Repeat positive SARS-CoV-2 RNA testing in nursing home residents during the initial 9 months of the COVID-19 pandemic: an observational retrospective analysis

Background: Nursing homes are high-risk COVID-19 settings with residents who are typically older and have multiple comorbidities. SARS-CoV-2 testing occurs frequently in nursing homes, with public health guidance suggesting that repeat testing is generally not warranted in the 90 days following init...

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Autores principales:	Jillian N. Armstrong, M.S., Lauren Campbell, B.S., Terry Rabatsky-her, MPH, Vivian Leung, MD, Sunil Parikh, MD, MPH
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	SARS-CoV-2 COVID-19 diagnosis RT-PCR reinfection Nursing Homes Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/19f55dcc7ffb4155bd37d862011e3e2c
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spelling	oai:doaj.org-article:19f55dcc7ffb4155bd37d862011e3e2c2021-11-12T04:50:21ZRepeat positive SARS-CoV-2 RNA testing in nursing home residents during the initial 9 months of the COVID-19 pandemic: an observational retrospective analysis2667-193X10.1016/j.lana.2021.100054https://doaj.org/article/19f55dcc7ffb4155bd37d862011e3e2c2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2667193X21000466https://doaj.org/toc/2667-193XBackground: Nursing homes are high-risk COVID-19 settings with residents who are typically older and have multiple comorbidities. SARS-CoV-2 testing occurs frequently in nursing homes, with public health guidance suggesting that repeat testing is generally not warranted in the 90 days following initial positive test results. Interpretation of repeat positive tests beyond 90 days is challenging and the consequences of decisions following these tests are significant. Methods: We utilized a surveillance system for COVID-19 to identify Connecticut nursing home residents who tested positive for SARS-CoV-2 by RNA-based testing ≥ 90 days after initial positive results. We analyzed statewide nursing home testing data over a 9-month period, from the first Connecticut nursing home case identified on March 15 through December 15, 2020, when nursing home COVID-19 vaccinations began in Connecticut. Findings: We identified 156 residents (median age 75 years) with positive RNA-based PCR tests occurring ≥90 days after an initial positive test. Residents with repeat positives tests represented approximately 2.6% (156/6,079) of nursing home residents surviving beyond 90 days of their initial SARS-CoV-2 diagnosis statewide since the start of the pandemic, with a median time to repeat positivity of 135 days (range 90–245 days). Deaths were reported in 12.8% (20/156) of residents following the repeat positive test, with 80% (16/20) having one or more intervening negative RT-PCR tests prior to the repeat positive test. Interpretation: Our analysis suggests that repeat positive testing in nursing home populations may exceed those reported in younger age groups. Repeat positive tests beyond 90 days may accompany severe outcomes, and should be prospectively investigated with genomic, virologic and additional data, when feasible. Data shed light on the duration of protective immunity following natural infection in this subset of largely elderly and medically frail individuals. Funding: This work was conducted in the context of the Connecticut DPH COVID-19 response and not supported by specific funding.Jillian N. Armstrong, M.S.Lauren Campbell, B.S.Terry Rabatsky-her, MPHVivian Leung, MDSunil Parikh, MD, MPHElsevierarticleSARS-CoV-2COVID-19diagnosisRT-PCRreinfectionNursing HomesPublic aspects of medicineRA1-1270ENThe Lancet Regional Health. Americas, Vol 3, Iss , Pp 100054- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	SARS-CoV-2 COVID-19 diagnosis RT-PCR reinfection Nursing Homes Public aspects of medicine RA1-1270
spellingShingle	SARS-CoV-2 COVID-19 diagnosis RT-PCR reinfection Nursing Homes Public aspects of medicine RA1-1270 Jillian N. Armstrong, M.S. Lauren Campbell, B.S. Terry Rabatsky-her, MPH Vivian Leung, MD Sunil Parikh, MD, MPH Repeat positive SARS-CoV-2 RNA testing in nursing home residents during the initial 9 months of the COVID-19 pandemic: an observational retrospective analysis
description	Background: Nursing homes are high-risk COVID-19 settings with residents who are typically older and have multiple comorbidities. SARS-CoV-2 testing occurs frequently in nursing homes, with public health guidance suggesting that repeat testing is generally not warranted in the 90 days following initial positive test results. Interpretation of repeat positive tests beyond 90 days is challenging and the consequences of decisions following these tests are significant. Methods: We utilized a surveillance system for COVID-19 to identify Connecticut nursing home residents who tested positive for SARS-CoV-2 by RNA-based testing ≥ 90 days after initial positive results. We analyzed statewide nursing home testing data over a 9-month period, from the first Connecticut nursing home case identified on March 15 through December 15, 2020, when nursing home COVID-19 vaccinations began in Connecticut. Findings: We identified 156 residents (median age 75 years) with positive RNA-based PCR tests occurring ≥90 days after an initial positive test. Residents with repeat positives tests represented approximately 2.6% (156/6,079) of nursing home residents surviving beyond 90 days of their initial SARS-CoV-2 diagnosis statewide since the start of the pandemic, with a median time to repeat positivity of 135 days (range 90–245 days). Deaths were reported in 12.8% (20/156) of residents following the repeat positive test, with 80% (16/20) having one or more intervening negative RT-PCR tests prior to the repeat positive test. Interpretation: Our analysis suggests that repeat positive testing in nursing home populations may exceed those reported in younger age groups. Repeat positive tests beyond 90 days may accompany severe outcomes, and should be prospectively investigated with genomic, virologic and additional data, when feasible. Data shed light on the duration of protective immunity following natural infection in this subset of largely elderly and medically frail individuals. Funding: This work was conducted in the context of the Connecticut DPH COVID-19 response and not supported by specific funding.
format	article
author	Jillian N. Armstrong, M.S. Lauren Campbell, B.S. Terry Rabatsky-her, MPH Vivian Leung, MD Sunil Parikh, MD, MPH
author_facet	Jillian N. Armstrong, M.S. Lauren Campbell, B.S. Terry Rabatsky-her, MPH Vivian Leung, MD Sunil Parikh, MD, MPH
author_sort	Jillian N. Armstrong, M.S.
title	Repeat positive SARS-CoV-2 RNA testing in nursing home residents during the initial 9 months of the COVID-19 pandemic: an observational retrospective analysis
title_short	Repeat positive SARS-CoV-2 RNA testing in nursing home residents during the initial 9 months of the COVID-19 pandemic: an observational retrospective analysis
title_full	Repeat positive SARS-CoV-2 RNA testing in nursing home residents during the initial 9 months of the COVID-19 pandemic: an observational retrospective analysis
title_fullStr	Repeat positive SARS-CoV-2 RNA testing in nursing home residents during the initial 9 months of the COVID-19 pandemic: an observational retrospective analysis
title_full_unstemmed	Repeat positive SARS-CoV-2 RNA testing in nursing home residents during the initial 9 months of the COVID-19 pandemic: an observational retrospective analysis
title_sort	repeat positive sars-cov-2 rna testing in nursing home residents during the initial 9 months of the covid-19 pandemic: an observational retrospective analysis
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/19f55dcc7ffb4155bd37d862011e3e2c
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Repeat positive SARS-CoV-2 RNA testing in nursing home residents during the initial 9 months of the COVID-19 pandemic: an observational retrospective analysis

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