Efficacy of a Test-Retest Strategy in Residents and Health Care Personnel of a Nursing Home Facing a COVID-19 Outbreak

• Published in: Journal of the American Medical Directors Association Vol. 21; no. 7; p. 933
• Main Authors: Blain, Hubert, Rolland, Yves, Tuaillon, Edouard, Giacosa, Nadia, Albrand, Mylène, Jaussent, Audrey, Benetos, Athanase, Miot, Stéphanie, Bousquet, Jean
• Format: Journal Article
• Language: English
• Published: United States 01.07.2020
• Subjects: Antibodies, Viral - analysis; Clinical Laboratory Techniques - methods; Clinical Laboratory Techniques - statistics & numerical data; Contact Tracing - methods; Contact Tracing - statistics & numerical data; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; COVID-19; COVID-19 Testing; COVID-19 Vaccines; Disease Outbreaks - prevention & control; DNA, Viral - analysis; Female; Health Personnel - statistics & numerical data; Humans; Infectious Disease Transmission, Vertical - prevention & control; Male; Nursing Homes - organization & administration; Occupational Health - statistics & numerical data; Outcome Assessment, Health Care; Pandemics; Patient Safety - statistics & numerical data; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Real-Time Polymerase Chain Reaction - methods; Skilled Nursing Facilities - organization & administration; United States - epidemiology; United States; COVID-19; nursing home; antibodies against SARS-CoV-2; rRT-PCR
• DOI: 10.1016/j.jamda.2020.06.013

To assess the American Testing Guidance for Nursing Homes (NHs)-updated May 19, 2020-with a new COVID-19 case. Case investigation. All 79 residents and 34 health care personnel (HCP) of an NH. Seven days after identification of a COVID-19 resident, all residents and HCP underwent real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) testing for SARS-CoV-2 with nasopharyngeal swabs. This was repeated weekly in all previously negative subjects until the testing identified no new cases, and in all positive subjects until the testing was negative. COVID-19 infection prevention and control (IPC) measures were implemented in all residents and HCP with positive testing or with COVID-19 symptoms. Standard IPC was also implemented in all HCP. Six weeks after initial testing, all residents underwent testing for enzyme-linked immunosorbent assay-based IgG antibodies directed against the SARS-CoV-2. Symptoms were serially recorded in residents and HCP. A total of 36 residents had a positive rRT-PCR at baseline and 2 at day 7. Six HCP had a positive rRT-PCR at baseline and 2 at day 7. No new COVID-19 cases were diagnosed later. Among the SARS-CoV-2-positive cases, 6 residents (16%) and 3 HCP (37%) were asymptomatic during the 14 days before testing. Twenty-five residents (92.3%) and all 8 HCP (100%) with a positive rRT-PCR developed IgG antibodies against SARS-CoV-2. Among the residents and HCP always having tested negative, 2 (5%) and 5 (11.5%), respectively, developed IgG antibodies against SARS-CoV-2. These 2 residents had typical COVID-19 symptoms before and after testing and 2/5 HCP were asymptomatic before and after testing. This study shows the validity of the updated American Testing Guidance for Nursing Homes (NHs). It suggests implementing COVID-19 IPC in both residents and HCP with positive testing or COVID-19 symptoms and warns that asymptomatic HCP with repeated negative rRT-PCR testing can develop antibodies against SARS-CoV-2.