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).
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/mm 3] (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.
Index: COVID-19, SARS-CoV-2, nursing homes, race and ethnicity