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Infectious Diseases

Asymptomatic and Presymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection Rates in a Multistate Sample of Skilled Nursing Facilities

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Internal Medicine

Published Online: October 19, 2020

Research Letter

Article Information and Disclosures

Elizabeth M. White, PhD, APRN¹;

Christopher M. Santostefano, BSN, RN¹;

Richard A. Feifer, MD, MPH²;

Cyrus M. Kosar, MA¹;

Carolyn Blackman, MD²;

Stefan Gravenstein, MD, MPH³;

Vincent Mor, PhD¹

Author Affiliations

¹Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
²Genesis HealthCare, Kennett Square, Pennsylvania
³Division of Geriatrics and Palliative Medicine, Brown University Alpert Medical School, Providence, Rhode Island

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Asymptomatic transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be a major contributing factor in skilled nursing facility (SNF) outbreaks. However, limited knowledge exists regarding the prevalence of asymptomatic and presymptomatic infection in this setting. Although an estimated 40% to 45% of SARS-CoV-2 infections in the general population are asymptomatic at time of testing,¹ a small number of US and international reports have documented higher asymptomatic rates in SNFs.²^- 5 We examined asymptomatic and presymptomatic infection rates in a large multistate sample of US SNFs, and examined variation in case counts by SARS-CoV-2 prevalence in the counties where SNFs are located.

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Article Information

Accepted for Publication: August 24, 2020.

Corresponding Author: Elizabeth M. White, PhD, APRN, Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 S Main St, Box G-S121-6, Providence, RI 02912 (elizabeth_white@brown.edu).

Published Online: October 19, 2020. doi:10.1001/jamainternmed.2020.5664

Author Contributions: Dr White had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: White, Santostefano, Feifer, Gravenstein, Mor.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: White, Kosar, Gravenstein.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: White, Santostefano, Feifer, Kosar.

Obtained funding: Mor.

Administrative, technical, or material support: White, Santostefano, Feifer, Blackman, Gravenstein.

Supervision: Feifer, Gravenstein, Mor.

Conflict of Interest Disclosures: Dr White reported grants from National Institute on Aging during the conduct of the study and personal fees from PACE Organization of Rhode Island outside the submitted work. Mr Kosar reported grants from National Institute on Aging during the conduct of the study. Dr Gravenstein reported grants from the National Institutes of Health during the conduct of the study. Dr Mor reported personal fees from naviHealth outside the submitted work. No other disclosures were reported.

Funding/Support: This research was supported by the National Institute on Aging (3P01AG027296-11S1, PI: Dr Mor).

Role of the Funder/Sponsor: The National Institute on Aging had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Richard Castor, Cliff Boyd, Joe Montgomery, and Denine Hastings of Genesis HealthCare; and Jeffrey Hiris from Brown University for their extensive data management support. They were not compensated.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.