Asymptomatic cases and limited transmission of SARS-CoV-2 in residents and healthcare workers in three Dutch nursing homes
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Abstract
Purpose
Many nursing homes worldwide have been hit by outbreaks of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to assess the contribution of a- and presymptomatic residents and healthcare workers in transmission of SARS-CoV-2 in three nursing homes.
Methods
Two serial point-prevalence surveys, 1 week apart, among residents and healthcare workers of three Dutch nursing homes with recent SARS-CoV-2 introduction. Nasopharyngeal and oropharyngeal testing for SARS-CoV-2, including reverse-transcriptase polymerase chain reaction (rRT-PCR) was presymptomatic or asymptomatic with standardized symptom assessment.
Results
In total, 297 residents and 542 healthcare workers participated in the study. At the first point-prevalence survey, 15 residents tested positive of which one was presymptomatic (Ct value>35) and three remained asymptomatic (Ct value of 23, 30 and 32). At the second point-prevalence survey one resident and one healthcare worker tested SARS-CoV-2 positive (Ct value >35 and 24, respectively) and both remained asymptomatic.
Conclusion
This study confirms a-and presymptomatic occurrence of Covid-19 among residents and health care workers. Ct values below 25 suggested that these cases have the potential to contribute to viral spread. However, very limited transmission impeded the ability to answer the research question. We describe factors that may contribute to the prevention of transmission and argue that the necessity of large-scale preemptive testing in nursing homes may be dependent of the local situation regarding prevalence of cases in the surrounding community and infection control opportunities.
KEY SUMMARY POINTS
Aim
To assess the contribution of a- and presymptomatic residents and healthcare workers in transmission of SARS-CoV-2 in three nursing homes by facility wide preemptive testing.
Findings
Occurrence of a-and presymptomatic residents and healthcare workers with Ct values below 25 was confirmed. However, evaluation of contribution to transmission of the virus was not possible because of limited positive cases in the follow-up.
Message
Necessity of large-scale preemptive testing for a- and presymptomatic SARS-CoV-2 cases in nursing homes may be dependent on prevalence of cases in the surrounding community and infection control opportunities.
Article activity feed
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SciScore for 10.1101/2020.08.31.20185033: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Health care workers were asked informed consent for using their data prior to questionnaire administration.
IRB: The Medical Ethics Committee of the VU University Medical Centre in of the Medical Research Involving Human Subjects Act.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed …SciScore for 10.1101/2020.08.31.20185033: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Health care workers were asked informed consent for using their data prior to questionnaire administration.
IRB: The Medical Ethics Committee of the VU University Medical Centre in of the Medical Research Involving Human Subjects Act.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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