March 9, 2020. The direction of potential introduction of Covid-19 from one facility to another is unknown.

See this image and copyright information in PMC

Comment in

Critical Infection Control Adaptations to Survive COVID-19 in Retirement Communities.
Munanga A. Munanga A. J Gerontol Nurs. 2020 Jun 1;46(6):3-5. doi: 10.3928/00989134-20200511-03. J Gerontol Nurs. 2020. PMID: 32453432 No abstract available.
Uncovering the Devaluation of Nursing Home Staff During COVID-19: Are We Fuelling the Next Health Care Crisis?
McGilton KS, Escrig-Pinol A, Gordon A, Chu CH, Zúñiga F, Sanchez MG, Boscart V, Meyer J, Corazzini KN, Jacinto AF, Spilsbury K, Backman A, Scales K, Fagertun A, Wu B, Edvardsson D, Lepore MJ, Leung AYM, Siegel EO, Noguchi-Watanabe M, Wang J, Bowers B. McGilton KS, et al. J Am Med Dir Assoc. 2020 Jul;21(7):962-965. doi: 10.1016/j.jamda.2020.06.010. Epub 2020 Jun 11. J Am Med Dir Assoc. 2020. PMID: 32674829 Free PMC article. No abstract available.

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[1] World Health Organization. Pneumonia of unknown cause — China. January 5, 2020. (https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-ch...).

[2] World Health Organization. Pneumonia of unknown cause — China. January 5, 2020. (https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-ch...).

[3] World Health Organization. Novel Coronavirus — China. January 12, 2020. (https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/).

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[5] Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-733. - PMC - PubMed

[6] Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-733. - PMC - PubMed

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[8] Centers for Disease Control and Prevention. Symptoms of coronavirus disease 2019 (COVID-19). 2020. (https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html).

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[10] World Health Organization. Coronavirus disease 2019 (COVID-19): situation report — 63. March 23, 2020. (https://www.who.int/docs/default-source/coronaviruse/situation-reports/2...).

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Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

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Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

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