Outbreaks Open Access
Like 0


Elderly care facilities have become a major focus of coronavirus disease (COVID-19) control. Here, we describe an outbreak of COVID-19 in a nursing home in Germany from 8 March to 4 May 2020 (58 days), and the effect of an intervention of general screening and cohort isolation. COVID-19 cases among residents and staff were recorded on a daily basis from the first positive SARS-CoV-2 test from a resident on 8 March 2020, until 4 May 2020 when the last staff member was classified COVID-19 negative. Eighty of 160 residents (50%) and 37 of 135 staff members (27%) tested positive for SARS-CoV-2. Twenty-seven of the 80 residents were asymptomatic but tested positive during the first general screening. Cohort isolation of SARS-CoV-2 positive residents by reorganising the facility proved to be a major effort. After the intervention, four further asymptomatic residents tested positive in follow-up screenings within a period of 6 days, and were possibly infected prior to the intervention. Thereafter, no further infections were recorded among residents. The described outbreak was controlled by implementing general screening and rigorous cohort isolation, providing a blueprint for similar facilities.


Article metrics loading...

Loading full text...

Full text loading...



  1. John Hopkins University (JHU). Coronavirus COVID-19 global cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. Baltimore: JHU. [Accessed: 27 Oct 2020]. Available from: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
  2. Kontis V, Bennett JE, Rashid T, Parks RM, Pearson-Stuttard J, Guillot M, et al. Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries. Nat Med. 14 Oct 2020.  PMID: 33057181 
  3. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The Incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med. 2020;172(9):577-82.  https://doi.org/10.7326/M20-0504  PMID: 32150748 
  4. Comber LO, Murchu E, Drummond L, Carty PG, Walsh KA, De Gascun CF, et al. Airborne transmission of SARS-CoV-2 via aerosols. Rev Med Virol. 2020;e2184. PMID: 33105071 
  5. Robert Koch Institute (RKI). Coronavirus Disease 2019 (COVID-19). Daily situation report of the Robert Koch Institute 15/03/2020. Berlin: RKI. [Accessed: 15 May 2020]. Available from: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-03-15-en.pdf?__blob=publicationFile
  6. Robert Koch Institute (RKI). Coronavirus Disease 2019 (COVID-19). Daily situation report of the Robert Koch Institute 24/05/2020. Berlin: RKI. [Accessed: 25 May 2020]. Available from: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-05-24-en.pdf?__blob=publicationFile
  7. Office for National Statistics (ONS). Deaths registered weekly in England and Wales, provisional: week ending 1 May 2020. Newport: ONS. [Accessed: 27 Oct 2020]. Available from:https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/weekending1may2020
  8. Istituto Superiore di Sanità (ISS). Epidemia COVID-19. Aggiornamento nazionale 14 maggio 2020 – ore 16:00. [COVID-19 epidemic. National Update 14 May 2020 16:00]. Rome: ISS. [Accessed: 27 Oct 2020]. Italian. Available from: https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_14-maggio-2020.pdf
  9. Santé Publique France. COVID-19, Point épidémiologique hebdomadaire du 22 octobre 2020. [COVID-19, Weekly epidemiological update 22 October 2020]. Paris: Santé Publique France. [Accessed: 27 Oct 2020]. French. Available from: https://www.santepubliquefrance.fr/content/download/290152/2768648
  10. Centers for Disease Control and Prevention (CDC). Provisional death counts for coronavirus disease (COVID-19). Weekly updates by select demographic and geographic characteristics, as of May 1 2020. Atlanta: CDC. [Accessed: 6 May 2020]. Available from: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm
  11. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team, Chinese Center for Disease Control and Prevention. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. J Epidemiol. 2020;41(2):145-51.  https://doi.org/10.3760/cma.j.issn.0254-6450.2020.02.003 
  12. Schilling J, et al. Vorläufige Bewertung der Krankheitsschwere von COVID-19 in Deutschland basierend auf übermittelten Fällen gemäß Infektionsschutzgesetz. [Preliminary estimation of the disease severity of COVID-19 in Germany based on reported cases according to infection prevention law]. Epidemiologisches Bulletin.2020;17:3-9. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2020/Ausgaben/17_20.pdf?__blob=publicationFile
  13. Stall NM, Farquharson C, Fan-Lun C, Wiesenfeld L, Loftus CA, Kain D, et al. A hospital partnership with a nursing home experiencing a COVID-19 outbreak: description of a multi-phase emergency response in Toronto, Canada. J Am Geriatr Soc. 2020;68(7):1376-81.  https://doi.org/10.1111/jgs.16625  PMID: 32441770 
  14. Villeneuve M, Herschaft R. NY nursing home reports 98 deaths linked to coronavirus. New York: The New York Times. [Accessed: 7 May 2020]. Available from: 2020.https://www.nytimes.com/aponline/2020/05/01/us/ap-us-virus-outbreak-new-york-nursing-home-.html
  15. McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, et al. Epidemiology of Covid-19 in a long-term care facility in King County, Washington. N Engl J Med. 2020;382(21):2005-11.  https://doi.org/10.1056/NEJMoa2005412  PMID: 32220208 
  16. Arons MM, Hatfield KM, Reddy SC, Kimball A, James A, Jacobs JR, et al. Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility. N Engl J Med. 2020;382(22):2081-90.  https://doi.org/10.1056/NEJMoa2008457  PMID: 32329971 
  17. Rada AG. Covid-19: the precarious position of Spain’s nursing homes. BMJ. 2020;369:m1554.  https://doi.org/10.1136/bmj.m1554  PMID: 32312710 
  18. American Geriatrics Society. American Geriatrics Society (AGS) policy brief: COVID-19 and nursing homes. J Am Geriatr Soc. 2020;68(5):908-11.  https://doi.org/10.1111/jgs.16477  PMID: 32267538 
  19. Quigley DD, Dick A, Agarwal M, Jones KM, Mody L, Stone PW. COVID-19 preparedness in nursing homes in the midst of the pandemic. J Am Geriatr Soc. 2020;68(6):1164-6.  https://doi.org/10.1111/jgs.16520  PMID: 32343362 
  20. Kimball A, Hatfield KM, Arons M, James A, Taylor J, Spicer K, et al. Public Health – Seattle & King County; CDC COVID-19 Investigation Team. Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility - King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):377-81.  https://doi.org/10.15585/mmwr.mm6913e1  PMID: 32240128 
  21. Robert Koch Institute. COVID-19 (Coronavirus SARS-CoV-2). Berlin: RKI. [Accessed: 4 May 2020]. German. Available from: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/nCoV.html
  22. Bayerisches Staatsministerium für Gesundheit und Pflege [Bavarian ministry for health and care]. Vollzug des Infektionsschutzgesetzes (IfSG), Corona-Pandemie: Einschränkung der Besuchsrechte für Krankenhäuser, Pflege- und Behinderteneinrichtungen. [Implementation of the infection control law, Corona pandemic: Restriction of the visitor permission in hospitals, facilities for elderly and handicapped]. Munich: Bayerisches Ministerialblatt [Bavarian ministerial gazette], 2020(141); [Accessed: 27 Oct 2020]. German. Available from: https://www.verkuendung-bayern.de/files/baymbl/2020/141/baymbl-2020-141.pdf
  23. Kirkcaldy RD, King BA, Brooks JT. COVID-19 and postinfection immunity: limited evidence, many remaining questions. JAMA. 2020;323(22):2245-6.  https://doi.org/10.1001/jama.2020.7869  PMID: 32391855 
  24. He X, Lau EHY, Wu P, Deng X, Wang J, Hao X, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020;26(5):672-5.  https://doi.org/10.1038/s41591-020-0869-5  PMID: 32296168 
  25. Wei WE, Li Z, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic Transmission of SARS-CoV-2 - Singapore, January 23-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):411-5.  https://doi.org/10.15585/mmwr.mm6914e1  PMID: 32271722 
  26. Youngs J, Marshall B, Farragher M, Whitney L, Glass S, Pope C, et al. Implementation of influenza point-of-care testing and patient cohorting during a high-incidence season: a retrospective analysis of impact on infection prevention and control and clinical outcomes. J Hosp Infect. 2019;101(3):276-84.  https://doi.org/10.1016/j.jhin.2018.11.010  PMID: 30471317 
  27. Bilefsky D. 31 Deaths: toll at Quebec nursing home in pandemic reflects global phenomenon. New York: The New York Times. [Accessed: 27 Apr 2020]. Available from: https://www.nytimes.com/2020/04/16/world/canada/montreal-nursing-homes-coronavirus.html
  28. European Centre for Disease Prevention and Control (ECDC). Infection prevention and control and preparedness for COVID-19 in healthcare settings. Fifth update. Stockholm: ECDC; 6 Oct 2020. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/Infection-prevention-and-control-in-healthcare-settings-COVID-19_5th_update.pdf
  29. Centers for Disease Control and Prevention (CDC). Testing guidelines for nursing homes. Updated Oct 16 2020. Atlanta: CDC. [Accessed: 29 Oct 2020]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-testing.html
  30. Centers for Disease Control and Prevention (CDC). Preparing for COVID-19 in nursing homes. Atlanta: CDC. [Accessed: 29 Oct 2020]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html
  31. El Haj M, Altintas E, Chapelet G, Kapogiannis D, Gallouj K. High depression and anxiety in people with Alzheimer’s disease living in retirement homes during the covid-19 crisis. Psychiatry Res. 2020;291:113294.  https://doi.org/10.1016/j.psychres.2020.113294  PMID: 32763552 
  32. Robert Koch Institute (RKI). Coronavirus Disease 2019 (COVID-19). Daily situation report of the Robert Koch Institute. Berlin: RKI; 4 Mar 2020. Available from: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-03-04-en.pdf?__blob=publicationFile

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error