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Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington.
N Engl J Med. 2020 05 21; 382(21):2005-2011.NEJM

Abstract

BACKGROUND

Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region.

METHODS

After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health-Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.

RESULTS

As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County.

CONCLUSIONS

In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.

Authors+Show Affiliations

From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32220208

Citation

McMichael, Temet M., et al. "Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington." The New England Journal of Medicine, vol. 382, no. 21, 2020, pp. 2005-2011.
McMichael TM, Currie DW, Clark S, et al. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. N Engl J Med. 2020;382(21):2005-2011.
McMichael, T. M., Currie, D. W., Clark, S., Pogosjans, S., Kay, M., Schwartz, N. G., Lewis, J., Baer, A., Kawakami, V., Lukoff, M. D., Ferro, J., Brostrom-Smith, C., Rea, T. D., Sayre, M. R., Riedo, F. X., Russell, D., Hiatt, B., Montgomery, P., Rao, A. K., ... Duchin, J. S. (2020). Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. The New England Journal of Medicine, 382(21), 2005-2011. https://doi.org/10.1056/NEJMoa2005412
McMichael TM, et al. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. N Engl J Med. 2020 05 21;382(21):2005-2011. PubMed PMID: 32220208.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. AU - McMichael,Temet M, AU - Currie,Dustin W, AU - Clark,Shauna, AU - Pogosjans,Sargis, AU - Kay,Meagan, AU - Schwartz,Noah G, AU - Lewis,James, AU - Baer,Atar, AU - Kawakami,Vance, AU - Lukoff,Margaret D, AU - Ferro,Jessica, AU - Brostrom-Smith,Claire, AU - Rea,Thomas D, AU - Sayre,Michael R, AU - Riedo,Francis X, AU - Russell,Denny, AU - Hiatt,Brian, AU - Montgomery,Patricia, AU - Rao,Agam K, AU - Chow,Eric J, AU - Tobolowsky,Farrell, AU - Hughes,Michael J, AU - Bardossy,Ana C, AU - Oakley,Lisa P, AU - Jacobs,Jesica R, AU - Stone,Nimalie D, AU - Reddy,Sujan C, AU - Jernigan,John A, AU - Honein,Margaret A, AU - Clark,Thomas A, AU - Duchin,Jeffrey S, AU - ,, Y1 - 2020/03/27/ PY - 2020/3/29/pubmed PY - 2020/3/29/medline PY - 2020/3/29/entrez SP - 2005 EP - 2011 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 382 IS - 21 N2 - BACKGROUND: Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region. METHODS: After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health-Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control. RESULTS: As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County. CONCLUSIONS: In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/32220208/full_citation L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa2005412?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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