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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

35 Pages Posted: 13 May 2021

See all articles by Jillian N. Armstrong

Jillian N. Armstrong

Yale University - Department of Epidemiology of Microbial Diseases

Lauren Campbell

Yale University - Department of Epidemiology of Microbial Diseases

Terry Rabatsky-Ehr

Connecticut Department of Public Health

Vivian Leung

Connecticut Department of Public Health

Sunil Parikh

Yale University - Department of Epidemiology of Microbial Diseases

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Abstract

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 current 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 investigated. 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.

Declaration of Interests: None to declare.

Suggested Citation

Armstrong, Jillian N. and Campbell, Lauren and Rabatsky-Ehr, Terry and Leung, Vivian and Parikh, Sunil, Repeat Positive SARS-CoV-2 RNA Testing in Nursing Home Residents During the Initial 9 Months of the COVID-19 Pandemic. Available at SSRN: https://ssrn.com/abstract=3831860 or http://dx.doi.org/10.2139/ssrn.3831860

Jillian N. Armstrong

Yale University - Department of Epidemiology of Microbial Diseases ( email )

New Haven, CT
United States

Lauren Campbell

Yale University - Department of Epidemiology of Microbial Diseases

New Haven, CT
United States

Terry Rabatsky-Ehr

Connecticut Department of Public Health ( email )

Hartford, CT
United States

Vivian Leung

Connecticut Department of Public Health

Hartford, CT
United States

Sunil Parikh (Contact Author)

Yale University - Department of Epidemiology of Microbial Diseases ( email )

New Haven, CT
United States