In late February 2020, an outbreak of SARS-CoV-2 occurred at a long-term care skilled nursing facility (SNF) in King County, Washington. On March 1, a healthcare provider tested positive for SARS-CoV-2 after working while symptomatic on February 26 and 28. Seven residents of the second facility were symptomatic with positive test results by March 6, 2020. 93% of facility A residents were tested and screened as symptomatic or asymptomatic at time of testing. Among 23 residents who tested positive, 10 (43%) were symptomatic and 13 (57%) were asymptomatic. Seven days later, 10 of the 13 previously asymptomatic had developed symptoms and were re-categorized as "presymptomatic". Large quantities of RNA in all cases indicated transmission potential regardless of symptoms.