Open AccessCharacterization of community‐wide transmission of SARS‐CoV‐2 in congregate living settings and local public health‐coordinated response during the initial phase of the COVID‐19 pandemic
Author(s) -
Terebuh Pauline D.,
Egwiekhor Amina J.,
Gullett Heidi L.,
Fakolade Adeola O.,
Miracle Jill E.,
Ganesh Prakash T.,
Rose Johnie,
Stange Kurt C.,
Szabo Andrea D.,
Grisez Barry,
Brennan Kevin,
Hrusch Suzanne,
Napolitano Jackie,
Brazile Ramona,
Allan Terrence
Publication year - 2021
Publication title -
influenza and other respiratory viruses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.743
H-Index - 57
eISSN - 1750-2659
pISSN - 1750-2640
DOI - 10.1111/irv.12819
Subject(s) - public health , pandemic , government (linguistics) , cluster (spacecraft) , jurisdiction , transmission (telecommunications) , intervention (counseling) , community engagement , health care , environmental health , business , medicine , nursing , covid-19 , political science , public relations , disease , linguistics , philosophy , electrical engineering , pathology , computer science , infectious disease (medical specialty) , law , programming language , engineering
Background Clusters of COVID‐19 cases amplify the pandemic and are critical targets for intervention, but comprehensive cluster‐level data are not collected systematically by federal or most state public health entities. This analysis characterizes COVID‐19 clusters among vulnerable populations housed in congregate living settings across an entire community and describes early mitigation efforts. Methods The Cuyahoga County Board of Health identified and interviewed COVID‐19 cases and exposed contacts, assessing possible connections to congregate living facilities within its jurisdiction from March 7, 2020, to May 15, 2020, during the first phase of the pandemic, while state of Ohio stay‐at‐home orders were in effect. A multi‐disciplinary team‐based response network was mobilized to support active case finding and develop facility‐focused containment strategies. Results We identified a cascade of 45 COVID‐19 clusters across community facilities (corrections, nursing, assisted living, intermediate care, extended treatment, shelters, group homes). Attack rates were highest within small facilities ( P < .01) and large facilities requiring extensive support to implement effective containment measures. For 25 clusters, we identified an index case who frequently (88%) was a healthcare worker. Engagement of clinical, community, and government partners through public health coordination efforts created opportunities to rapidly develop and coordinate effective response strategies to support the facilities facing the dawning impact of the pandemic. Conclusions Active cluster investigations can uncover the dynamics of community transmission affecting both residents of congregate settings and their caregivers and help to target efforts toward populations with ongoing challenges in access to detection and control resources.