Absence of COVID-19 Disease Among Chronically Ventilated Nursing Home Patients

Objective To describe the experience of COVID-19 disease among chronically ventilated and non-ventilated nursing home patients living in three separate nursing homes. Design Observational study of death, respiratory illness and COVID-19 polymerase chain reaction (PCR) results among residents and staff during nursing home outbreaks in 2020. Setting and Participants 93 chronically ventilated nursing home patients and 1151 non-ventilated patients living among three separate nursing homes on Long Island, New York as of March 15, 2020. Illness, PCR results, and antibody studies among staff are also reported. Measurements Death rate among chronically ventilated and non-ventilated patients between March 15 and May 15, 2020 compared to the same time in 2019. Prevalence of PCR positivity among ventilated and non-ventilated patients in 2020. Reported illness, PCR positivity and antibody among staff. Results Total numbers of deaths among chronically ventilated nursing home patients during this timeframe were similar to the analogous period 1 year earlier (9 of 93 in 2020 versus 8 of 100 in 2019 p=0.8) whereas deaths among non-ventilated patients were greatly increased (214 of 1151 in 2020 versus 55 of 1189 in 2019, p<0.0001). No ventilated patient deaths were clinically judged to be COVID-19 related. No clusters of COVID-19 illness could be demonstrated among ventilated patients. Surveillance PCR testing of ventilator patients failed to reveal COVID-19 positivity (none of 84 ventilator patients versus 81 of 971 non-ventilator patients, p=0.0002). Illness and evidence of COVID-19 infection was demonstrated among staff working both in non-ventilator and in ventilator units. Conclusions and Implications COVID-19 infection resulted in illness and death among non-ventilated nursing home residents as well as among staff. This was not observed among chronically ventilated patients. The mechanics of chronic ventilation appears to protect chronically ventilated patients from COVID-19 disease.