Outcomes of Nursing Home COVID-19 Patients by Initial Symptoms and Comorbidity: Results of Universal Testing of 1970 Residents

Abstract

Objective Clinical implications of asymptomatic cases of the novel coronavirus disease 2019 (COVID-19) in nursing homes remain poorly understood. We assessed the association of symptom status and medical comorbidities on mortality and hospitalization risk associated with COVID-19 in residents of a large nursing home system. Design Retrospective cohort study. Setting and Participants 1,970 residents from 15 nursing home facilities with universal COVID-19 testing in Maryland. Methods We used descriptive statistics to compare baseline characteristics, logistic regression to assess the association of comorbidities with COVID-19, and Cox regression to assess the association of asymptomatic and symptomatic COVID-19 with mortality and hospitalization. We assessed the association of comorbidities with mortality and hospitalization risk. Symptom status was assessed at the time of the first test. Maximum follow-up was 94 days. Results Among the 1,970 residents (mean age 73.8, 57% female, 68% Black), 752 (38.2%) were positive on their first test. Residents who were positive for COVID-19 and had multiple symptoms at the time of testing had the highest risk of mortality (HR 4.44; 95% CI: 2.97, 6.65) and hospitalization (SHR 2.38; 95% CI: 1.70, 3.33), even after accounting for comorbidity burden. Cases who were asymptomatic at testing had a higher risk of mortality (HR 2.92; 95% CI: 1.95, 4.35), but not hospitalization (HR 1.06; 95% CI: 0.82, 1.38) compared to those who were negative for COVID-19. Of 52 SARS-CoV-2 positive residents who were asymptomatic at the time of testing and were closely monitored for 14 days at one facility, only 6 (11.6%) developed symptoms. Conclusions and Implications Asymptomatic infection with SARS-CoV-2 in the nursing home setting was associated with increased risk of death suggesting a need for closer monitoring of these residents, particularly those with underlying cardiovascular and respiratory comorbidities.

Association Between Mood Disorders and Risk of COVID-19 Infection, Hospitalization, and Death

“…21 When relevant studies did not report an applicable OR, unadjusted ORs were calculated from summary data and combined with reported aORs. The meta-analyses included studies; aORs were derived from 11 studies, [22][23][24][25][26][27][28][29][30][31][32] crude summary data from 6 studies, [33][34][35][36][37][38] and both measures from 4 studies. [39][40][41][42] Authors of potentially eligible studies were contacted and asked to provide clarification and/or supplementary data where necessary; 4 study authors provided eligible summary data [34][35][36] and 1 provided aORs.…”

Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April–June 2020

“…The clinical characteristics observed in this LTCF cohort are notable in the context of the large cluster of infected and high mortality rate, among the highest reported in current literature to our knowledge [ 14 ]. Incidence, demographic associations [ 20 ], transmission and symptom status [ 9 , 10 , 11 , 12 , 13 , 15 , 16 , 19 ], and atypical presentation [ 17 , 18 , 21 ] in LTCF residents are widely discussed in the literature [ 14 ]. Less attention was paid to the clinical patterns of COVID-19 in LTCF residents, as it relates to mortality outcomes, and those that did were not in exclusively outpatient settings [ 22 , 23 ].…”

“…Existing studies on COVID-19 outbreaks in the institutionalized elderly largely focus on epidemiological characteristics [ 9 , 10 , 11 , 12 ] and clinical symptoms related to initial presentation and transmission [ 13 , 14 , 15 , 16 , 17 , 18 ]. Few studies assessed the clinical course and past initial symptom status of residents, as it relates to mortality outcomes [ 19 , 20 , 21 ], especially in a non-hospital setting [ 22 , 23 ], with an infection and mortality rate as high as those documented here. In this study, we report a COVID-19 outbreak among 116 residents of a nursing home with a very high infection and mortality rates, with a specific focus on the clinical presentation and characteristics associated with mortality.…”

Centenarians in nursing homes during the COVID-19 pandemic

“…We conducted a search in PubMed for articles on screening and cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in centenarians published between January 1 and November 10, 2020. We identified three studies that had included centenarians with COVID-19 [ 8 – 10 ] and three others that had included patients over 90 years [ 11 – 13 ]. None described specific characteristics and outcomes in centenarians managed for COVID-19 in nursing homes.…”