COVID-19 management in personal services settings: Lessons learned from a nail salon outbreak

Between June 20 and July 3, 2020 a COVID-19 outbreak associated with a personal service setting (PSS) was detected in the Kingston, Ontario and managed by the local public health unit (KFL&APH).

A mixed-methods analysis was conducted to review KFL&APH’s response to the outbreak. A social network analysis was conducted to determine the extent of the outbreak and route of acquisition of cases. Epidemic curves were created and analysed. Attack rates were calculated, and testing data and overall testing strategy were reviewed.

The outbreak consisted of 37 cases with 14 through direct PSS exposure. 23 cases were from subsequent generations, and a superspreading event led to 14 of those cases. The average age of cases was 38.6 years and 65% were female. One case required hospitalization. Over 10 000 tests were conducted using a multimodal approach, including fixed assessment centres, drive-through testing and targeted testing at outbreak sites. PCR lab results were available within 48 hours of sample collection.

Confirmed cases and their close contacts at high risk of virus acquisition were contacted within 24 hours of identification in 100% of instances. Cases and close contacts were required to self-isolate immediately. Three cases never developed symptoms and two cases of transmission were identified from asymptomatic individuals.

Ultimately three PSS were connected to the outbreak and temporarily closed by KFL&APH. Public health inspectors and nurses were deployed to inspect all PSS in the area. No additional cases were associated with other PSS in the area.

Factors involved in the successful containment of the outbreak included accessible testing, quick lab turnaround, efficient case management and contract tracing efforts, temporary closure of affected facilities and inspection of all area PSS. Rapid identification of cases followed by isolation of cases and close contacts stopped further transmission of the virus.

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