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Symptom-Based Testing Not Adequate for Detecting COVID-19

36.9 percent of long-term care residents were identified as SARS-CoV-2 RNA-positive on universal testing

TUESDAY, July 14, 2020 (HealthDay News) -- Using symptom-based testing alone is not adequate for identifying COVID-19 cases in long-term care facilities, according to a research letter published online July 14 in JAMA Internal Medicine.

Benjamin F. Bigelow, from the Johns Hopkins University School of Medicine in Baltimore, and colleagues performed universal testing of untested residents across 11 Maryland long-term care facilities that had previously conducted targeted testing based on individual residents' symptoms and had known positive cases.

The researchers found that within 20 days of detection of the index case, targeted symptom-based testing identified 153 cases prior to point-prevalence surveys. Overall, 39.6 percent of the remaining 893 residents who were universally tested were positive for severe acute respiratory syndrome coronavirus 2 RNA. Universal testing increased the total number of detected COVID-19 cases from 153 to 507 across all sites; 55.4 percent were asymptomatic. Two-week follow-up data were available for 426 residents from seven facilities (177 positive and 249 negative for COVID-19). Eighty-seven percent of the 177 who were positive were asymptomatic. Of those who tested positive and were asymptomatic at testing, 13 percent were hospitalized and 4.6 percent died with 14 days of testing. Of the 23 residents who were positive and symptomatic at testing, 17.4 and 8.7 percent were hospitalized and died within 14 days of testing, respectively.

"Additional testing resources are urgently needed to identify the true burden of COVID-19 and curb transmission in long-term care settings," the authors write.

One author disclosed financial ties to the pharmaceutical and health care industries.

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