Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020.
Identifieur interne : 000773 ( PubMed/Checkpoint ); précédent : 000772; suivant : 000774Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020.
Auteurs : Anne Kimball ; Kelly M. Hatfield ; Melissa Arons ; Allison James ; Joanne Taylor ; Kevin Spicer ; Ana C. Bardossy ; Lisa P. Oakley ; Sukarma Tanwar ; Zeshan Chisty ; Jeneita M. Bell ; Mark Methner ; Josh Harney ; Jesica R. Jacobs ; Christina M. Carlson ; Heather P. Mclaughlin ; Nimalie Stone ; Shauna Clark ; Claire Brostrom-Smith ; Libby C. Page ; Meagan Kay ; James Lewis ; Denny Russell ; Brian Hiatt ; Jessica Gant ; Jeffrey S. Duchin ; Thomas A. Clark ; Margaret A. Honein ; Sujan C. Reddy ; John A. JerniganSource :
- MMWR. Morbidity and mortality weekly report [ 1545-861X ] ; 2020.
Descripteurs français
- KwdFr :
- Femelle, Flambées de maladies, Humains, Infections à coronavirus (diagnostic), Infections à coronavirus (épidémiologie), Maladies asymptomatiques (épidémiologie), Mâle, Pandémies, Pneumopathie virale (épidémiologie), Soins de longue durée, Sujet âgé, Sujet âgé de 80 ans ou plus, Techniques de laboratoire clinique, Washington (épidémiologie), Établissements de soins qualifiés.
- MESH :
- diagnostic : Infections à coronavirus.
- épidémiologie : Infections à coronavirus, Maladies asymptomatiques, Pneumopathie virale, Washington.
- Femelle, Flambées de maladies, Humains, Mâle, Pandémies, Soins de longue durée, Sujet âgé, Sujet âgé de 80 ans ou plus, Techniques de laboratoire clinique, Établissements de soins qualifiés.
English descriptors
- KwdEn :
- Aged, Aged, 80 and over, Asymptomatic Diseases (epidemiology), Betacoronavirus (isolation & purification), Clinical Laboratory Techniques, Coronavirus Infections (diagnosis), Coronavirus Infections (epidemiology), Disease Outbreaks, Female, Humans, Long-Term Care, Male, Pandemics, Pneumonia, Viral (epidemiology), Skilled Nursing Facilities, Washington (epidemiology).
- MESH :
- geographic , epidemiology : Washington.
- diagnosis : Coronavirus Infections.
- epidemiology : Asymptomatic Diseases, Coronavirus Infections, Pneumonia, Viral.
- isolation & purification : Betacoronavirus.
- Aged, Aged, 80 and over, Clinical Laboratory Techniques, Disease Outbreaks, Female, Humans, Long-Term Care, Male, Pandemics, Skilled Nursing Facilities.
Abstract
Older adults are susceptible to severe coronavirus disease 2019 (COVID-19) outcomes as a consequence of their age and, in some cases, underlying health conditions (1). A COVID-19 outbreak in a long-term care skilled nursing facility (SNF) in King County, Washington that was first identified on February 28, 2020, highlighted the potential for rapid spread among residents of these types of facilities (2). On March 1, a health care provider at a second long-term care skilled nursing facility (facility A) in King County, Washington, had a positive test result for SARS-CoV-2, the novel coronavirus that causes COVID-19, after working while symptomatic on February 26 and 28. By March 6, seven residents of this second facility were symptomatic and had positive test results for SARS-CoV-2. On March 13, CDC performed symptom assessments and SARS-CoV-2 testing for 76 (93%) of the 82 facility A residents to evaluate the utility of symptom screening for identification of COVID-19 in SNF residents. Residents were categorized as asymptomatic or symptomatic at the time of testing, based on the absence or presence of fever, cough, shortness of breath, or other symptoms on the day of testing or during the preceding 14 days. Among 23 (30%) residents with positive test results, 10 (43%) had symptoms on the date of testing, and 13 (57%) were asymptomatic. Seven days after testing, 10 of these 13 previously asymptomatic residents had developed symptoms and were recategorized as presymptomatic at the time of testing. The reverse transcription-polymerase chain reaction (RT-PCR) testing cycle threshold (Ct) values indicated large quantities of viral RNA in asymptomatic, presymptomatic, and symptomatic residents, suggesting the potential for transmission regardless of symptoms. Symptom-based screening in SNFs could fail to identify approximately half of residents with COVID-19. Long-term care facilities should take proactive steps to prevent introduction of SARS-CoV-2 (3). Once a confirmed case is identified in an SNF, all residents should be placed on isolation precautions if possible (3), with considerations for extended use or reuse of personal protective equipment (PPE) as needed (4).
DOI: 10.15585/mmwr.mm6913e1
PubMed: 32240128
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Clark</name></author><author><name sortKey="Honein, Margaret A" sort="Honein, Margaret A" uniqKey="Honein M" first="Margaret A" last="Honein">Margaret A. Honein</name></author><author><name sortKey="Reddy, Sujan C" sort="Reddy, Sujan C" uniqKey="Reddy S" first="Sujan C" last="Reddy">Sujan C. Reddy</name></author><author><name sortKey="Jernigan, John A" sort="Jernigan, John A" uniqKey="Jernigan J" first="John A" last="Jernigan">John A. Jernigan</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32240128</idno><idno type="pmid">32240128</idno><idno type="doi">10.15585/mmwr.mm6913e1</idno><idno type="wicri:Area/PubMed/Corpus">000392</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000392</idno><idno type="wicri:Area/PubMed/Curation">000392</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000392</idno><idno type="wicri:Area/PubMed/Checkpoint">000773</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000773</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020.</title><author><name sortKey="Kimball, Anne" sort="Kimball, Anne" uniqKey="Kimball A" first="Anne" last="Kimball">Anne Kimball</name></author><author><name sortKey="Hatfield, Kelly M" sort="Hatfield, Kelly M" uniqKey="Hatfield K" first="Kelly M" last="Hatfield">Kelly M. Hatfield</name></author><author><name sortKey="Arons, Melissa" sort="Arons, Melissa" uniqKey="Arons M" first="Melissa" last="Arons">Melissa Arons</name></author><author><name sortKey="James, Allison" sort="James, Allison" uniqKey="James A" first="Allison" last="James">Allison James</name></author><author><name sortKey="Taylor, Joanne" sort="Taylor, Joanne" uniqKey="Taylor J" first="Joanne" last="Taylor">Joanne Taylor</name></author><author><name sortKey="Spicer, Kevin" sort="Spicer, Kevin" uniqKey="Spicer K" first="Kevin" last="Spicer">Kevin Spicer</name></author><author><name sortKey="Bardossy, Ana C" sort="Bardossy, Ana C" uniqKey="Bardossy A" first="Ana C" last="Bardossy">Ana C. Bardossy</name></author><author><name sortKey="Oakley, Lisa P" sort="Oakley, Lisa P" uniqKey="Oakley L" first="Lisa P" last="Oakley">Lisa P. Oakley</name></author><author><name sortKey="Tanwar, Sukarma" sort="Tanwar, Sukarma" uniqKey="Tanwar S" first="Sukarma" last="Tanwar">Sukarma Tanwar</name></author><author><name sortKey="Chisty, Zeshan" sort="Chisty, Zeshan" uniqKey="Chisty Z" first="Zeshan" last="Chisty">Zeshan Chisty</name></author><author><name sortKey="Bell, Jeneita M" sort="Bell, Jeneita M" uniqKey="Bell J" first="Jeneita M" last="Bell">Jeneita M. Bell</name></author><author><name sortKey="Methner, Mark" sort="Methner, Mark" uniqKey="Methner M" first="Mark" last="Methner">Mark Methner</name></author><author><name sortKey="Harney, Josh" sort="Harney, Josh" uniqKey="Harney J" first="Josh" last="Harney">Josh Harney</name></author><author><name sortKey="Jacobs, Jesica R" sort="Jacobs, Jesica R" uniqKey="Jacobs J" first="Jesica R" last="Jacobs">Jesica R. Jacobs</name></author><author><name sortKey="Carlson, Christina M" sort="Carlson, Christina M" uniqKey="Carlson C" first="Christina M" last="Carlson">Christina M. Carlson</name></author><author><name sortKey="Mclaughlin, Heather P" sort="Mclaughlin, Heather P" uniqKey="Mclaughlin H" first="Heather P" last="Mclaughlin">Heather P. Mclaughlin</name></author><author><name sortKey="Stone, Nimalie" sort="Stone, Nimalie" uniqKey="Stone N" first="Nimalie" last="Stone">Nimalie Stone</name></author><author><name sortKey="Clark, Shauna" sort="Clark, Shauna" uniqKey="Clark S" first="Shauna" last="Clark">Shauna Clark</name></author><author><name sortKey="Brostrom Smith, Claire" sort="Brostrom Smith, Claire" uniqKey="Brostrom Smith C" first="Claire" last="Brostrom-Smith">Claire Brostrom-Smith</name></author><author><name sortKey="Page, Libby C" sort="Page, Libby C" uniqKey="Page L" first="Libby C" last="Page">Libby C. Page</name></author><author><name sortKey="Kay, Meagan" sort="Kay, Meagan" uniqKey="Kay M" first="Meagan" last="Kay">Meagan Kay</name></author><author><name sortKey="Lewis, James" sort="Lewis, James" uniqKey="Lewis J" first="James" last="Lewis">James Lewis</name></author><author><name sortKey="Russell, Denny" sort="Russell, Denny" uniqKey="Russell D" first="Denny" last="Russell">Denny Russell</name></author><author><name sortKey="Hiatt, Brian" sort="Hiatt, Brian" uniqKey="Hiatt B" first="Brian" last="Hiatt">Brian Hiatt</name></author><author><name sortKey="Gant, Jessica" sort="Gant, Jessica" uniqKey="Gant J" first="Jessica" last="Gant">Jessica Gant</name></author><author><name sortKey="Duchin, Jeffrey S" sort="Duchin, Jeffrey S" uniqKey="Duchin J" first="Jeffrey S" last="Duchin">Jeffrey S. Duchin</name></author><author><name sortKey="Clark, Thomas A" sort="Clark, Thomas A" uniqKey="Clark T" first="Thomas A" last="Clark">Thomas A. Clark</name></author><author><name sortKey="Honein, Margaret A" sort="Honein, Margaret A" uniqKey="Honein M" first="Margaret A" last="Honein">Margaret A. Honein</name></author><author><name sortKey="Reddy, Sujan C" sort="Reddy, Sujan C" uniqKey="Reddy S" first="Sujan C" last="Reddy">Sujan C. Reddy</name></author><author><name sortKey="Jernigan, John A" sort="Jernigan, John A" uniqKey="Jernigan J" first="John A" last="Jernigan">John A. Jernigan</name></author></analytic><series><title level="j">MMWR. Morbidity and mortality weekly report</title><idno type="eISSN">1545-861X</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Asymptomatic Diseases (epidemiology)</term><term>Betacoronavirus (isolation & purification)</term><term>Clinical Laboratory Techniques</term><term>Coronavirus Infections (diagnosis)</term><term>Coronavirus Infections (epidemiology)</term><term>Disease Outbreaks</term><term>Female</term><term>Humans</term><term>Long-Term Care</term><term>Male</term><term>Pandemics</term><term>Pneumonia, Viral (epidemiology)</term><term>Skilled Nursing Facilities</term><term>Washington (epidemiology)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Femelle</term><term>Flambées de maladies</term><term>Humains</term><term>Infections à coronavirus (diagnostic)</term><term>Infections à coronavirus (épidémiologie)</term><term>Maladies asymptomatiques (épidémiologie)</term><term>Mâle</term><term>Pandémies</term><term>Pneumopathie virale (épidémiologie)</term><term>Soins de longue durée</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Techniques de laboratoire clinique</term><term>Washington (épidémiologie)</term><term>Établissements de soins qualifiés</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Washington</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Coronavirus Infections</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Infections à coronavirus</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Asymptomatic Diseases</term><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Betacoronavirus</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Infections à coronavirus</term><term>Maladies asymptomatiques</term><term>Pneumopathie virale</term><term>Washington</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Clinical Laboratory Techniques</term><term>Disease Outbreaks</term><term>Female</term><term>Humans</term><term>Long-Term Care</term><term>Male</term><term>Pandemics</term><term>Skilled Nursing Facilities</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Femelle</term><term>Flambées de maladies</term><term>Humains</term><term>Mâle</term><term>Pandémies</term><term>Soins de longue durée</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Techniques de laboratoire clinique</term><term>Établissements de soins qualifiés</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Older adults are susceptible to severe coronavirus disease 2019 (COVID-19) outcomes as a consequence of their age and, in some cases, underlying health conditions (1). A COVID-19 outbreak in a long-term care skilled nursing facility (SNF) in King County, Washington that was first identified on February 28, 2020, highlighted the potential for rapid spread among residents of these types of facilities (2). On March 1, a health care provider at a second long-term care skilled nursing facility (facility A) in King County, Washington, had a positive test result for SARS-CoV-2, the novel coronavirus that causes COVID-19, after working while symptomatic on February 26 and 28. By March 6, seven residents of this second facility were symptomatic and had positive test results for SARS-CoV-2. On March 13, CDC performed symptom assessments and SARS-CoV-2 testing for 76 (93%) of the 82 facility A residents to evaluate the utility of symptom screening for identification of COVID-19 in SNF residents. Residents were categorized as asymptomatic or symptomatic at the time of testing, based on the absence or presence of fever, cough, shortness of breath, or other symptoms on the day of testing or during the preceding 14 days. Among 23 (30%) residents with positive test results, 10 (43%) had symptoms on the date of testing, and 13 (57%) were asymptomatic. Seven days after testing, 10 of these 13 previously asymptomatic residents had developed symptoms and were recategorized as presymptomatic at the time of testing. The reverse transcription-polymerase chain reaction (RT-PCR) testing cycle threshold (Ct) values indicated large quantities of viral RNA in asymptomatic, presymptomatic, and symptomatic residents, suggesting the potential for transmission regardless of symptoms. Symptom-based screening in SNFs could fail to identify approximately half of residents with COVID-19. Long-term care facilities should take proactive steps to prevent introduction of SARS-CoV-2 (3). Once a confirmed case is identified in an SNF, all residents should be placed on isolation precautions if possible (3), with considerations for extended use or reuse of personal protective equipment (PPE) as needed (4).</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32240128</PMID><DateCompleted><Year>2020</Year><Month>04</Month><Day>06</Day></DateCompleted><DateRevised><Year>2020</Year><Month>04</Month><Day>10</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1545-861X</ISSN><JournalIssue CitedMedium="Internet"><Volume>69</Volume><Issue>13</Issue><PubDate><Year>2020</Year><Month>Apr</Month><Day>03</Day></PubDate></JournalIssue><Title>MMWR. Morbidity and mortality weekly report</Title><ISOAbbreviation>MMWR Morb. Mortal. Wkly. Rep.</ISOAbbreviation></Journal><ArticleTitle>Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020.</ArticleTitle><Pagination><MedlinePgn>377-381</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.15585/mmwr.mm6913e1</ELocationID><Abstract><AbstractText>Older adults are susceptible to severe coronavirus disease 2019 (COVID-19) outcomes as a consequence of their age and, in some cases, underlying health conditions (1). A COVID-19 outbreak in a long-term care skilled nursing facility (SNF) in King County, Washington that was first identified on February 28, 2020, highlighted the potential for rapid spread among residents of these types of facilities (2). On March 1, a health care provider at a second long-term care skilled nursing facility (facility A) in King County, Washington, had a positive test result for SARS-CoV-2, the novel coronavirus that causes COVID-19, after working while symptomatic on February 26 and 28. By March 6, seven residents of this second facility were symptomatic and had positive test results for SARS-CoV-2. On March 13, CDC performed symptom assessments and SARS-CoV-2 testing for 76 (93%) of the 82 facility A residents to evaluate the utility of symptom screening for identification of COVID-19 in SNF residents. Residents were categorized as asymptomatic or symptomatic at the time of testing, based on the absence or presence of fever, cough, shortness of breath, or other symptoms on the day of testing or during the preceding 14 days. Among 23 (30%) residents with positive test results, 10 (43%) had symptoms on the date of testing, and 13 (57%) were asymptomatic. Seven days after testing, 10 of these 13 previously asymptomatic residents had developed symptoms and were recategorized as presymptomatic at the time of testing. The reverse transcription-polymerase chain reaction (RT-PCR) testing cycle threshold (Ct) values indicated large quantities of viral RNA in asymptomatic, presymptomatic, and symptomatic residents, suggesting the potential for transmission regardless of symptoms. Symptom-based screening in SNFs could fail to identify approximately half of residents with COVID-19. Long-term care facilities should take proactive steps to prevent introduction of SARS-CoV-2 (3). Once a confirmed case is identified in an SNF, all residents should be placed on isolation precautions if possible (3), with considerations for extended use or reuse of personal protective equipment (PPE) as needed (4).</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kimball</LastName><ForeName>Anne</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Hatfield</LastName><ForeName>Kelly M</ForeName><Initials>KM</Initials></Author><Author ValidYN="Y"><LastName>Arons</LastName><ForeName>Melissa</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>James</LastName><ForeName>Allison</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Taylor</LastName><ForeName>Joanne</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Spicer</LastName><ForeName>Kevin</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Bardossy</LastName><ForeName>Ana C</ForeName><Initials>AC</Initials></Author><Author ValidYN="Y"><LastName>Oakley</LastName><ForeName>Lisa P</ForeName><Initials>LP</Initials></Author><Author ValidYN="Y"><LastName>Tanwar</LastName><ForeName>Sukarma</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Chisty</LastName><ForeName>Zeshan</ForeName><Initials>Z</Initials></Author><Author ValidYN="Y"><LastName>Bell</LastName><ForeName>Jeneita M</ForeName><Initials>JM</Initials></Author><Author ValidYN="Y"><LastName>Methner</LastName><ForeName>Mark</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Harney</LastName><ForeName>Josh</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Jacobs</LastName><ForeName>Jesica R</ForeName><Initials>JR</Initials></Author><Author ValidYN="Y"><LastName>Carlson</LastName><ForeName>Christina M</ForeName><Initials>CM</Initials></Author><Author ValidYN="Y"><LastName>McLaughlin</LastName><ForeName>Heather P</ForeName><Initials>HP</Initials></Author><Author ValidYN="Y"><LastName>Stone</LastName><ForeName>Nimalie</ForeName><Initials>N</Initials></Author><Author ValidYN="Y"><LastName>Clark</LastName><ForeName>Shauna</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Brostrom-Smith</LastName><ForeName>Claire</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Page</LastName><ForeName>Libby C</ForeName><Initials>LC</Initials></Author><Author ValidYN="Y"><LastName>Kay</LastName><ForeName>Meagan</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Lewis</LastName><ForeName>James</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Russell</LastName><ForeName>Denny</ForeName><Initials>D</Initials></Author><Author ValidYN="Y"><LastName>Hiatt</LastName><ForeName>Brian</ForeName><Initials>B</Initials></Author><Author ValidYN="Y"><LastName>Gant</LastName><ForeName>Jessica</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Duchin</LastName><ForeName>Jeffrey S</ForeName><Initials>JS</Initials></Author><Author ValidYN="Y"><LastName>Clark</LastName><ForeName>Thomas A</ForeName><Initials>TA</Initials></Author><Author ValidYN="Y"><LastName>Honein</LastName><ForeName>Margaret A</ForeName><Initials>MA</Initials></Author><Author ValidYN="Y"><LastName>Reddy</LastName><ForeName>Sujan C</ForeName><Initials>SC</Initials></Author><Author ValidYN="Y"><LastName>Jernigan</LastName><ForeName>John A</ForeName><Initials>JA</Initials></Author><Author ValidYN="Y"><CollectiveName>Public Health – Seattle & King County</CollectiveName></Author><Author ValidYN="Y"><CollectiveName>CDC COVID-19 Investigation Team</CollectiveName></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>04</Month><Day>03</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>MMWR Morb Mortal Wkly Rep</MedlineTA><NlmUniqueID>7802429</NlmUniqueID><ISSNLinking>0149-2195</ISSNLinking></MedlineJournalInfo><SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName><SupplMeshName Type="Protocol" UI="C000657964">COVID-19 diagnostic testing</SupplMeshName><SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058070" MajorTopicYN="N">Asymptomatic Diseases</DescriptorName><QualifierName UI="Q000453" 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Care</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012866" MajorTopicYN="Y">Skilled Nursing Facilities</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014861" MajorTopicYN="N" Type="Geographic">Washington</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading></MeshHeadingList><CoiStatement>All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. 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J Med. 2020 Mar 19;382(12):1177-1179</Citation><ArticleIdList><ArticleId IdType="pubmed">32074444</ArticleId></ArticleIdList></Reference></ReferenceList><ReferenceList><Reference><Citation>BMC Infect Dis. 2016 Oct 28;16(1):615</Citation><ArticleIdList><ArticleId IdType="pubmed">27793117</ArticleId></ArticleIdList></Reference></ReferenceList><ReferenceList><Reference><Citation>MMWR Morb Mortal Wkly Rep. 2020 Mar 27;69(12):343-346</Citation><ArticleIdList><ArticleId IdType="pubmed">32214079</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></pubmed><affiliations><list></list><tree><noCountry><name sortKey="Arons, Melissa" sort="Arons, Melissa" uniqKey="Arons M" first="Melissa" last="Arons">Melissa Arons</name><name sortKey="Bardossy, Ana C" sort="Bardossy, Ana C" uniqKey="Bardossy A" first="Ana C" last="Bardossy">Ana C. 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