Investigation of a COVID-19 outbreak in nursing home X, Bangkok, April 2021
Keywords:
outbreak investigation, COVID-19, death, nursing home, ThailandAbstract
Background: Department of Disease Control (DDC) operation team was notified of 3 COVID-19 cases in a nursing home in Bangkok. During 21 April–1 May 2021, the operation team investigated the outbreak to identify source and factors for contracting the disease, describe magnitude and characteristics of cases and contacts and provide recommendations and control measures.
Methods: We performed active case finding and contact tracing by interviewing the cases, healthcare workers (HCW), nursing home manager and reviewing case investigation forms. A confirmed case was defined as a nursing home resident or HCW in this nursing home who has positive RT-PCR test for SARS-CoV-2 during 4 April–12 May 2021. A probable case was a person who showed positive for SARS-CoV-2 rapid antibody testing and no history of COVID-19 vaccination. Laboratory was performed by RT-PCR and MassARRAY genotyping. Environmental study in the nursing home was done to identify the risk of transmission.
Results: There was a cluster of COVID-19 comprised 8 confirmed cases (2 HCW and 6 residents). Attack rate among 48 HCW and residents in related wards was 14.8%. Median age of the cases was 86 years. All cases were symptomatic. Case fatality rate among residents was 100% . No death occurred among HCWs. Median waiting times for hospital admission was 2.5 days. The samples showed probable Alpha variants. The index case was a nurse assistant who contracted the disease from her husband and the disease spread to other residents. Inadequate hand hygiene and inappropriate personal protective equipment were observed. No nursing home staff or residents received COVID-19 vaccination due to late vaccine allocation.
Conclusion: Nursing homes is vulnerable for severe COVID-19 disease, especially during period with unavailable vaccine. Thus, nursing home staffs and residents are a priority group for COVID-19 vaccination. Being a vulnerable population, infection control personnel should be required in nursing homes to monitor adherence to infection control protocol. Nursing homes and related hospitals should strengthen symptoms surveillance among residents and staffs.
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