Serial Testing for SARS-CoV-2 and Virus Whole Genome Sequencing Inform Infection Risk at Two Skilled Nursing Facilities with COVID-19 Outbreaks — Minnesota, April–June 2020
Authors: Joanne Taylor, Rosalind J. Carter, Nicholas Lehnertz, Lilit Kazazian, Maureen Sullivan, Xiong Wang, Jacob Garfin, Shane Diekman, Matthew Plumb, Mary Ellen Bennet, Tammy Hale,, Snigdha Vallabhaneni, Sarah Namugenyi, Deborah Carpenter, Darlene Turner-Harper, Marcus Booth, E. John Coursey, Karen Martin, Melissa McMahon, Amanda Beaudoin, Alan Lifson, Stacy Holzbauer, Sujan C. Reddy, John A. Jernigan, Ruth Lynfield, Brittney Bailey, Cory Cole, Kathy Como-Sabetti, Richard Danila, Emilio Dirlikov, Kris Ehresmann, Carrie Euerle, ; Ashley Fell, ; Rhylee Gilb, Bradley Goodwin, Kelly Hatfield, Nikki Hayes, Lisa Jacobson, ; Michelle Larson, ; Gina Liverseed, Leslie Lovett, J.P. Mahoehney, Erica Mumm, Nadia L. Oussayef, Sukarma SS. Tanwar, Sandra Turbes, Jacy Walters
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

Response Group SARS-CoV-2, the virus that causes coronavirus disease 2019 , can spread rapidly in high-risk congregate settings such as skilled nursing facilities (SNFs) (1).In Minnesota, SNF-associated cases accounted for 3,950 (8%) of 48,711 COVID-19 cases reported through July 21, 2020; 35% of SNF-associated cases involved health care personnel (HCP*), including six deaths.Facility-wide, serial testing in SNFs has been used to identify residents with asymptomatic and presymptomatic SARS-CoV-2 infection to inform mitigation efforts, including cohorting of residents with positive test results and exclusion of infected HCP from the workplace (2,3).During April-June 2020, the Minnesota Department of Health (MDH), with CDC assistance, conducted weekly serial testing at two SNFs experiencing COVID-19 outbreaks.Among 259 tested residents, and 341 tested HCP, 64% and 33%, respectively, had positive reverse transcription-polymerase chain reaction (RT-PCR) SARS-CoV-2 test results.Continued SARS-CoV-2 transmission was potentially facilitated by lapses in infection prevention and control (IPC) practices, up to 12-day delays in receiving HCP test results (53%) at one facility, and incomplete HCP participation (71%).Genetic sequencing demonstrated that SARS-CoV-2 viral genomes from HCP and resident specimens were clustered by facility, suggesting facility-based transmission.Residents and HCP working in SNFs are at risk for infection with SARS-CoV-2.As part of comprehensive COVID-19 preparation and response, including early identification of cases, SNFs should conduct serial testing of residents and HCP, maximize HCP testing participation, ensure availability of personal protective equipment (PPE), and enhance IPC practices † (4-5).* HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff members not employed by the health care facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the health care setting (e.g., clerical, dietary, environmental services, laundry,