Signs, Symptoms, and Comorbidities Associated With Onset and Prognosis of COVID-19 in a Nursing Home

Abstract

Background: Effective halting of outbreaks in skilled nursing facilities (SNFs) depends on the earliest recognition of cases. We assessed confirmed COVID-19 cases at an SNF impacted by COVID-19 in the United States to identify early indications of COVID-19 infection. Methods: We performed retrospective reviews of electronic health records for residents with laboratoryconfirmed SARS-CoV-2 during February 28eMarch 16, 2020. Records were abstracted for comorbidities, signs and symptoms, and illness outcomes during the 2 weeks before and after the date of positive specimen collection. Relative risks (RRs) of hospitalization and death were calculated. Results: Of the 118 residents tested among approximately 130 residents from Facility A during February 28eMarch 16, 2020, 101 (86%) were found to test positive for SARS-CoV-2. At initial presentation, about two-thirds of SARS-CoV-2epositive residents had an abnormal vital sign or change in oxygen status. Most (90.2%) symptomatic residents had elevated temperature, change in mental status, lethargy, change in oxygen status, or cough; 9 (11.0%) did not have fever, cough, or shortness of breath during their clinical course. Those with change in oxygen status had an increased relative risk (RR) of 30-day mortality [51.1% vs 29.7%, RR 1.7, 95% confidence interval (CI) 1.0e3.0]. RR of hospitalization was higher for residents with underlying hepatic disease (1.6, 95% CI 1.1e2.2) or obesity (1.5, 95% CI 1.1e2.1); RR of death was not statistically significant. Conclusions and Implications: Our findings reinforce the critical role that monitoring of signs and symptoms can have in identifying COVID-19 cases early. SNFs should ensure they have a systematic approach for responding to abnormal vital signs and oxygen saturation and consider ensuring common signs and symptoms identified in Facility A are among those they monitor. Published by Elsevier Inc. on behalf of AMDA e The Society for Post-Acute and Long-Term Care Medicine.Skilled nursing facilities (SNFs) have been a focal point for COVID-19 outbreaks, with rapid transmission noted soon after the first cases are recognized. 1,2 Early recognition of persons with COVID-19 in SNFs will remain critical to halting infection transmission and ensuring appropriate clinical care even after residents and staff are vaccinated. 3 The sum total of clinical signs and symptoms experienced by SNF residents has been previously reported from larger data sets. 4,5 However, many of these may not occur until days after illness onset. For practical purposes, the earliest signs and symptoms are the most Farrell A. Tobolowsky and Ana C. Bardossy contributed equally. Disclaimer: The findings and conclusions in the manuscript are those of the authors and do not necessarily represent the official views of the US Centers for Disease Control and Prevention or the Department of Health and Human Services.

Excess Mortality After COVID-19 in Swedish Long-Term Care Facilities

“…Although obesity is a well-known risk factor for developing severe COVID-19 in the general population, 14 studies in older people have shown conflicting results. 33,34 The lack of association in our study may be related to the well-known obesity paradox in very old people, 35 for whom body-mass-index is a poor indicator of body composition and body fat distribution. 36 It has also been hypothesized that malnutrition could be an important risk factor, 37,38 but we did not find an association between food intake and mortality after adjustment for other risk factors, as in a previous study.…”

COVID-19 Severity and Mortality Among Chronic Liver Disease Patients: A Systematic Review and Meta-Analysis

“…In total, 26 studies reported on the mortality outcome among CLD and non-CLD patients ( 8 , 10 – 12 , 15 , 19 , 20 , 22 , 24 – 26 , 29 , 30 , 33 , 35 , 38 , 39 , 41 , 44 – 51 ). The pooled OR was 2.35 (95% CI, 1.84–3.00; I 2 = 96.26%; 95% PI, 0.76–7.18) ( Figure 3 ), indicating that COVID-19 patients with CLD had 2.35 times higher odds of dying as patients without CLD.…”

“…In our analysis, 25 studies reported the severity of the CLD and the non-CLD groups (9,10,(19)(20)(21)23,24,(27)(28)(29)31,32,34,36,37,(40)(41)(42)(43)(44)46,(49)(50)(51)(52). The pooled OR was 2.44 (95% CI, 1.89-3.16; I 2 = 91.3%; 95% PI, 0.79-7.55) (Figure 2), indicating that the odds of developing severe disease among COVID-19 patients with CLD were 2.44 times higher than among those without CLD.…”

What Kind of Interventions Were Perceived as Effective Against Coronavirus-19 in Nursing Homes in Italy? A Descriptive Qualitative Study

“…In this field, a clear conceptual and practical definition of "close contacts" according to specific features of the NH environment is required and evaluating the effectiveness of the different compartmentalization strategies enacted is recommended. [40][41][42] To support the reshaped environment and mission, services have been reorganized and increased, but, probably due to the limited resources available, the increased ventilation and coordination between the environmental cleaning and disinfection was enacted only in a few NHs, despite their relevance. 21,25,27 Nurses have been invited to also increase the standards of care by undertaking more checks/monitoring of the residents', not only to measure their vital signs but also to detect early changes 22,41,42 by using news tools and their clinical judgement and their deeper knowledge of the personal and clinical history of each resident.…”

“…[40][41][42] To support the reshaped environment and mission, services have been reorganized and increased, but, probably due to the limited resources available, the increased ventilation and coordination between the environmental cleaning and disinfection was enacted only in a few NHs, despite their relevance. 21,25,27 Nurses have been invited to also increase the standards of care by undertaking more checks/monitoring of the residents', not only to measure their vital signs but also to detect early changes 22,41,42 by using news tools and their clinical judgement and their deeper knowledge of the personal and clinical history of each resident. However, given the lack of nurses and the increased needs, ensuring higher standards of monitorization might have led to missed care in some fundamental needs (eg, help with eating and hygiene).…”