SARS-CoV-2 has a high risk of outbreak in long-term skilled nursing facilities (SNF). Coronavirus disease (COVID-19) has high mortality rates among the elderly with chronic health conditions . Following identification of COVID-19 index case in a SNF, serial point-prevalence was implemented with reverse transcription–polymerase chain reaction (RT-PCR) and immunochromatographic assays . Active surveillance and early isolation of infected patients were implemented . Out of 23 SNF residents and 26 healthcare workers (HCW), 18 (78 %) and 12 (46 %) tested positive for SARS-CoV-2, respectively . High proportion (38 %) of positive patients were asymptomatic and RT-PCR was positive up to six days before symptoms . Five (21.74 %) residents were hospitalized with COVID-19, and 2 (9 %) died; only 1 (4 %) HCW needed to be hospitalized and no staff members died . Active surveillance helped COVID-19 control and management in a SNF . Testing symptomatic individuals only may fail to identify and isolate all persons contributing to transmission . In high-risk elderly, only symptoms screening may not be enough for outbreak control.