Outcomes of Nursing Home COVID-19 Patients by Initial Symptoms and Comorbidity: Results of Universal Testing of 1970 Residents.
Olive Tang, Benjamin F Bigelow, Fatima Sheikh and 4 others
PMID 33153910WHAT IT FOUND
Nursing home residents who tested positive for SARS-CoV-2 had higher death risk than negative residents, even when asymptomatic.
Symptomatic residents had the highest risk. Residents with dementia were more likely to be recorded as asymptomatic.
Key findings
01Of 1970 nursing home residents tested, 752 initially tested positive, and 424 of them had no documented symptoms at testing.
02Thirty-day cumulative death rates were 39% among positive residents with two or more symptoms, 27% with one symptom, 14% with no symptoms, and 7% among negative residents.
03Thirty-day cumulative hospitalization rates were 45% among positive residents with multiple symptoms, 35% among positive residents with one symptom, 22% among asymptomatic positive residents, and 21% among negative residents.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Symptom status was recorded only at the time of testing, and day-to-day symptom tracking was not documented for most residents, so some residents called asymptomatic may have been presymptomatic. Hospitalization was assessed only among 1845 residents who consented to hospital transfer, so the hospitalization analysis did not include all residents. The swab tests can have false negatives, which may have placed some infected residents in the negative group. Infection and symptom status were treated as fixed at the first test, so residents who later tested positive stayed in the negative group. The close monitoring subanalysis involved only 52 residents at one facility. The paper does not test whether universal testing, pulse oximetry, or monitoring changed death or hospitalization.
Declared interests
The article is listed as supported by NIH extramural research. The supplied text does not include an author conflict-of-interest declaration.
The easy way to misread this
Do not read the similar hospitalization risk for asymptomatic positive and negative residents as proof that asymptomatic infection is harmless. The study still found a higher death rate in asymptomatic positive residents than in negative residents.