Outcomes of nursing home COVID-19 patients by initial symptoms and comorbidity: Results of universal testing of 1,970 residents

Objective Clinical implications of asymptomatic cases of the novel coronavirus disease 2019 (COVID-19) in nursing homes remain poorly understood We assessed the association of symptom status and medical comorbidities on mortality and hospitalization risk associated with COVID-19 in residents of a large nursing home system Design Retrospective cohort study Setting and Participants 1,970 residents from 15 nursing home facilities with universal COVID-19 testing in Maryland Methods We used descriptive statistics to compare baseline characteristics, logistic regression to assess the association of comorbidities with COVID-19, and Cox regression to assess the association of asymptomatic and symptomatic COVID-19 with mortality and hospitalization We assessed the association of comorbidities with mortality and hospitalization risk Symptom status was assessed at the time of the first test Maximum follow-up was 94 days Results Among the 1,970 residents (mean age 73 8, 57% female, 68% Black), 752 (38 2%) were positive on their first test Residents who were positive for COVID-19 and had multiple symptoms at the time of testing had the highest risk of mortality (HR 4 44;95% CI: 2 97, 6 65) and hospitalization (SHR 2 38;95% CI: 1 70, 3 33), even after accounting for comorbidity burden Cases who were asymptomatic at testing had a higher risk of mortality (HR 2 92;95% CI: 1 95, 4 35), but not hospitalization (HR 1 06;95% CI: 0 82, 1 38) compared to those who were negative for COVID-19 Of 52 SARS-CoV-2 positive residents who were asymptomatic at the time of testing and were closely monitored for 14 days at one facility, only 6 (11 6%) developed symptoms Conclusions and Implications Asymptomatic infection with SARS-CoV-2 in the nursing home setting was associated with increased risk of death suggesting a need for closer monitoring of these residents, particularly those with underlying cardiovascular and respiratory comorbidities