#15,113
King County, Washington was one of the earliest, and hardest hit, U.S. community in the United States with COVID-19, and as of last night's update, had recorded 562 confirmed cases and 56 deaths.
This unusually high apparent CFR is due to the fact that of the 56 deaths reported, 35 are confirmed to be associated with Life Care Center of Kirkland, a long term care facility (LTCF) caring for mostly elderly, and often frail patients.On Tuesday, the CDC held a COVID-19 COCA Call (Update and Information for Long-term Care Facilities) in hopes reducing similar tragedies in other facilities around the country. The hour-long presentation is now archived and available for viewing online.
Late yesterday the CDC's MMWR published two early releases (see MMWR: Severe Outcomes Among Patients with COVID-19 - United States) and the following one on the Life Care facility (Facility `A') in Washington State.
The cut-off date for this report was March 9th, and since that time the facility has reported 12 additional deaths. Sadly, this event isn't over yet, and this is not the only LTCF affected by COVID-19 in King County or across the nation.I've only included some excerpts from a much longer report, so follow the link below to read it in its entirety.
COVID-19 in a Long-Term Care Facility — King County, Washington, February 27–March 9, 2020
Early Release / March 18, 2020 / 69
Temet M. McMichael, PhD1,2,3; Shauna Clark1; Sargis Pogosjans, MPH1; Meagan Kay, DVM1; James Lewis, MD1; Atar Baer, PhD1; Vance Kawakami, DVM1; Margaret D. Lukoff, MD1; Jessica Ferro, MPH1; Claire Brostrom-Smith, MSN1; Francis X. Riedo, MD4; Denny Russell5; Brian Hiatt5; Patricia Montgomery, MPH6; Agam K. Rao, MD3; Dustin W. Currie, PhD2,3; Eric J. Chow, MD2,3; Farrell Tobolowsky, DO2,3; Ana C. Bardossy, MD2,3; Lisa P. Oakley, PhD2,3; Jesica R. Jacobs, PhD3,7; Noah G. Schwartz, MD2,3; Nimalie Stone, MD3; Sujan C. Reddy, MD3; John A. Jernigan, MD3; Margaret A. Honein, PhD3; Thomas A. Clark, MD3; Jeffrey S. Duchin, MD1; Public Health – Seattle & King County, EvergreenHealth, and CDC COVID-19 Investigation Team (View author affiliations)View suggested citation
Summary
What is already known about this topic?
Coronavirus disease (COVID-19) can cause severe illness and death, particularly among older adults with chronic health conditions.
What is added by this report?
Introduction of COVID-19 into a long-term residential care facility in Washington resulted in cases among 81 residents, 34 staff members, and 14 visitors; 23 persons died. Limitations in effective infection control and prevention and staff members working in multiple facilities contributed to intra- and interfacility spread.
What are the implications for public health practice?
Long-term care facilities should take proactive steps to protect the health of residents and preserve the health care workforce by identifying and excluding potentially infected staff members, restricting visitation except in compassionate care situations, ensuring early recognition of potentially infected patients, and implementing appropriate infection control measures.
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Discussion
These findings demonstrate that outbreaks of COVID-19 in long-term care facilities can have a critical impact on vulnerable older adults. In Washington, local and state authorities implemented comprehensive prevention measures for long-term care facilities (7–9) that included 1) implementation of symptom screening and restriction policies for visitors and nonessential personnel; 2) active screening of health care personnel, including measurement and documentation of body temperature and ascertainment of respiratory symptoms to identify and exclude symptomatic workers; 3) symptom monitoring of residents; 4) social distancing, including restricting resident movement and group activities; 5) staff training on infection control and PPE use; and 6) establishment of plans to address local PPE shortages, including county and state coordination of supply chains and stockpile releases to meet needs. These strategies require coordination and support from public health authorities, partnering health care systems, regulatory agencies, and their respective governing bodies (8–10).
The findings in this report suggest that once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members, and visitors. In the context of rapidly escalating COVID-19 outbreaks in much of the United States, it is critical that long-term care facilities implement active measures to prevent introduction of COVID-19.
Measures to consider include identifying and excluding symptomatic staff members, restricting visitation except in compassionate care situations, and strengthening infection prevention and control guidance and adherence (7,9,10).¶ Substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to COVID-19. The underlying health conditions and advanced age of many long-term care facility residents and the shared location of patients in one facility places these persons at risk for severe morbidity and death. Rapid and sustained public health interventions focusing on surveillance, infection control, and mitigation efforts are resource-intensive but are critical to curtailing COVID-19 transmission and decreasing the impact on vulnerable populations, such as residents of long-term care facilities, and the community at large.
As this pandemic expands, continued implementation of public health measures targeting vulnerable populations such as residents of long-term care facilities (8) and health care personnel will be critical. As public health measures are continually implemented, public information needs will only grow. To provide information for patients and families as well as communicate more broadly to all stakeholders, public officials and other community leaders need to work together to encourage everyone to understand and adhere to recommended guidelines to manage this outbreak.(Continue . . . )
