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White EM, Saade EA, Yang X, Canaday DH, Blackman C, Santostefano CM, Nanda A, Feifer RA, Mor V, Rudolph JL, Gravenstein S. SARS-CoV-2 antibody detection in skilled nursing facility residents. Journal of the American Geriatrics Society. 2021 Jul 1; 69(7):1722-1728.
OBJECTIVE: To describe the frequency and timing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody detection in a convenience sample of skilled nursing facility (SNF) residents with and without confirmed SARS-CoV-2 infection. DESIGN: Retrospective analysis of SNF electronic health records. SETTING: Qualitative SARS-CoV-2 antibody test results were available from 81 SNFs in 16 states. PARTICIPANTS: Six hundred and sixty nine SNF residents who underwent both polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2. MEASUREMENTS: Presence of SARS-CoV-2 antibodies following the first positive PCR test for confirmed cases, or first PCR test for non-cases. RESULTS: Among 397 residents with PCR-confirmed infection, antibodies were detected in 4 of 7 (57.1%) tested within 7-14?days of their first positive PCR test; in 44 of 47 (93.6%) tested within 15-30?days; in 182 of 219 (83.1%) tested within 31-60?days; and in 110 of 124 (88.7%) tested after 60?days. Among 272 PCR negative residents, antibodies were detected in 2 of 9 (22.2%) tested within 7-14?days of their first PCR test; in 41 of 81 (50.6%) tested within 15-30?days; in 65 of 148 (43.9%) tested within 31-60?days; and in 9 of 34 (26.5%) tested after 60?days. No significant differences in baseline resident characteristics or symptoms were observed between those with versus without antibodies. CONCLUSIONS: These findings suggest that vulnerable older adults can mount an antibody response to SARS-CoV-2, and that antibodies are most likely to be detected within 15-30?days of diagnosis. That antibodies were detected in a large proportion of residents with no confirmed SARS-CoV-2 infection highlights the complexity of identifying who is infected in real time. Frequent surveillance and diagnostic testing based on low thresholds of clinical suspicion for symptoms and/or exposure will remain critical to inform strategies designed to mitigate outbreaks in SNFs while community SARS-CoV-2 prevalence remains high.