Prolonged persistence of PCR-detectable virus during an outbreak of SARS-CoV-2 in an inpatient geriatric psychiatry unit in King County, Washington

Corcorran, Maria A.; Olin, Svaya; Rani, Golo; Nasenbeny, Keri; Constantino-Shor, Cheri; Holmes, Charity; Quinnan-Hostein, Laura; Solan, W. J.; Newman, Gretchen Snoeyenbos; Roxby, Alison C.; Greninger, Alexander L.; Jerome, Keith R.; Neme, Santiago; Lynch, John B.; Dellit, Timothy H.; Cohen, Seth A.

doi:10.1016/j.ajic.2020.08.025

Cited by 15 publications

(17 citation statements)

References 19 publications

(57 reference statements)

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“…Testing for SARS-CoV-2 has predominantly been performed on molecular platforms with exquisite analytical sensitivities that can detect fewer than 100 viral RNA copies per ml of viral transport medium (VTM) ( 1 ). These analytical sensitivities result in the detection of low-level shedding in patients for weeks to months after initial infection, often with very low viral loads ( 2 – 5 ). A double-edged sword of the sensitivity offered by real-time reverse transcription-quantitative PCR (qRT-PCR) is the possibility that the molecular methodology detects RNA copies of virus that may not necessarily correlate with an active infection, especially if the result is a low viral load ( 6 – 8 ).…”

Section: Introductionmentioning

confidence: 99%

Analytical Sensitivity of the Abbott BinaxNOW COVID-19 Ag Card

et al. 2021

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Multiple rapid antigen (Ag) tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recently received emergency-use authorization (EUA) from the U.S. Food and Drug Administration (FDA). Although less sensitive than molecular detection methods, rapid antigen testing offers the potential for inexpensive, quick, decentralized testing. Robust analytical sensitivity data in comparison to reverse transcription-quantitative PCR (qRT-PCR) are currently lacking for many rapid antigen tests. Here, we evaluated the analytical sensitivity of the Abbott BinaxNOW COVID-19 Ag card using SARS-CoV-2-positive clinical specimens quantified by reverse transcription-droplet digital PCR (RT-ddPCR) and multiple FDA EUA qRT-PCR platforms using RNA standards. Initial and confirmatory limits of detection for the BinaxNOW COVID-19 Ag card were determined to be equivalent to 4.04 × 104 to 8.06 × 104 copies/swab. We further confirmed this limit of detection with 72 additional clinical samples positive for SARS-CoV-2 in either phosphate-buffered saline or viral transport medium. One hundred percent of samples with viral loads of >40,000 copies/swab were detected by rapid antigen testing. These data indicate that the BinaxNOW COVID-19 Ag card has an analytical sensitivity approximately equivalent to a generic qRT-PCR cycle threshold (CT) value of 29 to 30.

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Section: Introductionmentioning

confidence: 99%

Analytical Sensitivity of the Abbott BinaxNOW COVID-19 Ag Card

et al. 2021

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“…They followed the provided checklist but focused on the larger picture of reducing cross-contamination (CDC, 2020). Developing a culture of best practice also required peer accountability and engagement of staff in preventing the further spread of SARS-CoV-2 (Corcorran et al, 2020).…”

Section: Resultsmentioning

confidence: 99%

“…The information presented in this article is based on a retroactive review of staff engagement and enhanced infection control practices that led to the containment of an outbreak of SARS-CoV-2 that occurred from March 11 to May 5, 2020, in an inpatient geriatric psychiatric unit with separate, but adjacent, locked East and West wings in King County, Washington. More detailed methods regarding the outbreak identification, repeat testing, and detection of viral shedding in SARS-CoV-2 have been previously described (Corcorran et al, 2020).…”

Section: Methodsmentioning

confidence: 99%

“…SARS-CoV-2 infection can present in a varied manner: symptoms can be mild, such as those associated with the common cold or influenza, to severe, resulting in pneumonia, respiratory distress, renal failure, and even death (Hamm, 2020). A smaller percentage of people have been shown to test positive while remaining asymptomatic (Corcorran et al, 2020). Elderly people older than 60 years with medical comorbidities have a higher incidence of mortality associated with SARS-CoV-2 infection (Bhatraju et al, 2020; Etard et al, 2020).…”

Section: Objectivementioning

confidence: 99%

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Containment of a COVID-19 Outbreak in an Inpatient Geriatric Psychiatry Unit

Constantino-Shor

Rani

Olin

et al. 2020

J Am Psychiatr Nurses Assoc

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Objectives: The first known COVID-19 outbreak in a long-term care facility in the United States was identified on February 28, 2020, in King County, Washington. That facility became the initial U.S. epicenter of the COVID-19 pandemic when they discovered 129 cases associated with the outbreak (81 residents, 34 staff members, and 14 visitors) and 23 persons died. The vulnerability of the elderly population, shared living and social spaces, suboptimal infection control practices, and prolonged contact between residents were identified as contributing factors to the rapid spread of the disease. The first known case of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a U.S. inpatient geriatric psychiatry unit was also in King County, Washington, and occurred soon afterward on March 11th, 2020. Between March 11 and March 18, nine inpatients and seven staff members were confirmed to have SARS-CoV-2 infection. This article examines how the swift identification and isolation of confirmed patients, an enhanced infection prevention protocol, and engagement of frontline psychiatric care staff prevented a catastrophic outcome in a vulnerable population. Methods: Here we describe infection control and nursing-led interventions that were quickly enacted in response to this SARS-CoV-2 outbreak in an inpatient geriatric psychiatry unit. Results: The interventions effectively contained the outbreak, with no further patients and only one staff member testing positive for SARS-CoV-2 over the subsequent 2-month time period. Conclusions: We share our learnings and preventative infection control measures that can be adapted to a variety of settings to prevent or contain future outbreaks of COVID-19.

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“…While symptomatic carriers have much higher transmissibility probabilities compared with asymptomatic carriers, recent studies found little to no difference in viral load between pre-symptomatic, asymptomatic, and symptomatic patients. 19-23 However, asymptomatic carriers could have faster clearance. 17,24 For example, Yang et al 18 reported a median duration of viral shedding of 8 days (interquartile range [IQR]: 2–12) for asymptomatic and 19 days (IQR: 16–24) for symptomatic carriers.…”

Section: Methodsmentioning

confidence: 99%

Optimal test-assisted quarantine strategies for COVID-19

Peng

Zhou

Pettit

et al. 2020

Preprint

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BackgroundUntil herd immunity occurs for COVID-19, quarantine will remain a pillar for disease mitigation. A 14-day quarantine, although widely recommended for self-quarantine after potential infections and mandated by many government agencies can be physically and mentally stressful for those under quarantine and leads to lost productivity. Testing during quarantine is currently implemented by businesses and governments as a promising method to shorten the duration of quarantine. However, to our knowledge, no study has been performed to evaluate the performance of test-assisted quarantines or to identify the most effective choices of testing schedule.MethodsBased on statistical models for the transmissibility and viral loads of SARS-CoV-2 infections and the sensitivities of available SARS-CoV-2 testing methods, we performed extensive simulations to evaluate the performance of quarantine strategies with one or more tests administered during quarantine. Sensitivity analyses were performed to evaluate the impact of perturbations in model assumptions on the determination of optimal strategies.FindingsWe found that SARS-CoV-2 testing can effectively reduce the length of quarantine without compromising personal or public safety. Whereas a single RT-PCR test performed before the end of quarantine can reduce the duration of quarantine to 10 days, two tests can further reduce the duration to 8-days and three tests with a highly sensitive RT-PCR test can justify a 6-day quarantine. More strategic testing schedules and one more day of quarantine are needed if tests are administrated with a less sensitive but more cost-effective antigen test.InterpretationTesting during quarantine could substantially reduce the length of isolation, reducing the physical and mental stress caused by long quarantines. With increasing capacity and lowered costs of SARS-CoV-2 tests, testing-assisted quarantines could be safer and more cost-effective than 14-day quarantines and warrant more widespread use.

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Prolonged persistence of PCR-detectable virus during an outbreak of SARS-CoV-2 in an inpatient geriatric psychiatry unit in King County, Washington

Cited by 15 publications

References 19 publications

Analytical Sensitivity of the Abbott BinaxNOW COVID-19 Ag Card

Analytical Sensitivity of the Abbott BinaxNOW COVID-19 Ag Card

Containment of a COVID-19 Outbreak in an Inpatient Geriatric Psychiatry Unit

Optimal test-assisted quarantine strategies for COVID-19

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