key: cord-0888768-dd02ghw3
authors: Malara, Alba; Noale, Marianna; Abbatecola, Angela Marie; Borselli, Gilda; Cafariello, Carmine; Fumagalli, Stefano; Gareri, Pietro; Mossello, Enrico; Trevisan, Caterina; Volpato, Stefano; Monzani, Fabio; Coin, Alessandra; Bellelli, Giuseppe; Okoye, Chukwuma; Del Signore, Susanna; Zia, Gianluca; Incalzi, Raffaele Antonelli
title: Clinical features of SARS-CoV-2 infection in Italian Long-Term Care Facilities: GeroCovid LTCFs Observational Study
date: 2021-10-23
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2021.10.009
sha: f6653ff92815eeb1ffe01b29b13b46ef4b92439d
doc_id: 888768
cord_uid: dd02ghw3

nan

LTCFs Observational Study 2 3

The burden of Covid-19 in Long Term Care Facilities (LTCs) was high worldwide. According to an 4 Italian national survey, during the first pandemic wave, of the 33.8% of residents who died with 5

Covid-19 like symptoms, only 7.4% had tested positive to a SARS-CoV-2 swab test because of 6 limitations in accessing diagnostic tests 1 . The prevalence of frailty, multimorbidity and dementia 2-3 , 7 as well as the frequent atypical or asymptomatic manifestations of Covid-19 in such population 4 , 8 were some of the factors that contributed to the spread of the infection in this setting. The picture was 9 further complicated by the fact that a substantial number of residents suffered from conditions that 10 mimic SARS-CoV-2 infection 5 . In this study, we aimed to investigate the clinical features associated 11 with SARS-CoV-2 infection and mortality due to Covid-19 in Italian LTCFs. As reported in Table 1 , SARS-CoV-2 positive residents were older compared to both SARS-CoV-2

Concerning the patterns of chronic diseases, we found that dementia or cognitive impairment, central 36 and peripheral arterial disease were more prevalent in SARS-CoV-2 positive residents compared to 37 SARS-CoV-2 negative groups; arterial hypertension, cardiomyopathy, osteoarthrosis and poor 38 nutritional status were more prevalent in SARS-CoV-2 negative residents with suspicious symptoms 39 compared to SARS-CoV-2 asymptomatic and SARS-CoV-2 positive residents. The mortality of 40 SARS-CoV-2 positive residents was 21.6%, compared to 10.8% among SARS-CoV-2 negative 41 symptomatic residents (HR=0.27, 95%CI 0.12-0.59, p=0.001) , and 1.8% among SARS-CoV-2 42 negative asymptomatic residents (HR=0.07, 95%CI 0.02-0.25, p=0.001). 43

Our results are partly in line with those of previous works. For instance, the frequency of hypertension 44 among Covid-19 patients enrolled in other studies ranged between 15% and 35% 7 . In our sample, the 45 lower prevalence of hypertension found among SARS-CoV-2 positive residents compared to 46 symptomatic or asymptomatic negative individuals, may be interpreted as part of the phenomenon of 47 "reverse epidemiology", i.e. some degrees of hypertension may protect against all-cause mortality 8 . 48

On the other hand, asymptomatic SARS-CoV-2 negative residents with a history of close contact had 49 a lowest prevalence of neurological diseases, dementia, and malnutrition, while SARS-CoV-2 50 positive individuals appeared to be more likely to present such conditions. As already underlined by 51 previous study, our data support the higher risk that individuals with dementia may have in getting 52 SARS-CoV-2 infection 9 . Finally, worthy of interest is the high mortality found among SARS-CoV-2 53 negative symptomatic residents, who were likely to have experienced non-SARS CoV-2 infections 54 or exacerbations of their chronic conditions. Overall, these findings suggest that attributing death to 55

Covid-19 only based on epidemiological or clinical criteria, without confirmation by nasopharyngeal 56 swab test, may be misleading and probably contributed to overestimating Covid-19 related mortality 57 in LTCs setting, especially during the first pandemic wave. 58 59 60 Abbreviations: SD, Standard Deviation; Q1, Quartile 1; Q3, Quartile 3.

*: Ischaemic, valvulopathy or arrhythmia; **: or other bronchopneumopathies § : information before COVID-19 incidence

Presymptomatic SARS-CoV-2 infections and 73 transmission in a skilled nursing facility

Clinical Suspicion of COVID-19 in Nursing Home 75 Residents: Symptoms and Mortality Risk Factors

COVID-19 on the health of geriatric patients: The European GeroCovid Observational Study

COVID-19 and arterial hypertension: Hypothesis or 81 evidence?

Risk Factors in the Geriatric Population

Dementia and Parkinson's Disease: Risk Factors for 30-Day Mortality in 85 Nursing Home Residents with COVID-19