Atypical symptoms, SARS-CoV-2 test results and immunisation rates in 456 residents from eight nursing homes facing a COVID-19 outbreak

• Published in: Age and ageing Vol. 50; no. 3; pp. 641 - 648
• Main Authors: Blain, Hubert, Gamon, Lucie, Tuaillon, Edouard, Pisoni, Amandine, Giacosa, Nadia, Albrand, Mylène, Miot, Stéphanie, Rolland, Yves, Picot, Marie-Christine, Bousquet, Jean
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.05.2021; Oxford Publishing Limited (England); Oxford University Press (OUP)
• Subjects: Anorexia; Antibodies; Asymptomatic; Atypical; Behavior change; Chemical analysis; Coronaviruses; COVID-19; Disease control; Fatigue; Frail; Geriatry and gerontology; Human health and pathology; Immunization; Immunoglobulin G; Infectious diseases; Life Sciences; Nucleocapsids; Nursing homes; Older people; Oxygen; Polymerase chain reaction; Professional identity; Research Paper; Saturation; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Symptoms; Tests; Unexplained; COVID-19; symptoms; testing for SARS-CoV-2; antibodies; older people; immunisation; nursing homes; rRT-PCR
• ISSN: 0002-0729; 1468-2834; 1468-2834
• DOI: 10.1093/ageing/afab050

Background Frail older persons may have an atypical presentation of coronavirus disease 2019 (COVID-19). The value of real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) testing for identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nursing homes (NHs) residents is not known. Objective To determine whether (i) atypical symptoms may predict rRT-PCR results and (ii) rRT-PCR results may predict immunisation against SARS-CoV-2 in NH residents. Design A retrospective longitudinal study. Setting Eight NHs with at least 10 rRT-PCR-positive residents. Subjects A total of 456 residents. Methods Typical and atypical symptoms recorded in residents’ files during the 14 days before and after rRT-PCR testing were analysed. Residents underwent blood testing for IgG-SARS-CoV-2 nucleocapsid protein 6 to 8 weeks after testing. Univariate and multivariate analyses compared symptoms and immunisation rates in rRT-PCR-positive and negative residents. Results A total of 161 residents had a positive rRT-PCR (35.3%), 17.4% of whom were asymptomatic before testing. Temperature >37.8°C, oxygen saturation <90%, unexplained anorexia, behavioural change, exhaustion, malaise and falls before testing were independent predictors of a further positive rRT-PCR. Among the rRT-PCR-positive residents, 95.2% developed SARS-CoV-2 antibodies vs 7.6% in the rRT-PCR-negative residents. Among the residents with a negative rRT-PCR, those who developed SARS-CoV-2 antibodies more often had typical or atypical symptoms (P = 0.02 and <0.01, respectively). Conclusion This study supports a strategy based on (i) testing residents with typical or unexplained atypical symptoms for an early identification of the first SARS-CoV-2 cases, (ii) rT-PCR testing for identifying COVID-19 residents, (iii) repeated wide-facility testing (including asymptomatic cases) as soon as a resident is tested positive for SARS-CoV-2 and (iv) implementing SARS-CoV-2 infection control measures in rRT-PCR-negative residents when they have unexplained typical or atypical symptoms.