Symptom-based screening doesn’t effectively control COVID-19 in skilled nursing facilities. Instead, repeated point prevalence surveys (serial testing) and robust infection prevention support can lower case counts, say federal investigators.

After a March uptick in Detroit COVID-19 cases, health officials expanded SARS-CoV-2 testing and began infection prevention and control activities in all skilled care facilities. Twenty-six received serial testing of all residents and healthcare staff — irrespective of symptoms. This, along with on-site assessments and consultation, identified a 44% asymptomatic case rate. Within 21 days of diagnosis, 37 infected patients had been hospitalized and died. 

Investigators then returned to 12 of the hardest-hit facilities to conduct a second survey. These operators received more rounds of testing along with increased infection prevention and control support. This included analyses of cohorting practices, supply and use of personal protective equipment, hand hygiene practices, and staffing mitigation planning. New cases subsequently fell from 35% to 18%.

Assessment and consultation were “critical” to mitigating suspected causes of ongoing transmission, the researchers wrote. A serial testing strategy along with robust infection prevention support should be standard tools for COVID-19 control, they concluded.

Full findings are available on the Centers for Disease Control and Prevention website.