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Signs, Symptoms, and Comorbidities Associated With Onset and Prognosis of COVID-19 in a Nursing Home.
Tobolowsky, Farrell A; Bardossy, Ana C; Currie, Dustin W; Schwartz, Noah G; Zacks, Rachael L T; Chow, Eric J; Dyal, Jonathan W; Ali, Hammad; Kay, Meagan; Duchin, Jeffrey S; Brostrom-Smith, Claire; Clark, Shauna; Sykes, Kaitlyn; Jernigan, John A; Honein, Margaret A; Clark, Thomas A; Stone, Nimalie D; Reddy, Sujan C; Rao, Agam K.
  • Tobolowsky FA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; CDC COVID-19 Emergency Response, Atlanta, GA, USA. Electronic address: oqk3@cdc.gov.
  • Bardossy AC; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; CDC COVID-19 Emergency Response, Atlanta, GA, USA. Electronic address: okl1@cdc.gov.
  • Currie DW; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
  • Schwartz NG; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
  • Zacks RLT; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
  • Chow EJ; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
  • Dyal JW; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
  • Ali H; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
  • Kay M; Public Health-Seattle & King County, Seattle, WA, USA.
  • Duchin JS; Public Health-Seattle & King County, Seattle, WA, USA.
  • Brostrom-Smith C; Public Health-Seattle & King County, Seattle, WA, USA.
  • Clark S; Public Health-Seattle & King County, Seattle, WA, USA.
  • Sykes K; Public Health-Seattle & King County, Seattle, WA, USA.
  • Jernigan JA; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
  • Honein MA; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
  • Clark TA; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
  • Stone ND; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
  • Reddy SC; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
  • Rao AK; CDC COVID-19 Emergency Response, Atlanta, GA, USA.
J Am Med Dir Assoc ; 22(3): 498-503, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1099168
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 laboratory-confirmed SARS-CoV-2 during February 28-March 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 28-March 16, 2020, 101 (86%) were found to test positive for SARS-CoV-2. At initial presentation, about two-thirds of SARS-CoV-2-positive 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) 1.0-3.0]. RR of hospitalization was higher for residents with underlying hepatic disease (1.6, 95% CI 1.1-2.2) or obesity (1.5, 95% CI 1.1-2.1); 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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Skilled Nursing Facilities / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Systematic review/Meta Analysis Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: J Am Med Dir Assoc Journal subject: History of Medicine / Medicine Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Skilled Nursing Facilities / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Systematic review/Meta Analysis Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: J Am Med Dir Assoc Journal subject: History of Medicine / Medicine Year: 2021 Document Type: Article