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Are presymptomatic SARS-CoV-2 infections in nursing home residents unrecognised symptomatic infections? Sequence and metadata from weekly testing in an extensive nursing home outbreak.
van den Besselaar, Judith H; Sikkema, Reina S; Koene, Fleur M H P A; van Buul, Laura W; Oude Munnink, Bas B; Frénay, Ine; Witt, René Te; Koopmans, Marion P G; Hertogh, Cees M P M; Buurman, Bianca M.
  • van den Besselaar JH; Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, 1105 AZ Amsterdam, the Netherlands.
  • Sikkema RS; Department of Viroscience, Erasmus Medical Center, 3015 CN Rotterdam, the Netherlands.
  • Koene FMHPA; Department of Medical Microbiology, Amsterdam University Medical Center, 1105 AZ Amsterdam, the Netherlands.
  • van Buul LW; Department of Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, 1018WT Amsterdam, The Netherlands.
  • Oude Munnink BB; Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, 1081 BT Amsterdam, The Netherlands.
  • Frénay I; Department of Viroscience, Erasmus Medical Center, 3015 CN Rotterdam, the Netherlands.
  • Witt RT; Regional Laboratory for Medical microbiology (RLM) Dordrecht- Gorinchem, 3318 AT Dordrecht, The Netherlands.
  • Koopmans MPG; Eurofins|NMDL-LCPL, 2280 CA Rijswijk, The Netherlands.
  • Hertogh CMPM; Department of Viroscience, Erasmus Medical Center, 3015 CN Rotterdam, the Netherlands.
  • Buurman BM; Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, 1081 BT Amsterdam, The Netherlands.
Age Ageing ; 50(5): 1454-1463, 2021 09 11.
Article in English | MEDLINE | ID: covidwho-1406457
ABSTRACT

BACKGROUND:

Sars-CoV-2 outbreaks resulted in a high case fatality rate in nursing homes (NH) worldwide. It is unknown to which extent presymptomatic residents and staff contribute to the spread of the virus.

AIMS:

To assess the contribution of asymptomatic and presymptomatic residents and staff in SARS-CoV-2 transmission during a large outbreak in a Dutch NH.

METHODS:

Observational study in a 185-bed NH with two consecutive testing strategies testing of symptomatic cases only, followed by weekly facility-wide testing of staff and residents regardless of symptoms. Nasopharyngeal and oropharyngeal testing with RT-PCR for SARs-CoV-2, including sequencing of positive samples, was conducted with a standardised symptom assessment.

RESULTS:

185 residents and 244 staff participated. Sequencing identified one cluster. In the symptom-based test strategy period, 3/39 residents were presymptomatic versus 38/74 residents in the period of weekly facility-wide testing (P-value < 0.001). In total, 51/59 (91.1%) of SARS-CoV-2 positive staff was symptomatic, with no difference between both testing strategies (P-value 0.763). Loss of smell and taste, sore throat, headache or myalga was hardly reported in residents compared to staff (P-value <0.001). Median Ct-value of presymptomatic residents was 21.3, which did not differ from symptomatic (20.8) or asymptomatic (20.5) residents (P-value 0.624).

CONCLUSIONS:

Symptoms in residents and staff are insufficiently recognised, reported or attributed to a possible SARS-CoV-2 infection. However, residents without (recognised) symptoms showed the same potential for viral shedding as residents with symptoms. Weekly testing was an effective strategy for early identification of SARS-Cov-2 cases, resulting in fast mitigation of the outbreak.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Observational study / Prognostic study Limits: Humans Language: English Journal: Age Ageing Year: 2021 Document Type: Article Affiliation country: Ageing

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Observational study / Prognostic study Limits: Humans Language: English Journal: Age Ageing Year: 2021 Document Type: Article Affiliation country: Ageing