Efficacy of a Test-Retest Strategy in Residents and Health Care Personnel of a Nursing Home facing a COVID-19 Outbreak

Objective To assess the American Testing Guidance for Nursing Homes (NHs) - updated May 19, 2020 - with a new COVID-19 case Design Case investigation Setting and Subjects: All 79 residents and 34 Health Care Personnel (HCP) of a NH Methods 7 days after identification of a COVID-19 resident, all residents and HCP underwent rRT-PCR testing for SARS-CoV-2 with nasopharyngeal swabs This was repeated weekly in all previously negative subjects until the testing identified no new cases and in all positive subjects until the testing was negative COVID-19 infection prevention and control (IPC) measures were implemented in all residents and HCP with positive testing or with COVID-19 symptoms Standard IPC was also implemented in all HCP Six weeks after initial testing, all residents underwent testing for ELISA-based IgG antibodies directed against the SARS-CoV-2 Symptoms were serially recorded in residents and HCP Results 36 residents had a positive RT-PCR at baseline and two at day 7 Six HCP had a positive RT-PCR at baseline and two at day 7 No new COVID-19 cases were diagnosed later Among the SARS-CoV-2-positive cases, six residents (16%) and three HCP (37%) were asymptomatic during the 14 days before testing Twenty-five residents (92 3%) and all 8 HCP (100%) with a positive RT-PCR developed IgG antibodies against SARS-CoV-2 Among the residents and HCP always having tested negative, 2 (5%) and 5 (11 5%) developed IgG antibodies against SARS-CoV-2 These 2 residents had typical COVID-19 symptoms before and after testing and 2/5 HCP were asymptomatic before and after testing Conclusions and Implications This study shows the validity of the updated American Testing Guidance for Nursing Homes (NHs) It suggests implementing COVID-19 IPC in both residents and HCP with positive testing or COVID-19 symptoms and warns that asymptomatic HCP with repeated negative RT-PCR testing can develop antibodies against SARS-CoV-2