• Ellora N Karmarkar, Irin Blanco, Pauli N Amornkul, Amie DuBois, Xianding Deng, Patrick K Moonan, Beth L Rubenstein, David A Miller, Idamae Kennedy, Jennifer Yu, Justin P Dauterman, Melissa Ongpin, Wilmie Hathaway, Lisa Hoo, Stephanie Trammell, Ejovwoke F Dosunmu, Guixia Yu, Zenith Khwaja, Wendy Lu, Nawzaneen Z Talai, Seema Jain, Janice K Louie, Susan S Philip, Scot Federman, Godfred Masinde, Debra A Wadford, Naveena Bobba, Juliet Stoltey, Adrian Smith, Erin Epson, Charles Y Chiu, Ayanna S Bennett, Amber M Vasquez, and Troy Williams.
• Epidemic Intelligence Service Program, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia.
• Infect Control Hosp Epidemiol. 2021 Oct 1; 42 (10): 1173-1180.

ObjectiveTo describe epidemiologic and genomic characteristics of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large skilled-nursing facility (SNF), and the strategies that controlled transmission.Design, Setting, And ParticipantsThis cohort study was conducted during March 22-May 4, 2020, among all staff and residents at a 780-bed SNF in San Francisco, California.MethodsContact tracing and symptom screening guided targeted testing of staff and residents; respiratory specimens were also collected through serial point prevalence surveys (PPSs) in units with confirmed cases. Cases were confirmed by real-time reverse transcription-polymerase chain reaction testing for SARS-CoV-2, and whole-genome sequencing (WGS) was used to characterize viral isolate lineages and relatedness. Infection prevention and control (IPC) interventions included restricting from work any staff who had close contact with a confirmed case; restricting movement between units; implementing surgical face masking facility-wide; and the use of recommended PPE (ie, isolation gown, gloves, N95 respirator and eye protection) for clinical interactions in units with confirmed cases.ResultsOf 725 staff and residents tested through targeted testing and serial PPSs, 21 (3%) were SARS-CoV-2 positive: 16 (76%) staff and 5 (24%) residents. Fifteen cases (71%) were linked to a single unit. Targeted testing identified 17 cases (81%), and PPSs identified 4 cases (19%). Most cases (71%) were identified before IPC interventions could be implemented. WGS was performed on SARS-CoV-2 isolates from 4 staff and 4 residents: 5 were of Santa Clara County lineage and the 3 others were distinct lineages.ConclusionsEarly implementation of targeted testing, serial PPSs, and multimodal IPC interventions limited SARS-CoV-2 transmission within the SNF.

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