Management and outcomes of a COVID-19 outbreak in a nursing home with predominantly Black residents

J Am Geriatr Soc. 2021 May;69(5):1155-1165. doi: 10.1111/jgs.17126. Epub 2021 Mar 24.

Abstract

Background/objectives: Few studies present clinical management approaches and outcomes of coronavirus disease 2019 (COVID-19) outbreaks in skilled nursing facilities (SNFs). We describe outcomes of a clinical management pathway for a large COVID-19 outbreak in an urban SNF with predominantly racial minority (>90% black), medically complex, older residents.

Design: Single-center, retrospective, and observational cohort study (March 1, 2020-May 31, 2020).

Setting and participants: All subacute and long-term care residents at an urban SNF between March 1, 2020 and May 31, 2020 (Chicago, IL).

Intervention: A multicomponent management pathway was developed to manage a large COVID-19 outbreak in an SNF.

Measurements: Chart review was used to extract demographics, comorbidities, symptoms, lab results, and clinical outcomes over 12 weeks, which were summarized and compared between residents with and without COVID-19.

Results: A multicomponent clinical management pathway was used to care for residents with COVID-19, which included frequent scheduled clinical and laboratory evaluation, use of intravenous fluids, supplemental oxygen, antibiotics when indicated, and goals-of-care discussions. Of the 204 residents, 172 (84.3%) tested positive for SARS-CoV-2 during the 3-month period, with 50.5% symptomatic, 9.3% presymptomatic, and 24.5% asymptomatic, with a 30-day mortality rate of 15.7%. Predominant symptoms were low-grade fever >99 °F, anorexia, delirium, and fatigue. While in the facility, approximately one-quarter of residents experienced hypernatremia [Na > 145 mEq/L] (24.5%), acute kidney injury [Cr > 0.03 mg/dL or 1.5× baseline] (29.7%), or leukopenia [WBC < 4.8 1000/mm3 ] (39.4%).

Conclusion: We present the first available clinical strategy guiding the medical management of a COVID-19 syndrome in an urban SNF, caring for largely black residents, which may lead to improved mortality.

Keywords: COVID-19; SARS-CoV-2; nursing homes; race and ethnicity.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • African Americans / statistics & numerical data*
  • Aged
  • COVID-19 Testing / statistics & numerical data*
  • COVID-19* / diagnosis
  • COVID-19* / mortality
  • Chicago
  • Comorbidity*
  • Humans
  • Nursing Homes*
  • Practice Guidelines as Topic*
  • Retrospective Studies
  • SARS-CoV-2 / isolation & purification