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McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, Lewis J, Baer A, Kawakami V, Lukoff MD, Ferro J, Brostrom-Smith C, Rea TD, Sayre MR, Riedo FX, Russell D, Hiatt B, Montgomery P, Rao AK, Chow EJ, Tobolowsky F, Hughes MJ, Bardossy AC, Oakley LP, Jacobs JR, Stone ND, Reddy SC, Jernigan JA, Honein MA, Clark TA, Duchin JS. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. N Engl J Med 2020; 382:2005-2011. [PMID: 32220208 PMCID: PMC7121761 DOI: 10.1056/nejmoa2005412] [Citation(s) in RCA: 885] [Impact Index Per Article: 221.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region. METHODS After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health-Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control. RESULTS As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County. CONCLUSIONS In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.
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Affiliation(s)
- Temet M McMichael
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Dustin W Currie
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Shauna Clark
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Sargis Pogosjans
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Meagan Kay
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Noah G Schwartz
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - James Lewis
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Atar Baer
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Vance Kawakami
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Margaret D Lukoff
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Jessica Ferro
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Claire Brostrom-Smith
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Thomas D Rea
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Michael R Sayre
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Francis X Riedo
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Denny Russell
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Brian Hiatt
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Patricia Montgomery
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Agam K Rao
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Eric J Chow
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Farrell Tobolowsky
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Michael J Hughes
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Ana C Bardossy
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Lisa P Oakley
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Jesica R Jacobs
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Nimalie D Stone
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Sujan C Reddy
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - John A Jernigan
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Margaret A Honein
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Thomas A Clark
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
| | - Jeffrey S Duchin
- From Public Health-Seattle and King County (T.M.M., S.C., S.P., M.K., J.L., A.B., V.K., M.D.L., J.F., C.B.-S., J.S.D.), University of Washington, Seattle (T.D.R., M.R.S., J.S.D.), EvergreenHealth, Kirkland (F.X.R.), Washington State Public Health Laboratory, Shoreline (D.R., B.H.), and Washington State Department of Health, Tumwater (P.M.) - all in Washington; and the Epidemic Intelligence Service (T.M.M., D.W.C., N.G.S., E.J.C., F.T., A.C.B., L.P.O.), COVID-19 Emergency Response (T.M.M., D.W.C., N.G.S., A.K.R., E.J.C., F.T., M.J.H., A.C.B., L.P.O., J.R.J., N.D.S., S.C.R., J.A.J., M.A.H., T.A.C.), and Laboratory Leadership Service (J.R.J.), Centers for Disease Control and Prevention, Atlanta
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