February 27, 2021

A CDC study published on February 26, 2021 entitled, “Suspected Recurrent SARS-CoV-2 Infections Among Residents of a Skilled Nursing Facility During a Second COVID-19 Outbreak — Kentucky, July–November 2020” stated: “Reinfection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is believed to be rare. Some level of immunity after SARS-CoV-2 infection is expected; however, the evidence regarding duration and level of protection is still emerging. The Kentucky Department for Public Health (KDPH) and a local health department conducted an investigation at a skilled nursing facility (SNF) that experienced a second COVID-19 outbreak in October 2020, 3 months after a first outbreak in July. Five residents received positive SARS-CoV-2 reverse transcription–polymerase chain reaction (RT-PCR) test results during both outbreaks. During the first outbreak, three of the five patients were asymptomatic and two had mild symptoms that resolved before the second outbreak. Disease severity in the five residents during the second outbreak was worse than that during the first outbreak and included one death.”

The five patients with recurrent COVID-19 ranged in age from 67 to 99 years and four were women. Each of the five patients had more than three chronic underlying health conditions, and all were permanent residents of the SNF. None of the patients with recurrent COVID-19 had an immunosuppressive condition or was taking immunosuppressive medications that might have hindered clearance of the virus or predisposed them to virus reactivation.

Among these five patients, only two were symptomatic during the first outbreak; neither had fever or respiratory symptoms, and neither was hospitalized. Both had complete resolution of symptoms between the two outbreaks. All residents with recurrent COVID-19 had at least four consecutive negative RT-PCR test results between their two positive tests. All five patients received their positive RT-PCR results for the second COVID-19 diagnosis in the midst of the second facility outbreak and therefore after facility exposure to SARS-CoV-2. Three patients with recurrent infection had roommates who received positive SARS-CoV-2 RT-PCR results before they received their own positive test results, confirming direct exposure. One patient was in a private room, and another had a roommate who did not have COVID-19. Although no direct route of exposure was identified for these two patients, exposure to SARS-CoV-2 was very likely because of the large number of infected persons in the facility during the second outbreak. Although three of the five patients with recurrent COVID-19 were asymptomatic during their first infectious episode, all five experienced symptoms during their second infectious episode; the two patients who were symptomatic during the first outbreak experienced more severe symptoms during the second infectious episode compared with the symptoms they had during the first outbreak. One resident patient required hospitalization and subsequently died.

Th study concluded: “Based on the observations of this study, testing and cohorting practices in SNFs should not assume that residents infected >90 days earlier are immune to COVID-19. Public health interventions to limit transmission are vital for all persons in SNFs, including those who have previously been infected with SARS-CoV-2; these include physical distancing, use of masks (including by SNF residents, if tolerated), and frequent hand hygiene using hand sanitizer with 60%–95% alcohol or washing with soap and water for at least 20 seconds. Vaccination in these settings, as recommended by the Advisory Committee on Immunization Practices, is particularly important to optimally protect these vulnerable persons.”


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