534. Halting a SARS-COV2 Outbreak in a Veterans Affairs Nursing Home

Background: Health care systems have been significantly overwhelmed during the SARS-CoV-2 (SC2) pandemic Cases in the USA have exceeded 1 9 million with over 40% of deaths occurring in nursing homes and assisting living facilities We describe our experience in controlling an outbreak in our community living centers (CLC) Methods: We retrospectively reviewed the charts of Veterans with positive nasopharyngeal (NP) RT-PCR for SC2 from March 24 to April 18, 2020 in 2 neighboring CLC units (80 bed capacity), at Northport Affairs Medical Center Results: Twenty five Veterans (24 men) tested positive for SC2 Of these, 5 remained asymptomatic, 9 got hospitalized, 6 died No coinfection with influenza or other respiratory viruses identified 11 health care workers (HCW) tested positive Figure 1 shows test results by date Table 1 summarizes the demographic characteristics, medical history, and laboratory findings The median age was 74 years, with no difference in age between recovered and deceased, 73 vs 77, P:0 105 Simplified acute physiology score (SAPS) II score was higher in the deceased group (P=0 001) and so were D-dimer (admission and peak levels), CRP, LDH, and peak ferritin/procalcitonin levels There was no ICU admission Figure 2 illustrates the CLC 1 and 2 outline of beds depicting positive cases in sequence of detection Initial spread of the virus was fast, affecting residents and HCW CLC visits were prohibited, floating of staff minimized, internal group activities halted, infection control measures and education on proper use of personal protective equipment provided A SC2 (or “COVID”) unit was created in CLC1 and all patients and staff got tested Withdrawal of isolation precautions required resolution of symptoms, and two sequential negative NP PCR tests which were obtained after 14 days from diagnosis If the PCR was positive, a repeat test was obtained in 72 hours 13 patients had persistent positive PCR for average 32 days (19 to 52) since diagnosis 7/13 got tested and all were positive for SC2 IgG antibody Conclusion: Controlling SARS-CoV-2 outbreaks in nursing homes is a unique challenge as the virus can spread quickly among residents and staff Mortality rate in our cohort was 24% Prompt, effective isolation and broad testing was instrumental in halting the SC2 (COVID-19) outbreak (Table Presented)