Atypical clinical presentation of COVID-19 infection in residents of a long-term care facility

Eur Geriatr Med. 2020 Dec;11(6):1085-1088. doi: 10.1007/s41999-020-00352-9. Epub 2020 Oct 6.

Abstract

Purpose: To assess the magnitude of the infection in residents from-and staff working in-a long-term-care facility (LTCF) 7 days after the identification of one resident with confirmed COVID-19 infection and to assess the clinical presentation of the infected residents.

Methods: All residents and staff members of a LTCF were tested for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction on nasopharyngeal swab. Residents were studied clinically 4 weeks after the first COVID diagnosis.

Results: Thirty-eight of the 79 residents (48.1%) tested positive for SARS-CoV-2. Respiratory symptoms were preceded by diarrhea (26.3%), a fall (18.4%), fluctuating temperature with hypothermia (34.2%) and delirium in one resident. Respiratory symptoms, including cough and oxygen desaturation, appeared after those initial symptoms or as the first sign in 36.8% and 52.2%, respectively. At any time of the disease, fever was observed in 65.8%. Twelve deaths occurred among the COVID-19 residents. Among the 41 residents negative for SARS-CoV-2, symptoms included cough (21.9%), diarrhea (7.3%), fever (21.9%), hypothermia (9.7%), and transient hypoxemia (9.8%). No deaths were observed in this group. 27.5% of the workers were also COVID-19 positive.

Conclusion: The rapid dissemination of the COVID-19 infection may be explained by the delay in the diagnosis of the first cases due to atypical presentation. Early recognition of symptoms compatible with COVID-19 may help to diagnose COVID-19 residents earlier and test for SARS-CoV-2 symptomatic and asymptomatic staff and residents earlier to implement appropriate infection control practices.

Keywords: COVID-19; Long-term-care facility; Testing for SARS-CoV-2; rRT-PCR.

Publication types

  • Observational Study

MeSH terms

  • Accidental Falls
  • Aged
  • Aged, 80 and over
  • COVID-19 / diagnosis*
  • COVID-19 / epidemiology*
  • COVID-19 / mortality
  • COVID-19 / physiopathology
  • COVID-19 Nucleic Acid Testing
  • Delayed Diagnosis
  • Diarrhea
  • Female
  • Health Personnel
  • Humans
  • Long-Term Care*
  • Male
  • Pandemics
  • Polymerase Chain Reaction
  • SARS-CoV-2 / genetics
  • Skilled Nursing Facilities*