January 23, 2021
Reviewed by Erica Kaufman West, MD
Asymptomatic and presymptomatic spread is thought to be a common cause of community spread of SARS-CoV-2. It is unclear what role asymptomatic and presymptomatic patients play in subacute and long-term care facilities.
Reporting their results in a research letter published in JAMA Internal Medicine, researchers analyzed data from Genesis HealthCare, a multistate long-term care provider with approximately 350 skilled nursing facilities (SNFs) across the U.S. They considered patients symptomatic if they showed any signs or symptoms of COVID-19 within 5 days prior to testing. Patients were presymptomatic if they developed symptoms within 14 days after testing positive, and they were asymptomatic if they never showed signs or symptoms from the 5 days prior to 14 days after the test. Unlike community members, these patients were monitored at least twice a day by medical staff, which should translate into accurate symptom documentation.
There were 5,403 unique positive patients. Of these, 2,194 (40.6%) cases were asymptomatic, 1,033 (19.1%) were presymptomatic, and 2,176 (40.3%) were symptomatic at presentation. Unsurprisingly, counties with higher community positivity saw higher rates of asymptomatic and presymptomatic cases than those with lower community transmission. It would follow that regular testing in SNFs could alert public health officials about impending rises in community spread.