Risk Factors, Presentation, and Course of COVID-19 in a Large, Academic Long-term Care Facility

Shi, Sandra M.; Bakaev, Innokentiy; Chen, Helen; Travison, Thomas G.; Berry, Sarah D.

Abstract Objective To describe clinical characteristics, and risk factors associated with COVID-19 in long-stay nursing home residents. Design and Participants Retrospective cohort study (3/16/2020-5/8/2020). Setting Academic long-term chronic care facility (Boston, MA) Participants Long-term care residents Methods Patient characteristics and clinical symptoms were obtained via electronic medical records and Minimum Data Set. Staff residence was inferred by zip codes. COVID-19 infection was confirmed by polymerase chain reaction testing using nasopharyngeal swabs. Residents were followed until discharge from facility, death, or up to 21 days. Risk of COVID-19 infection were modeled by generalized estimating equation to estimate the relative risk and 95% confidence intervals of patient characteristics and staff community of residence. Results Overall 146 of 389 (37.5%) long-stay residents tested positive for COVID-19. At the time of positive test, 66 of 146 (45.5%) residents were asymptomatic. In the subsequent illness course the most common symptom was anorexia (70.8%), followed by delirium (57.6%). During follow-up 44 (30.1%) of residents with COVID-19 died. Mortality increased with frailty (16.7% in pre-frail, 22.2% in moderately frail, and 50.0% in frail; p<0.001). The proportion of residents infected with COVID-19 varied across the long-term care units (range: 0-90.5%). In adjusted models male sex (RR: 1.80, 95% CI, 1.07, 3.05), bowel incontinence (RR: 1.97, 95% CI 1.10, 3.52), and staff residence remained significant predictors of COVID-19. For every 10% increase in the proportion of staff living in a high prevalence community, the risk of testing positive increased by 6% (95% CI, 1.04, 1.08). Conclusions and Implications Among long-term care residents diagnosed with COVID-19, nearly half were asymptomatic at the time of diagnosis. Predictors of COVID-19 infection included male sex, bowel incontinence and staff residence in a community with a high burden of COVID-19. Universal testing of patients and staff in communities with high COVID-19 rates is essential to mitigating outbreaks.