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Notes from the Field: Universal Statewide Laboratory Testing for SARS-CoV-2 in Nursing Homes – West Virginia, April 21-May 8, 2020

Our take —

This study presents information on the prevalence of SARS-CoV-2 infection among staff and residents of nursing homes in West Virginia following an executive order from the governor requiring universal testing in all nursing homes in the state. Overall, 0.1% of residents (11/8911) and 0.2% of staff (31/13,687) had positive results for SARS-CoV-2. Of the 42 cases identified among residents and staff, 19% were asymptomatic. While over 98% of residents and staff were tested, it is important to note that testing was done to detect current infections, thus any past infections may have been missed. The implementation of universal testing and infection prevention protocols likely prevented continuous transmissions and larger outbreaks of COVID-19 among staff and residents of West Virginia nursing homes.

Study design


Study population and setting

On April 17th 2020, the governor of West Virginia issued an executive order for the state’s Bureau for Public Health to coordinate universal testing for SARS-CoV-2 among residents and staff in all 123 nursing homes in the state, regardless of symptoms. This order was issued following 307 reported COVID-19 cases among residents and staff in 7 West Virginia nursing homes from March 17 to April 16, 2020. From April 21st, nasal/nasopharyngeal swabs were collected from nursing home residents and tested using real-time reverse transcription PCR. An outbreak was defined as ≥ 2 more lab-confirmed cases of COVID-19 within 14 days among staff or residents of a facility. In facilities with active outbreaks, all persons who had never been tested and those who had previously tested negative received testing. In accordance with CDC guidelines, residents with positive test results were isolated in private rooms, and staff with positive results were required to isolate at home. Staff who tested negative but had were close contacts of residents/other staff who tested positive were required to quarantine at home for 14 days since last exposure. After implementation of universal testing, staff and residents were screened daily, and anyone with signs/symptoms of COVID-19 was tested.

Summary of Main Findings

From April 21 to May 8, 2020, universal testing was conducted in all 123 nursing homes in West Virginia. A total of 42 COVID-19 cases (11 residents & 31 staff members) were identified in 28 nursing homes—none of these facilities had a previous outbreak. This represented a positivity rate of 0.1% among residents who were tested (n = 8911) and 0.2% among staff members who were tested (n=13,687). Of the 42 cases, 20 were single cases from 20 facilities, and 22 cases from outbreaks at 8 facilities; 6 residents and 2 staff members were asymptomatic. Prior to universal testing, there had been 32 COVID-19 associated deaths among nursing home residents in the state; however, no COVID-19 related deaths occurred among residents in the period under consideration. A total of 1.3% (115/9,026) of residents and 1.7% (239/13,926) of staff declined testing.

Study Strengths

Statewide universal testing across nursing homes using real-time reverse transcription PCR for detection of SARS-CoV-2.


It is possible that residents and staff who declined receiving testing differed from those who were tested, however the numbers declining were proportionately low. It is important to note that testing was done to detect current SARS-CoV-2 infections, thus any past infections may have been missed.

Value added

This study describes the use of universal testing to estimate prevalence of SARS-CoV-2 infection among staff and residents of nursing homes in West Virginia during the first wave of the COVID-19 pandemic in the US. This study provides important information about nursing homes, a type of facility whose residents are particularly vulnerable to adverse outcomes from COVID-19.

This review was posted on: 24 September 2020