The first case of COVID-19 in Connecticut was reported in a nursing home on March 15; from there the number of infections skyrocketed.
A point prevalence survey (which involves testing groups of individuals at a single time) led by the Yale School of Public Health found that 601 people (28.3% of the 2,117 people tested in 33 nursing homes) were infected with the virus.
The survey is the most comprehensive one yet in the state’s nursing homes, and the largest report in the United States. The study provides an important baseline, said Sunil Parikh, associate professor and the study’s lead author. The findings corroborate what has largely been known by public health experts and frontline workers: Nursing homes are particularly susceptible to the pandemic because of their elderly population, close living quarters and the fact that many residents already have other medical conditions that make them more vulnerable to COVID-19.
“Nursing homes have been the epicenter of the disease in Connecticut, and much of the U.S and Europe,” said Parikh. “Point prevalence surveys are a necessary tool to get a handle of the state of an outbreak in nursing homes. Without widespread testing of all residents, it would have been impossible to effectively institute proper infection control measures, such as isolating infected, uninfected and exposed residents from one another.”
Residents of nursing homes account for over 60% of the COVID-19 deaths in the state so far, the authors said.
Parikh and colleagues from the Yale School of Public Health, Connecticut Department of Public Health and the Centers for Disease Control and Prevention found that of the 601 positive cases identified, approximately 90% of the patients were asymptomatic at the time of testing, meaning that they had no apparent symptoms of the disease, and only a small proportion of them went on to develop symptoms over the next few weeks.
There are 215 nursing homes in the state. Parikh said that nursing homes that were targeted early on had evidence of ongoing outbreaks, but testing in remaining facilities was completed by mid-June. Notably, when data from approximately 200 facilities were aggregated, the percent of residents who were asymptomatic remained at 90%, lending further support to the researchers’ initial findings, he said.
“This study also shows how quickly the virus can take hold in congregate settings, as the majority of nursing homes had over half of their residents test positive within a month of identifying their first case, despite standard infection prevention measures at the time. Clearly, PPE and testing shortages, coupled with a symptom-based testing strategy, made it difficult to get a handle on these outbreaks early on.”
Some of the survey’s other key findings include:
- Nineteen nursing homes had infections rates of at least 50%.
- Of the 530 asymptomatic nursing home residents identified in the study, 11.7% developed symptoms within 14 days.
- Only three of the nursing homes tested had no positive cases.
“What we need to figure out now is the optimal frequency for repeat surveys of both residents and staff moving forward. Cases in nursing homes have now dramatically dropped, and we also need to rigorously assess the impact of point prevalence surveys on curtailing the outbreaks in these congregate settings,” said Parikh