 asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 infection rates in a multistate sample of skilled nursing facilities asymptomatic transmission of severe acute respiratory syndrome coronavirus 2 sars cov 2 may be a major contributing factor in skilled nursing facility snf outbreaks however limited knowledge exists regarding the prevalence of asymptomatic and presymptomatic infection in this setting although an estimated 40% to 45% of sars cov 2 infections in the general population are asymptomatic at time of testing a small number of us and international reports have documented higher asymptomatic rates in snfs researchers examined asymptomatic and presymptomatic infection rates in a large multistate sample of us snfs and examined variation in case counts by sars cov 2 prevalence in the counties where snfs are located 