Care home study finds almost two thirds of residents with Covid-19 displayed unusual or no symptoms

Almost two thirds of care home residents who tested positive for coronavirus had either no symptoms or not the typical ones, a small study has found.

The death rate at four London nursing homes involved in the research was three times higher than in previous years, and around half of the deaths were attributed to Covid-19 on the death certificate.

Those behind the study said “regular, systematic testing of all residents and staff regardless of symptoms” is urgently needed to control the spread of the virus in such environments.

Researchers said each of the nursing homes had an outbreak of Covid-19, and 103 people died out of a total population across all four homes of 394 residents between March 1 and May 1.

More than half of those who died had dementia, the study – involving a team of academics from the UK Dementia Research Institute (UK DRI), GPs, infectious diseases experts, a geriatric clinical outreach team and local authority colleagues – found.

Using a robotic testing platform, 313 residents and a selection of staff were tested for the virus.

Results showed that 40% of residents were positive for coronavirus, and 60% of those were asymptomatic or displaying only atypical symptoms.

Some residents had already suffered with cough or shortness of breath, and others did not have a fever, the study found, leading researchers to conclude that the usual approaches to infection control which rely on identifying symptoms, contact tracing and isolation, are ineffective.

Of the asymptomatic staff sample tested, 4% were positive, which researchers said suggested that staff are likely to be a factor in transmitting infection.

Professor David Sharp (pictured), joint senior author of the investigation and director of the UK DRI’s care research and technology centre based at Imperial College London and the University of Surrey, said the death rate in this study showed just how “pressing” the issue in care homes is.

He said: “Dealing with an outbreak of this nature in a nursing home presents many challenges. We found that a very high proportion of those testing positive had no symptoms, or different symptoms from those expected. This makes it extremely difficult for staff to recognise illness and take appropriate measures to protect those they care for.

“Universal and systematic testing of residents and staff is needed across nursing homes if infection is to be contained.”

Fiona Carragher, director of research and influencing for the Alzheimer’s Society – which part-funded the study, said the data is “just a snapshot of the devastation that coronavirus is wreaking in care homes”.

Noting the findings that many patients did not have typical symptoms or any at all, she added: “At least seven in 10 people in care homes have dementia, and it’s clear that to keep them safe, we need regular, systematic testing of all residents and staff regardless of symptoms.

“Our funded researchers have done excellent work to understand the reality of Covid-19 and dementia on the front line, laying the groundwork for more extensive studies to build on, so we can develop a truly evidenced-based approach to keeping people with dementia and all care home residents safe during the pandemic.”

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