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On August 11, 2020, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly in nursing homes once it is introduced (1,2). To prevent outbreaks, more data are needed to identify sources of introduction and means of transmission within nursing homes. Nursing home residents who receive hemodialysis (dialysis) might be at higher risk for SARS-CoV-2 infections because of their frequent exposures outside the nursing home to both community dialysis patients and staff members at dialysis centers (3). Investigation of a COVID-19 outbreak in a Maryland nursing home (facility A) identified a higher prevalence of infection among residents undergoing dialysis (47%; 15 of 32) than among those not receiving dialysis (16%; 22 of 138) (p<0.001). Among residents with COVID-19, the 30-day hospitalization rate among those receiving dialysis (53%) was higher than that among residents not receiving dialysis (18%) (p = 0.03); the proportion of dialysis patients who died was 40% compared with those who did not receive dialysis (27%) (p = 0.42). Careful consideration of infection control practices throughout the dialysis process (e.g., transportation, time spent in waiting areas, spacing of machines, and cohorting), clear communication between nursing homes and dialysis centers, and coordination of testing practices between these sites are critical to preventing COVID-19 outbreaks in this medically vulnerable population. In April 2020, a COVID-19 outbreak occurred at a Maryland nursing home (facility A), a 200-bed skilled nursing facility specializing in postacute and long-term care, with an independently operated dialysis center co-located on site. In Maryland, during the month of April, approximately 25% of all SARS-CoV-2 tests had positive results when considering the rolling 7-day average, and approximately half of nursing homes in the state had active outbreaks. † The Maryland Department of Health conducted SARS-CoV-2 testing for symptomatic nursing home residents with a 3-5-day turnaround time for results. Because of the evolving outbreak and limited testing capacity at the health department, a Johns Hopkins response team provided SARS-CoV-2 testing with a 24-hour turnaround * These authors contributed equally to this work. † https://coronavirus.maryland.gov/.

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