Covid in care homes: many are asymptomatic or have ‘atypical’ symptoms

Published by  Communications

On 11th Aug 2020

Nurse wearing blue gloves holding the hands of an elderly woman in a wheelchair

‘Intelligent’ testing strategies identified atypical symptomatic as well as asymptomatic residents with Covid-19 infection in care homes, resulting in early isolation and management

Many care home residents who have Covid-19 infection are either asymptomatic or experience ‘atypical’ symptoms – according to a new study from the University of East Anglia (UEA) and North Norfolk Primary Care, supported by UEA Health and Social Care Partners.

Due to the rapid-response nature of this evaluation, it has not yet been peer reviewed.

In response to Covid-19, a new ‘intelligent’ testing service was implemented in care homes in North Norfolk. The service, implemented by the enhanced care home team (ECHT) with North Norfolk general practitioners, identified Covid-19 symptoms amongst residents. They found that around half of residents who tested positive for Covid-19 were asymptomatic, but some went on to develop symptoms.

They also found that in many cases symptoms were not typical and did not include a high temperature, cough or loss of smell. Instead, residents who tested positive for Covid-19 often presented as ‘generally unwell’.

The team say that effective testing and screening of residents and staff in care homes is vital for identifying cases and controlling the spread of the virus.

Dr Paul Everden, from UEA’s Norwich Medical School and Innovation Lead for North Norfolk Primary Care, said: “The Covid-19 pandemic is disproportionately affecting older people, especially in care homes. We wanted to develop a service with our local GP’s, implemented by our ECHT, to keep residents and staff safe by early identification of infection.”

ECHT tested 518 residents in 44 care homes and 340 staff in 10 care homes for Covid-19 using nose and throat swabs between April 7 and June 29. Test results and symptoms were compared for residents. Positive asymptomatic residents were followed for up to 14 days after testing.

The ECHT found that 103 residents tested positive in 14 homes and 49 staff in seven homes. However, of the residents, only 38 (37 per cent) had typical symptoms at the time of the test.

More than half (54 residents) were completely asymptomatic when tested, and 12 developed symptoms within 14 days. Some of those with a positive test result did experience typical symptoms such as a cough or fever, but feeling generally unwell was also common.

Dr Everden said: “We found that older people in care homes are frequently asymptomatic, but can go on to become symptomatic, i.e presymptomatic. We also found that of those who tested positive, some were just ‘generally unwell’.

“We carried out this service evaluation in North Norfolk but we would expect to see similar results nationally. All UK care homes are at high risk of Covid-19 infection and residents are extremely vulnerable to infection and death.

“Older people in care homes have multiple co-morbidities including dementia, lung disease, a reduced sense of smell, and may have communication problems too. Together this means it is difficult for staff to identify typical listed Covid-19 symptoms – a temperature, cough and anosmia. It may also be difficult for some patients to recognise or communicate that they are feeling unwell.

“At the time of launching this service there was no testing in the community, let alone in care homes. It was therefore vital that we put into place an ‘intelligent’ testing service that allowed the earliest ‘pick up’ of infection with the least use of a precious resource. It was through this process that we identified asymptomatic and presymptomatic people who could potentially infect other residents and staff.

“Our trigger for testing a resident was any general deterioration in health status with isolation and then, if positive, testing of all other residents and staff.

“These findings are really vital for protecting care home communities and we hope they will help keep residents and staff safe – particularly if we are to face future waves of the pandemic in the UK where resources will again indeed be precious.”

Testing for SARS-CoV-2 in care home staff and residents in English care homes: A service evaluation’, is published on the MedRvix preprint server.

Latest News

  News
04 Mar 2021

How governments and companies should listen to the people on climate change

People are more engaged in reducing carbon emissions than previously thought - and governments, scientists and companies should listen to them - according to new...

Read more >
  News
The Earth in space
04 Mar 2021

UEA’s Development Studies makes global top ten

UEA’s Development Studies has been rated as one of the top ten in the world by a global university rankings table released today (Wednesday 3 March).

Read more >
  News
03 Mar 2021

Tenfold increase in CO2 emissions cuts needed to stem climate emergency

New research shows 64 countries cut their fossil CO2 emissions during 2016-2019, but the rate of reduction needs to increase tenfold to meet the Paris Agreement...

Read more >
Are you searching for something?
  News
03 Mar 2021

Tenfold increase in CO2 emissions cuts needed to stem climate emergency

New research shows 64 countries cut their fossil CO2 emissions during 2016-2019, but the rate of reduction needs to increase tenfold to meet the Paris Agreement...

Read more >
  News
02 Mar 2021

Independent music squashed out of streaming playlists and revenue

Bands and artists on independent record labels get less than their fair share of access to the most popular playlists on streaming platforms such as Spotify –...

Read more >
  News
01 Mar 2021

World Wildlife Day spotlight on the Centre for Ecology, Evolution and Conservation

From protecting pollinators to studying bird migration, safeguarding Antarctic penguins and writing about jellyfish superpowers – a group of UEA researchers are...

Read more >
  News
25 Feb 2021

Huge gaps in UK regulation exist following transition from EU, new academic report finds 

The UK is still not in a position to assume responsibility for regulation in several critical policy areas including trade, crime and the environment, according...

Read more >
  News
Picture of Dr Sally Howes OBE
24 Feb 2021

Space expert appointed as new UEA Chair

Dr Sally Howes OBE has been appointed as Chair of the University of East Anglia (UEA) Council, bringing with her a wealth of experience in strategic roles in the...

Read more >
  News
24 Feb 2021

How rehabilitation could help people with Covid-19 recover

Progressive exercise and early mobilisation are among the elements of rehabilitation programmes that may improve recovery for people who are hospitalised with...

Read more >