Rates of asymptomatic SARS-CoV-2 infection in skilled nursing facilities are high
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Researchers found high rates of asymptomatic and presymptomatic SARS-CoV-2 infections in a multistate sample of skilled nursing facilities between March and July.
The findings highlight the importance of universal COVID-19 testing to identify and isolate cases of the disease, Elizabeth M. White, PhD, APRN, an investigator in the department of health services, policy and practice at Brown University School of Public Health, and colleagues wrote in JAMA Internal Medicine.
The researchers analyzed data collected from March 16 to July 15 at 182 skilled nursing facilities across the United States. Residents were deemed symptomatic if, at presentation, they had new symptoms within 5 days prior to their first positive test date; presymptomatic if they had no symptoms in the 5 days before testing but developed symptoms in the 14 days following testing; and asymptomatic if they had no symptoms from 5 days pretest to 14 days posttest.
According to White and colleagues, there were 5,403 unique SARS-CoV-2 cases among residents at presentation (symptomatic, 40.3%; presymptomatic, 19.1%; and asymptomatic, 40.6%).
Among 173 skilled nursing facilities that underwent at least one facility-wide survey, there were “slightly higher” cumulative rates of asymptomatic and presymptomatic infection than the remaining facilities, which only conducted unit-based surveys. The researchers wrote that the facilities in counties with higher SARS-CoV-2 prevalence generally had higher combined counts of asymptomatic and presymptomatic cases during the first survey than facilities in counties with lower prevalence. The 173 facilities accounted for 5,011 of the reported cases at presentation (symptomatic, 39.8%; presymptomatic, 19.3%; and asymptomatic, 40.9%). The remaining cases were from facilities that only conducted unit-based testing (symptomatic, 46.7%; presymptomatic, 16.3%; and asymptomatic, 37%.)
The findings “build on emerging evidence” that skilled nursing facilities represent “an important predictor of outbreaks,” White and colleagues wrote.