SARS‐CoV‐2 antibody detection in skilled nursing facility residents

White, Elizabeth M.; Saade, Elie A.; Yang, Xiaofei; Canaday, David H.; Blackman, Carolyn; Santostefano, Christopher M.; Nanda, Aman; Feifer, Richard A.; Mor, Vincent; Rudolph, James L.; Gravenstein, Stefan

OBJECTIVE: To describe the frequency and timing of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibody detection in a convenience sample of skilled nursing facility (SNF) residents with and without confirmed SARS‐CoV‐2 infection. DESIGN: Retrospective analysis of SNF electronic health records. SETTING: Qualitative SARS‐CoV‐2 antibody test results were available from 81 SNFs in 16 states. PARTICIPANTS: Six hundred and sixty nine SNF residents who underwent both polymerase chain reaction (PCR) and antibody testing for SARS‐CoV‐2. MEASUREMENTS: Presence of SARS‐CoV‐2 antibodies following the first positive PCR test for confirmed cases, or first PCR test for non‐cases. RESULTS: Among 397 residents with PCR‐confirmed infection, antibodies were detected in 4 of 7 (57.1%) tested within 7–14 days of their first positive PCR test; in 44 of 47 (93.6%) tested within 15–30 days; in 182 of 219 (83.1%) tested within 31–60 days; and in 110 of 124 (88.7%) tested after 60 days. Among 272 PCR negative residents, antibodies were detected in 2 of 9 (22.2%) tested within 7–14 days of their first PCR test; in 41 of 81 (50.6%) tested within 15–30 days; in 65 of 148 (43.9%) tested within 31–60 days; and in 9 of 34 (26.5%) tested after 60 days. No significant differences in baseline resident characteristics or symptoms were observed between those with versus without antibodies. CONCLUSIONS: These findings suggest that vulnerable older adults can mount an antibody response to SARS‐CoV‐2, and that antibodies are most likely to be detected within 15–30 days of diagnosis. That antibodies were detected in a large proportion of residents with no confirmed SARS‐CoV‐2 infection highlights the complexity of identifying who is infected in real time. Frequent surveillance and diagnostic testing based on low thresholds of clinical suspicion for symptoms and/or exposure will remain critical to inform strategies designed to mitigate outbreaks in SNFs while community SARS‐CoV‐2 prevalence remains high.