Using Non-Pharmaceutical Interventions and High Isolation of Asymptomatic Carriers to Contain the Spread of SARS-CoV-2 in Nursing Homes

Objective. Using a pandemic influenza model modified for COVID-19, this study investigated the degree of control over pre-symptomatic transmission that common non-pharmaceutical interventions (NPIs) would require to reduce the spread in long-term care facilities. Methods. We created a stochastic compartmental SEIR model with Poisson-distributed transition states that compared the effect of R0, common NPIs, and isolation rates of pre-symptomatic carriers primarily on attack rate, peak cases, and timing in a 200-resident nursing home. Model sensitivity was assessed with 1st order Sobol' indices. Results. The most rigorous NPIs decreased the peak number of infections by 4.3 and delayed the peak by 9.7 days in the absence of pre-symptomatic controls. Reductions in attack rate were not likely, even with rigorous application of all defined NPIs, unless pre-symptomatic carriers were identified and isolated at rates exceeding 76%. Attack rate was most sensitive to the pre-symptomatic isolation rate (Sobol' index > 0.7) and secondarily to R0. Conclusions. Common NPIs delayed and reduced epidemic peaks. Reducing attack rates ultimately required efficient isolation of pre-symptomatic cases, including rapid antigen tests on a nearly daily basis. This must be accounted for in testing and contact tracing plans for group living settings.