The prior infection with SARS-CoV-2 study (PICOV) in nursing home residents and staff - study protocol description and presentation of preliminary findings on symptoms

Maria E Goossens, Kristof Y Neven, Pieter Pannus, Cyril Barbezange, Isabelle Thomas, Steven Van Gucht, Katelijne Dierick, Marie-Noëlle Schmickler, Mathieu Verbrugghe, Nele Van Loon, Kevin K Ariën, Arnaud Marchant, Stanislas Goriely, Isabelle Desombere, Maria E Goossens, Kristof Y Neven, Pieter Pannus, Cyril Barbezange, Isabelle Thomas, Steven Van Gucht, Katelijne Dierick, Marie-Noëlle Schmickler, Mathieu Verbrugghe, Nele Van Loon, Kevin K Ariën, Arnaud Marchant, Stanislas Goriely, Isabelle Desombere

Abstract

Background: The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has presented itself as one of the most important health concerns of the 2020's, and hit the geriatric population the hardest. The presence of co-morbidities and immune ageing in the elderly lead to an increased susceptibility to COVID-19, as is the case for other influenza-like illnesses (ILI) or acute respiratory tract infections (ARI). However, little is known, about the impact of a previous or current infection on the other in terms of susceptibility, immune response, and clinical course. The aim of the "Prior Infection with SARS-COV-2" (PICOV) study is to compare the time to occurrence of an ILI or ARI between participants with a confirmed past SARS-CoV-2 infection (previously infected) and those without a confirmed past infection (naïve) in residents and staff members of nursing homes. This paper describes the study design and population characteristics at baseline.

Methods: In 26 Belgian nursing homes, all eligible residents and staff members were invited to participate, resulting in 1,226 participants. They were classified as naïve or previously infected based on the presence of detectable SARS-CoV-2 antibodies and/or a positive RT-qPCR result before participation in the study. Symptoms from a prior SARS-CoV-2 infection between March and August 2020 were compared between previously infected residents and staff members.

Results: Infection naïve nursing home residents reported fewer symptoms than previously infected residents: on average 1.9 and 3.1 symptoms, respectively (p = 0.016). The same effect was observed for infection naïve staff members and previously infected staff members (3.1 and 6.1 symptoms, respectively; p <0.0001). Moreover, the antibody development after a SARS-CoV-2 infection differs between residents and staff members, as previously infected residents tend to have a higher rate of asymptomatic cases compared to previously infected staff members (20.5% compared to 12.4%; p <0.0001).

Conclusions: We can postulate that COVID-19 disease development and symptomatology are different between a geriatric and younger population. Therefore, the occurrence and severity of a future ILI and/or ARI might vary from resident to staff.

Keywords: ARI; Antibody; Belgium; COVID-19; Cohort; ILI; Multicentric; Nursing home; SARS-CoV-2; Symptoms.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow of the PICOV study. Recruitment of the participants finished on December 8th, 2020, as did the baseline sampling (collection of a nasopharyngeal swab, saliva, serum blood, and heparinised blood for peripheral blood mononuclear cell [PBMC] isolation). Follow-up sampling after flu vaccination concluded on the 22nd of January (collection of serum blood). Sampling at the end of the study is planned for spring 2021 (collection of saliva, serum blood, and heparinised blood for PBMC isolation). If a participant develops an influenza-like illness (ILI) or an acute respiratory infection (ARI), a nasopharyngeal swab is collected at the onset of symptoms to distinguish between a SARS-CoV-2 or influenza infection. After attenuations of the illness, approximately two to three weeks after the onset of symptoms, serum, and heparinised blood is collected
Fig. 2
Fig. 2
Flow chart of the study population. 1,359 participants of nursing homes provided us with an informed consent. Reasons for withdrawal are provided for the 116 drop-outs. 33 participants did not complete the baseline questionnaire, resulting in a final study population of 1,226 with 374 nursing home residents and 852 staff members
Fig. 3
Fig. 3
Number of symptoms in staff members and residents of nursing homes. Residents reported an average of 3.1 (±2.4) symptoms during a past SARS-CoV-2 infection, compared to 1.9 (±1.1) symptoms for residents without a previous infection. For staff members with a past SARS-CoV-2 infection, the number of symptoms averaged at 6.1 (±4.0) while those without an infection averaged 3.1 (±2.2) symptoms

References

    1. Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, Si H-R, Zhu Y, Li B, Huang C-L, Chen H-D, Chen J, Luo Y, Guo H, Jiang R-D, Liu M-Q, Chen Y, Shen X-R, Wang X, Zheng X-S, Zhao K, Chen Q-J, Deng F, Liu L-L, Yan B, Zhan F-X, Wang Y-Y, Xiao G-F, Shi Z-L. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270–3. doi: 10.1038/s41586-020-2012-7.
    1. Oran DP, Topol EJ. Prevalence of Asymptomatic SARS-CoV-2 Infection : A Narrative Review. Ann Intern Med. 2020;173(5):362–7. doi: 10.7326/M20-3012.
    1. Mori H, Obinata H, Murakami W, Tatsuya K, Sasaki H, Miyake Y, Taniguchi Y, Ota S, Yamaga M, Suyama Y, Tamura K. Comparison of COVID-19 disease between young and elderly patients: Hidden viral shedding of COVID-19. J Infect Chemother. 2021;27(1):70–75. doi: 10.1016/j.jiac.2020.09.003.
    1. Wu D, Wu T, Liu Q, Yang Z. The SARS-CoV-2 outbreak: What we know. Int J Infect Dis. 2020;94:44–8. doi: 10.1016/j.ijid.2020.03.004.
    1. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–13. doi: 10.1016/S0140-6736(20)30211-7.
    1. O’Driscoll M, Ribeiro Dos Santos G, Wang L, Cummings DAT, Azman AS, Paireau J, Fontanet A, Cauchemez S, Salje H. Age-specific mortality and immunity patterns of SARS-CoV-2. Nature. 2020:1–6. 10.1038/s41586-020-2918-0.
    1. Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe disease and death. BMJ (Clinical research ed.) 2020;368:1198.
    1. Hardy OJ, Dubourg D, Bourguignon M, Dellicour S, Eggerickx T, Gilbert M, Sanderson J-P, Scohy A, Vandael E, Decroly J-M. Arld apart: levels and factors of excess mortality due to COVID-19 in care homes. The case of Wallonia - Belgium. medRxiv. 2020. 10.1101/2020.08.29.20183210.
    1. Weiss P, Murdoch DR. Clinical course and mortality risk of severe COVID-19. Lancet (London, England) 2020;395(10229):1014–5. doi: 10.1016/S0140-6736(20)30633-4.
    1. Chen Y, Klein SL, Garibaldi BT, Li H, Wu C, Osevala NM, Li T, Margolick JB, Pawelec G, Leng SX. Aging in COVID-19: Vulnerability, immunity and intervention. Ageing Res Rev. 2021;65:101205. doi: 10.1016/j.arr.2020.101205.
    1. Care for the elderly - For a Healthy Belgium. . Accessed 11 Jan 2021.
    1. Molenberghs G, Faes C, Verbeeck J, Deboosere P, Abrams S, Willem L, Aerts J, Theeten H, Devleesschauwer B, Sierra NB, Renard F, Herzog S, Lusyne P, Heyden J. V. d., Oyen HV, Damme PV, Hens N. Belgian COVID-19 Mortality, Excess Deaths, Number of Deaths per Million, and Infection Fatality Rates (9 March — 28 June 2020). medRxiv. 2020. 10.1101/2020.06.20.20136234.
    1. Wang M, Wu Q, Xu W, Qiao B, Wang J, Zheng H, Jiang S, Mei J, Wu Z, Deng Y, Zhou F, Wu W, Zhang Y, Lv Z, Huang J, Guo X, Feng L, Xia Z, Li D, Xu Z, Liu T, Zhang P, Tong Y, Li Y. Clinical diagnosis of 8274 samples with 2019-novel coronavirus in Wuhan. medRxiv. 2020. 10.1101/2020.02.12.20022327.
    1. Lin D, Liu L, Zhang M, Hu Y, Yang Q, Guo J, Guo Y, Dai Y, Xu Y, Cai Y, Chen X, Zhang Z, Huang K. Co-infections of SARS-CoV-2 with multiple common respiratory pathogens in infected patients. Sci China Life Sci. 2020;63(4):606–9. doi: 10.1007/s11427-020-1668-5.
    1. Cuadrado-Payán E, Montagud-Marrahi E, Torres-Elorza M, Bodro M, Blasco M, Poch E, Soriano A, Piñeiro GJ. SARS-CoV-2 and influenza virus co-infection. Lancet (London, England) 2020;395(10236):84. doi: 10.1016/S0140-6736(20)31052-7.
    1. Hashemi SA, Safamanesh S, Ghasemzadeh-Moghaddam H, Ghafouri M, Azimian A. High prevalence of SARS-CoV-2 and influenza A virus (H1N1) coinfection in dead patients in Northeastern Iran. J Med Virol. 2021;93(2):1008–12. doi: 10.1002/jmv.26364.
    1. Bai L, Zhao Y, Dong J, Liang S, Guo M, Liu X, Wang X, Huang Z, Sun X, Zhang Z, Dong L, Liu Q, Zheng Y, Niu D, Xiang M, Song K, Ye J, Zheng W, Tang Z, Tang M, Zhou Y, Shen C, Dai M, Zhou L, Chen Y, Yan H, Lan K, Xu K. Co-infection of influenza A virus enhances SARS-CoV-2 infectivity. bioRxiv. 2020. 10.1101/2020.10.14.335893.
    1. White EM, Santostefano CM, Feifer RA, Kosar CM, Blackman C, Gravenstein S, Mor V. Asymptomatic and Presymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection Rates in a Multistate Sample of Skilled Nursing Facilities. JAMA Intern Med. 2020;180(12):1709–11. doi: 10.1001/jamainternmed.2020.5664.
    1. Watson J, Whiting PF, Brush JE. Interpreting a covid-19 test result. BMJ. 2020;369:1808. doi: 10.1136/bmj.m1808.
    1. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Qual Life Res Int J Qual Life Aspects Treat Care Rehabil. 2011;20(10):1727–36. doi: 10.1007/s11136-011-9903-x.
    1. Rockwood K, Theou O. Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources. Can Geriatr J. 2020;23(3):210–5. doi: 10.5770/cgj.23.463.
    1. Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10(1):20–30. doi: 10.1093/geront/10.1_Part_1.20.
    1. Pangman VC, Sloan J, Guse L. An examination of psychometric properties of the mini-mental state examination and the standardized mini-mental state examination: implications for clinical practice. Appl Nurs Res ANR. 2000;13(4):209–13. doi: 10.1053/apnr.2000.9231.
    1. Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, Bleicker T, Brünink S, Schneider J, Schmidt ML, Mulders DG, Haagmans BL, Veer B. v. d., Brink S. v. d., Wijsman L, Goderski G, Romette J-L, Ellis J, Zambon M, Peiris M, Goossens H, Reusken C, Koopmans MP, Drosten C. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Eurosurveillance. 2020;25(3):2000045. doi: 10.2807/1560-7917.ES.2020.25.3.2000045.
    1. Lassaunière R, Frische A, Harboe ZB, Nielsen ACY, Fomsgaard A, Krogfelt KA, Jørgensen CS. Evaluation of nine commercial SARS-CoV-2 immunoassays. medRxiv. 2020. 10.1101/2020.04.09.20056325.
    1. GeurtsvanKessel CH, Okba NMA, Igloi Z, Embregts CWE, Laksono BM, Leijten L, Rahamat-Langendoen J, Akker JPCVD, Kampen JJAV, Eijk AAVD, Binnendijk RSV, Haagmans B, Koopmans M. Towards the next phase: evaluation of serological assays for diagnostics and exposure assessment. medRxiv. 2020. 10.1101/2020.04.23.20077156.
    1. Van Elslande J, Houben E, Depypere M, Brackenier A, Desmet S, André E, Van Ranst M, Lagrou K, Vermeersch P. Diagnostic performance of seven rapid IgG/IgM antibody tests and the Euroimmun IgA/IgG ELISA in COVID-19 patients. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2020;26(8):1082–7.
    1. Neumann-Podczaska A, Al-Saad SR, Karbowski LM, Chojnicki M, Tobis S, Wieczorowska-Tobis K. COVID 19 - Clinical Picture in the Elderly Population: A Qualitative Systematic Review. Aging Dis. 2020;11(4):988–1008. doi: 10.14336/AD.2020.0620.
    1. Öztaş Ayhan H, Işiksal S. Memory recall errors in retrospective surveys: A reverse record check study. Qual Quant. 2005;38(5):475–93. doi: 10.1007/s11135-005-2643-7.
    1. Graham NSN, Junghans C, Downes R, Sendall C, Lai H, McKirdy A, Elliott P, Howard R, Wingfield D, Priestman M, Ciechonska M, Cameron L, Storch M, Crone MA, Freemont PS, Randell P, McLaren R, Lang N, Ladhani S, Sanderson F, Sharp DJ. SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes. J Infect. 2020;81(3):411–9. doi: 10.1016/j.jinf.2020.05.073.
    1. Magnavita N, Tripepi G, Di Prinzio RR. Symptoms in Health Care Workers during the COVID-19 Epidemic, A Cross-Sectional Survey. Int J Environ Res Public Health. 2020;17(14):5218. doi: 10.3390/ijerph17145218.
    1. Rudberg A-S, Havervall S, Månberg A, Jernbom Falk A, Aguilera K, Ng H, Gabrielsson L, Salomonsson A-C, Hanke L, Murrell B, McInerney G, Olofsson J, Andersson E, Hellström C, Bayati S, Bergström S, Pin E, Sjöberg R, Tegel H, Hedhammar M, Phillipson M, Nilsson P, Hober S, Thålin C. SARS-CoV-2 exposure, symptoms and seroprevalence in healthcare workers in Sweden. Nat Commun. 2020;11(1):5064. doi: 10.1038/s41467-020-18848-0.
    1. Parente-Arias P, Barreira-Fernandez P, Quintana-Sanjuas A, Patiño-Castiñeira B. Recovery rate and factors associated with smell and taste disruption in patients with coronavirus disease 2019. Am J Otolaryngol. 2020. 10.1016/j.amjoto.2020.102648.
    1. Vaira LA, Deiana G, Fois AG, Pirina P, Madeddu G, De Vito A, Babudieri S, Petrocelli M, Serra A, Bussu F, Ligas E, Salzano G, De Riu G. Objective evaluation of anosmia and ageusia in COVID-19 patients: Single–center experience on 72 cases. Head Neck. 2020;42(6):1252–8. doi: 10.1002/hed.26204.
    1. Schiffman SS. Taste and smell losses in normal aging and disease. JAMA. 1997;278(16):1357–62. doi: 10.1001/jama.1997.03550160077042.
    1. Carfì A, Bernabei R, Landi F, for the Gemelli Against COVID-19 Post-Acute Care Study Group Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603. doi: 10.1001/jama.2020.12603.
    1. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, Kang L, Guo L, Liu M, Zhou X, Luo J, Huang Z, Tu S, Zhao Y, Chen L, Xu D, Li Y, Li C, Peng L, Li Y, Xie W, Cui D, Shang L, Fan G, Xu J, Wang G, Wang Y, Zhong J, Wang C, Wang J, Zhang D, Cao B. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet. 2021;397(10270):220–32. doi: 10.1016/S0140-6736(20)32656-8.
    1. Lam MH-B, Wing Y-K, Yu MW-M, Leung C-M, Ma RCW, Kong APS, So WY, Fong SY-Y, Lam S-P. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Arch Intern Med. 2009;169(22):2142–7. doi: 10.1001/archinternmed.2009.384.
    1. Stavem K, Ghanima W, Olsen MK, Gilboe HM, Einvik G. Persistent symptoms 1.5–6 months after COVID-19 in non-hospitalised subjects: a population-based cohort study. Thorax. 2020. 10.1136/thoraxjnl-2020-216377.
    1. Schmier JK, Halpern MT. Patient recall and recall bias of health state and health status. Expert Rev Pharmacoeconomics Outcome Res. 2004;4(2):159–63. doi: 10.1586/14737167.4.2.159.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe