Jennifer Carnahan, M.D., MPH

Nursing home residents who develop COVID-19 may face weeks of illness, no matter how severe their symptoms, according to a study conducted in a central Indiana facility.

Although many U.S. nursing homes have been devastated by the COVID-19 pandemic, the typical disease course previously has not been well described, noted investigators from Indiana University and the Regenstrief Institute, Indianapolis. 

The researchers analyzed electronic medical records and medical director tracking notes for 74 residents from late March through June 17, 2020. Residents often, but not always, experienced fever. Anorexia, or decreased food interest, was also a key symptom, as were hypoxia (low oxygen in body tissues), and fatigue and/or malaise. 

Residents’ COVID-19 symptoms lasted more than three weeks, on average, reported senior author Kathleen Unroe, M.D., MHA, and corresponding author Jennifer Carnahan, M.D., MPH. Among those infected, 25 died, with most deaths (23) considered related to the resident’s COVID-19 infection. A smaller group experienced a rapidly progressing, fatal course, and experienced  more symptoms than their peers, the research team reported.

Overall, “nursing home residents will have a low symptom burden but will still have some indicator of infection,” Unroe and Carnahan concluded. Most cases can be effectively managed in nursing homes with appropriate staffing and resources such as personal protective equipment and testing capacity. However, it should be recognized that the relatively long disease course makes it necessary to prolong isolation, use extensive amounts of PPE, and can significantly impact resident quality of life, they added. 

The study has “implications for the resources needed to care for and support these residents during active infection and post-disease,” Unroe and Carnahan concluded. “Future studies should combine data from nursing home residents across the country to identify the risk factors for disease trajectories identified in this case series,” they said.

Full findings were published in the Journal of the American Geriatrics Society.

In related news:

Neurological illness diagnosed in many COVID long-haulers  Specialists are seeing recovered COVID-19 patients with lingering neurological symptoms such as postural orthostatic tachycardia syndrome, or POTS, according to a new report from Kaiser Health News. POTS is a disorder of the autonomic nervous system, which controls involuntary functions such as heart rate, blood pressure and vein contractions. Patients describe a racing heart when standing, severe headaches, constant nausea and brain fog. All COVID patients who have rapid heartbeat, dizziness, brain fog or fatigue should be screened for POTS, sources told the news outlet.