Using Serologic Testing to Assess the Effectiveness of Outbreak Control Efforts, Serial Polymerase Chain Reaction Testing, and Cohorting of Positive Severe Acute Respiratory Syndrome Coronavirus 2 Patients in a Skilled Nursing Facility

Dora, Amy V; Winnett, Alexander; Fulcher, Jennifer A.; Sohn, Linda; Calub, Feliza; Lee-Chang, Ian; Ghadishah, Elham; Schwartzman, William A.; Beenhouwer, David O.; Vallone, John; Graber, Christopher J.; Goetz, Matthew Bidwell; Bhattacharya, Debika

doi:10.1093/cid/ciaa1286

Cited by 10 publications

(7 citation statements)

References 12 publications

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“…Routine temperature screening independent of other diagnostic tools, 66,70 symptom-based testing, 16,53,54,60,61,64,65,107,108 and single point-prevalence screening by nasopharyngeal reverse transcription polymerase chain reaction following case identification, demonstrated limited effectiveness. 48,49,51,52,54,55,64,66,70,71 A single-cohort study examined postexposure prophylaxis with hydroxychloroquine to prevent transmission of COVID-19, with inconclusive results. 62…”

Section: Ineffective Strategiesmentioning

confidence: 99%

Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence

Dykgraaf

Matenge

Desborough

et al. 2021

Journal of the American Medical Directors Association

111

116

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Objectives The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision-making. Design Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long term care. Setting and Participants Residents and staff in care settings such as nursing homes and long term care facilities. Methods PubMed/Medline, Cochrane Library and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (for example commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesised narratively using tabulated data extracts and summary tables. Results Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control (IPC) measures. Symptom or temperature based screening, and single point-prevalence testing, were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, inter-sectoral collaboration and policy that facilitated access to critical resources were all significant enablers of success. Conclusions and Implications High quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long term care residents from COVID-19 and other infectious diseases. This rapid review summarises current evidence regarding strategies which may be effective.

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Section: Ineffective Strategiesmentioning

confidence: 99%

Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence

Dykgraaf

Matenge

Desborough

et al. 2021

Journal of the American Medical Directors Association

111

116

View full text Add to dashboard Cite

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“…The aim of this study was to retrospectively describe the evolution of symptoms, infections, and mortality at a nursing facility in Val d'Oise (France) that had implemented a protocol for the prevention and treatment of COVID-19. Between 24 January and 3 July 2020, the nursing facility recorded a COVID-19 incidence of 51% based on the presence of one or more COVID-19 symptoms, 35% based on positive RT-PCR (amongst residents tested for RT-PCR) and 41% based on positive serology (amongst residents tested for serology), with a COVID-19 mortality rate of 8%, with incidence due to testing at the lower end of the range reported in the literature for nursing facilities (5,6,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) (Table 5). The most commonly reported COVID-19 symptoms were fever (36%), cough (21%), dyspnea (21%) and asthenia (19%).…”

Section: Discussionmentioning

confidence: 98%

Low mortality from COVID-19 at a nursing facility in France following a combined preventive and active treatment protocol

Worcel¹,

Ali²,

Ramos-Pascual³

et al. 2021

Ann Palliat Med

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Background: The aim of this study was to retrospectively describe the evolution of symptoms, infections, and mortality at a nursing facility in France that had implemented a protocol for the prevention and treatment of COVID-19.Methods: A database was created on 21 March 2020 to store all information related to residents, including co-morbidities, as well as COVID-19 symptoms, incidence, and mortality. Residents followed a COVID-19 protocol, consisting of preventive (administering vitamins and zinc, social distancing, and temperature checks) and active (antibiotics, anticoagulants, and corticosteroids) measures. RT-PCR and serology testing were performed on residents. A new coefficient, named the Zemgor coefficient, was calculated as the haemoglobin-to-albumin ratio at 2 time points 15 days apart, to monitor hypoxemia.Results: In January 2020, the nursing facility housed 192 residents, 75 men and 117 women, aged 80±11.One or more co-morbidities were present in 94% of residents, with the most common being dementia. The COVID-19 protocol provided 61% of residents with anticoagulants, 51%with antibiotics, 21% with oxygen therapy, and 3% with corticosteroids. The COVID-19 incidence was 51% based on presence of COVID-19 symptoms, 35% based on positive RT-PCR (amongst residents tested for RT-PCR) and 41% based on positive serology (amongst residents tested for serology), and the COVID-19 mortality rate was 8%. The Zemgor coefficient was 0.049±0.053 for patients with hypoxemia compared to 0.011±0.041 for patients without hypoxemia (P=0.001). Conclusions:The protocol for the prevention and treatment of COVID-19 implemented at this nursing facility resulted in a COVID-19 incidence and mortality at the lower end of that reported by other nursing facilities.

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“…Data in healthcare workers using serum serologic analysis shows that the presence of IgG antibodies from natural infection substantially reduces the risk of reinfection for the ensuing 6 months 17 . Two studies using serum samples to evaluate seroprevalence for SARS‐CoV‐2 in older adults in nursing homes showed high rates of seroconversion post‐outbreak, though sampling was only conducted on one occasion and therefore no information on duration beyond 5 weeks post‐ infection could be elicited 5,18 . Data in older adults specifically evaluating the duration of positivity beyond 3 months from infection are lacking.…”

Section: Discussionmentioning

confidence: 99%

Evaluating immunity to SARS‐CoV‐2 in nursing home residents using saliva IgG

Katz

Heaney

Pisanic

et al. 2022

J American Geriatrics Society

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Background: SARS-CoV-2 circulating variants coupled with waning immunity pose a significant threat to the long-term care (LTC) population. Our objective was to measure salivary IgG antibodies in residents and staff of an LTC facility to (1) evaluate IgG response in saliva post-natural infection and vaccination and(2) assess its feasibility to describe the seroprevalence over time.Methods: We performed salivary IgG sampling of all residents and staff who agreed to test in a 150-bed skilled nursing facility during three seroprevalence surveys between October 2020 and February 2021. The facility had SARS-CoV-2 outbreaks in May 2020 and November 2020, when 45 of 138 and 37 of 125 residents were infected, respectively; they offered two Federal vaccine clinics in January 2021. We evaluated quantitative IgG in saliva to the Nucleocapsid (N), Spike (S), and Receptor-binding domain (RBD) Antigens of SARS-CoV-2 over time post-infection and post-vaccination. Results: One hundred twenty-four residents and 28 staff underwent saliva serologic testing on one or more survey visits. Over three surveys, the SARS-CoV-2 seroprevalence at the facility was 49%, 64%, and 81%, respectively. IgG to S, RBD, and N Antigens all increased post infection. Post vaccination, the infection naïve group did not have a detectable N IgG level, and N IgG levels for the previously infected did not increase post vaccination (p < 0.001). Fully vaccinated subjects with prior COVID-19 infection had significantly higher RBD and S IgG responses compared with those who were infection-naïve prior to vaccination (p < 0.001 for both).

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Using Serologic Testing to Assess the Effectiveness of Outbreak Control Efforts, Serial Polymerase Chain Reaction Testing, and Cohorting of Positive Severe Acute Respiratory Syndrome Coronavirus 2 Patients in a Skilled Nursing Facility

Cited by 10 publications

References 12 publications

Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence

Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence

Low mortality from COVID-19 at a nursing facility in France following a combined preventive and active treatment protocol

Evaluating immunity to SARS‐CoV‐2 in nursing home residents using saliva IgG

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