LAUSR

Background Effective halting of outbreaks in Skilled Nursing Facilities (SNFs) depends on the earliest recognition of cases. We assessed confirmed COVID-19 cases at a SNF impacted by COVID-19 in the United States to identify early indications of COVID-19 infection. Methods We performed retrospective reviews of electronic health records for residents with laboratory-confirmed SARS-CoV-2 during February 28–March 16, 2020. Records were abstracted for co-morbidities, signs and symptoms, and illness outcomes during the two weeks before and after the date of positive specimen collection. Relative Risks (RR) of hospitalization and death were calculated. Results Of the 118 residents tested among approximately 130 residents from Facility A during February 28 – March 16, 2020, 101 (86%) were found to test positive for SARS-CoV-2. At initial presentation, about two thirds of SARS-Cov-2-positive residents had an abnormal vital sign or change in oxygen status. Most (90.2%) symptomatic residents had elevated temperature, change in mental status, lethargy, change in oxygen status, or cough; nine (11.0%) did not have fever, cough, or shortness of breath during their clinical course. Those with change in oxygen status had an increased relative risk of 30-day mortality (51.1% vs. 29.7%, RR: 1.7 [1.0-3.0]). RR of hospitalization was higher for residents with underlying hepatic disease (1.6 [95% CI: 1.1-2.2]) or obesity (1.5 [95% CI: 1.1-2.1]); RR of death was not statistically significant. Conclusions and implications Our findings reinforce the critical role that monitoring of signs and symptoms can have in identifying COVID-19 cases early. SNFs should ensure they have a systematic approach for responding to abnormal vital signs and oxygen saturation and consider ensuring common signs and symptoms identified in Facility A are among those they monitor.