534 - Halting a SARS-COV2 Outbreak in a Veterans Affairs Nursing Home.

Background: Health care systems have been significantly overwhelmed during the SARS-CoV-2 (SC2) pandemic. Cases in the USA have exceeded 1.9 million with over 40% of deaths occurring in nursing homes and assisting living facilities.  We describe our experience in controlling an outbreak in our community living centers (CLC)

Methods: We retrospectively reviewed the charts of Veterans with positive nasopharyngeal (NP) RT-PCR for SC2 from March 24 to April 18, 2020 in 2 neighboring CLC units (80 bed capacity), at Northport Affairs Medical Center.

Results: Twenty five Veterans (24 men) tested positive for SC2. Of these, 5 remained asymptomatic, 9 got hospitalized, 6 died. No coinfection with influenza or other respiratory viruses identified. 11 health care workers (HCW) tested positive. Figure 1 shows test results by date.  Table 1 summarizes the demographic characteristics, medical history, and laboratory findings. The median age was 74 years, with no difference in age between recovered and deceased, 73 vs. 77, P:0.105. Simplified acute physiology score (SAPS) II score was higher in the deceased group (P=0.001) and so were D-dimer (admission and peak levels), CRP, LDH, and peak ferritin/procalcitonin levels. There was no ICU admission. Figure 2 illustrates the CLC 1 and 2 outline of beds depicting positive cases in sequence of detection. Initial spread of the virus was fast, affecting residents and HCW. CLC visits were prohibited, floating of staff minimized, internal group activities halted, infection control measures and education on proper use of personal protective equipment provided. A SC2 (or “COVID”) unit was created in CLC1 and all patients and staff got tested. Withdrawal of isolation precautions required resolution of symptoms, and two sequential negative NP PCR tests which were obtained after 14 days from diagnosis. If the PCR was positive, a repeat test was obtained in 72 hours.  13 patients had persistent positive PCR for average 32 days (19 to 52) since diagnosis. 7/13 got tested and all were positive for SC2 IgG antibody.SARS-CoV -2 Outbreak in VA Nursing Home, Dates of Tests
Bed Outline of CLCs Depicting the Location And Numerical Sequence of Positive Tests
Comparison Between Recovered vs Deceased Nursing Home Veterans with COVID-19


Conclusion: Controlling SARS-CoV-2 outbreaks in nursing homes is a unique challenge as the virus can spread quickly among residents and staff. Mortality rate in our cohort was 24%. Prompt, effective isolation and broad testing was instrumental in halting the SC2 (COVID-19) outbreak.