Variation in SARS‐CoV‐2 Prevalence in US Skilled Nursing Facilities

White, Elizabeth M.; Kosar, Cyrus M.; Feifer, Richard A.; Blackman, Carolyn; Gravenstein, Stefan; Ouslander, Joseph; Mor, Vincent

OBJECTIVE: To identify county and facility factors associated with SARS‐CoV‐2 outbreaks in skilled nursing facilities (SNFs). DESIGSN: Cross‐sectional study linking county SARS‐CoV‐2 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post‐acute and long‐term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020. SETTING AND PARTICIPANTS: The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non‐Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks. MEASUREMENTS: For Genesis and non‐Genesis SNFs: any outbreak (one or more residents testing positive for SARS‐CoV‐2). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, prevalence after universal testing. RESULTS: 118 (34.6%) Genesis SNFs and 640 (21.2%) non‐Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% CI: 9.6, 57.7, P = .008) difference in the probability of an outbreak for Genesis and non‐Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI: 4.4, 20.8, P = .003) for Genesis SNFs. A 10 bed difference in facility size was associated with a 0.9 percentage point (95% CI: 0.6, 1.2; P < .001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five Star‐ratings or past infection control deficiency citations and probability or severity of outbreak. CONCLUSIONS: Larger SNFs and SNFs in areas of high SARS‐CoV‐2 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications. This article is protected by copyright. All rights reserved.