Symptom-Based COVID-19 Screening Inadequate in Assisted and Independent Living Facility

COVID-19 outbreaks with significant morbidity and mortality have been well described in nursing home settings (NEJM JW Infect Dis Jun 2020 and N Engl J Med 2020; 382:2005). Less is known about the epidemiology and optimal infection control measures in independent and assisted living facilities. Now, a report describes a COVID-19 outbreak in an assisted and independent living facility for which public health authorities were asked to provide help after two infected residents were hospitalized. The facility consisted of private apartments with communal recreational and dining areas. The mean resident age was 85.8. Social distancing and hygiene measures were implemented 72 hours before the investigation, which included a symptom survey and testing of staff and residents; all residents were retested 1 week later.

Although 33 of 80 residents (41%) reported at least one symptom (current or recent) consistent with COVID-19, only 3 residents (4%) initially tested positive. All were asymptomatic at testing; one reported resolved cough and one loose bowel movement within the previous 14 days. Two symptomatic staff members tested positive as well. One of the three positive residents later developed mild cough but did not require hospitalization. At the 1-week repeat test, one additional asymptomatic resident was detected. At day 21, all infected residents were doing well.