Screening Testing for SARS‐CoV‐2 upon Admission to Rehabilitation Hospitals in a High COVID‐19 Prevalence Community

• Published in: PM & R 2020-10, Vol.12 (10), p.1009-1014
• Main Authors: Kirshblum, Steven C., DeLauter, Gabrielle, Lopreiato, Maeve C., Pomeranz, Bruce, Dawson, Amanda, Hammerman, Samuel, Gans, Bruce M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Betacoronavirus; Clinical Laboratory Techniques - methods; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; COVID-19; COVID-19 Testing; Female; Hospitals, Rehabilitation; Humans; Male; Mass Screening - methods; Middle Aged; Original Research; Pandemics; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Prevalence; Retrospective Studies; SARS-CoV-2; United States - epidemiology
• ISSN: 1934-1482; 1934-1563
• DOI: 10.1002/pmrj.12454

Background While planning for the care of coronavirus disease 2019 (COVID‐19) patients during the pandemic crisis has dominated the focus of leaders of inpatient rehabilitation facilities (IRFs), patients with injuries/illnesses unrelated to COVID‐19 continue to need inpatient rehabilitation admission. To maintain a safe environment for all patients and staff, we established an admission screening plan of testing for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) to determine the presence of asymptomatic patients who were infected with the virus upon admission. Objective To determine the prevalence of patients who test positive for SARS‐CoV‐2 but were presumed to be COVID‐19 negative at the time of admission to IRF in New Jersey. Design Retrospective analysis of SARS‐CoV‐2 testing results. Setting Four freestanding IRFs in New Jersey operated as one system. Patients All (N = 103) patients sequentially admitted from 4 to 27 April 2020 with no symptoms or evidence of COVID‐19 disease at the time of transfer from the acute hospital. Interventions Specimens were collected for SARS‐CoV‐2 analysis at the time of admission to the IRF and patients were monitored for subsequent symptom development over the next 14 days. Main Outcome Measures Results of SARS‐CoV‐2 testing upon admission and evidence of development of clinical signs or symptoms of COVID‐19. Results Seven asymptomatic persons (6.8% of admissions) without clinical signs/symptoms of COVID‐19 tested positive on admission. Of these, five developed symptoms of COVID‐19, with a mean onset of 3.2 (range of 2‐5) days. Five additional patients became symptomatic and tested positive within the next 3 to 10 days (mean of 5.2 days). Overall, 11.6% of admissions (12/103) had a positive test within 14 days of admission. Conclusions Admission testing to postacute centers for SARS‐CoV‐2 can help identify presymptomatic or asymptomatic individuals, especially in areas where COVID‐19 is prevalent. Negative results, however, do not preclude COVID‐19 and should not be used as the sole basis for patient management decisions.