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Impact of fever thresholds in detection of COVID-19 in Department of Veterans Affairs Community Living Center residents.
Bej, Taissa; Kothadia, Sonya; Wilson, Brigid M; Song, Sunah; Briggs, Janet M; Banks, Richard E; Donskey, Curtis J; Perez, Federico; Jump, Robin L P.
  • Bej T; Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA.
  • Kothadia S; Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  • Wilson BM; Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA.
  • Song S; Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  • Briggs JM; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  • Banks RE; Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  • Donskey CJ; Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA.
  • Perez F; Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA.
  • Jump RLP; Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA.
J Am Geriatr Soc ; 69(11): 3044-3050, 2021 11.
Article in English | MEDLINE | ID: covidwho-1398482
ABSTRACT

BACKGROUND:

Among nursing home residents, for whom age and frailty can blunt febrile responses to illness, the temperature used to define fever can influence the clinical recognition of COVID-19 symptoms. To assess the potential for differences in the definition of fever to characterize nursing home residents with COVID-19 infections as symptomatic, pre-symptomatic, or asymptomatic, we conducted a retrospective study on a national cohort of Department of Veterans Affairs (VA) Community Living Center (CLC) residents tested for SARS-CoV-2.

METHODS:

Residents with positive SARS-CoV-2 tests were classified as asymptomatic if they did not experience any symptoms, and as symptomatic or pre-symptomatic if the experienced a fever (>100.4°F) before or following a positive SARS-CoV-2 test, respectively. All-cause 30-day mortality was assessed as was the influence of a lower temperature threshold (>99.0°F) on classification of residents with positive SARS-CoV-2 tests.

RESULTS:

From March 2020 through November 2020, VA CLCs tested 11,908 residents for SARS-CoV-2 using RT-PCR, with a positivity of rate of 13% (1557). Among residents with positive tests and using >100.4°F, 321 (21%) were symptomatic, 425 (27%) were pre-symptomatic, and 811 (52%) were asymptomatic. All-cause 30-day mortality among residents with symptomatic and pre-symptomatic COVID-19 infections was 24% and 26%, respectively, while those with an asymptomatic infection had mortality rates similar to residents with negative SAR-CoV-2 tests (10% and 5%, respectively). Using >99.0°F would have increased the number of residents categorized as symptomatic at the time of testing from 321 to 773.

CONCLUSIONS:

All-cause 30-day mortality was similar among VA CLC residents with symptomatic or pre-symptomatic COVID-19 infection, and lower than rates reported in non-VA nursing homes. A lower temperature threshold would increase the number of residents recognized as having symptomatic infection, potentially leading to earlier detection and more rapid implementation of therapeutic interventions and infection prevention and control measures.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Skilled Nursing Facilities / Veterans / Fever / COVID-19 Testing / COVID-19 Type of study: Diagnostic study / Etiology study / Observational study / Risk factors Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Am Geriatr Soc Year: 2021 Document Type: Article Affiliation country: Jgs.17415

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Skilled Nursing Facilities / Veterans / Fever / COVID-19 Testing / COVID-19 Type of study: Diagnostic study / Etiology study / Observational study / Risk factors Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Am Geriatr Soc Year: 2021 Document Type: Article Affiliation country: Jgs.17415