• Judith H van den Besselaar, Reina S Sikkema, Fleur M H P A Koene, Laura W van Buul, Bas B Oude Munnink, Ine Frénay, WittRené TeRTEurofins|NMDL-LCPL, 2280 CA Rijswijk, The Netherlands., KoopmansMarion P GMPGDepartment of Viroscience, Erasmus Medical Center, 3015 CN Rotterdam, the Netherlands., HertoghCees M P MCMPMDepartment of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, 1081 BT Amsterdam, The Netherlands., and Bianca M Buurman.
• Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, 1105 AZ Amsterdam, the Netherlands.
• Age Ageing. 2021 Sep 11; 50 (5): 1454-1463.

BackgroundSars-CoV-2 outbreaks resulted in a high case fatality rate in nursing homes (NH) worldwide. It is unknown to which extent presymptomatic residents and staff contribute to the spread of the virus.AimsTo assess the contribution of asymptomatic and presymptomatic residents and staff in SARS-CoV-2 transmission during a large outbreak in a Dutch NH.MethodsObservational study in a 185-bed NH with two consecutive testing strategies: testing of symptomatic cases only, followed by weekly facility-wide testing of staff and residents regardless of symptoms. Nasopharyngeal and oropharyngeal testing with RT-PCR for SARs-CoV-2, including sequencing of positive samples, was conducted with a standardised symptom assessment.Results185 residents and 244 staff participated. Sequencing identified one cluster. In the symptom-based test strategy period, 3/39 residents were presymptomatic versus 38/74 residents in the period of weekly facility-wide testing (P-value < 0.001). In total, 51/59 (91.1%) of SARS-CoV-2 positive staff was symptomatic, with no difference between both testing strategies (P-value 0.763). Loss of smell and taste, sore throat, headache or myalga was hardly reported in residents compared to staff (P-value <0.001). Median Ct-value of presymptomatic residents was 21.3, which did not differ from symptomatic (20.8) or asymptomatic (20.5) residents (P-value 0.624).ConclusionsSymptoms in residents and staff are insufficiently recognised, reported or attributed to a possible SARS-CoV-2 infection. However, residents without (recognised) symptoms showed the same potential for viral shedding as residents with symptoms. Weekly testing was an effective strategy for early identification of SARS-Cov-2 cases, resulting in fast mitigation of the outbreak.© The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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