Clinical Suspicion – Symptoms and Mortality

Angie Szumlinski Studies

In a recent study published in the Journal of American Medical Directors Association, residents in nursing homes were evaluated to describe symptomatology, mortality, and risk factors for mortality related to COVID-19. Data was collected from residents with clinically-suspected COVID-19, via electronic health records and registration was performed on diagnostic status (confirmed COVID-19+/ruled out COVID-19-) and symptomatology (typical and atypical symptoms).

In the sample of residents with clinically-suspected COVID-19, COVID-19 was confirmed in 1,538 residents (38%). Although symptomatology overlapped between residents with COVID-19+ and COVID-19-, those testing positive for COVID-19 were three times more likely to die within 30 days. Within this group, mortality was higher for men than for women and it was observed that there was higher mortality for residents with dementia, reduced kidney function, and Parkinson’s Disease, even when corrected for age, gender and comorbidities.

About 40% of the residents with clinically-suspected COVID-19 actually had COVID-19, based on the RT-PCR test. Despite an overlap in symptomatology, mortality rate was three times higher for residents with COVID-19+. This emphasizes the importance of using low-threshold testing in nursing home residents which is an essential prerequisite to using limited personal protective equipment and isolation measures efficiently.

Lots of words, lots of research, bottom line, practice safely, maintain PPE and transmission-based precautions per CDC guidelines, and keep your staff safe.

Stay the course, stay strong, stay well, mask up, and stay tuned!