Long‐Term Care Facilities and the COVID‐19 Pandemic: Lessons Learned in Madrid

Abstract

This case highlights the findings on 18F-FDG PET/CT in a nursing home physician suspected of COVID-19, raises a number of clinical dilemmas, and points to the potential use of PET/CT in studying the pathophysiology of COVID-19 as follows: 1. Our patient had two negative RT-PCR tests for SARS-CoV-2, confirming the high false-negative rate when compared with CT imaging. A review of seven previously published studies of both inpatients and outpatients with SARS-CoV-2 infection reported a wide variation in sensitivity of RT-PCR, depending on the time the test was taken after symptom onset. Specifically, the false-negative rate of RT-PCR tests was 38% on the day of symptom onset, 20% 3 to 4 days after symptom onset, and 66% 2 weeks after symptom onset. Other factors that could contribute to the two negative RT-PCR tests include sampling, storage, and processing errors and different viral loads, depending on stage of the disease. Most important, the sensitivity of chest CT for diagnosing COVID-19 has been shown to be 98% compared with 71% for RT-PCR. 5 2. The 18F-FDG PET/CT findings in this patient are consistent with past studies showing multiple, bilateral FDGpositive GGOs, multilobar consolidations, and evidence of lymph node involvement. 6 3. GGOs are often unperceivable on chest radiography, particularly in patients with few symptoms or low severity. Although we are not suggesting that routine 18F-FDG PET/CT scans be done on patients suspected of COVID-19, we believe the standard of care should be that patients with a clinical syndrome including respiratory symptoms and/or signs consistent with COVID-19, a negative chest X-ray, and neoplastic comorbidities have a chest CT scan. 7 Bilateral GGOs or consolidation on chest CT scan in the proper clinical situation should prompt the radiologist to suggest COVID-19 as a possible diagnosis. 8 4.Findings consistent with COVID-19 will be found in patients having 18F-FDG PET/CT for either staging or recurrence of malignancies. Consequently, nuclear medicine departments and staff need to assume that all patients undergoing 18F-FDG PET/CT need to be screened before scanning, personnel properly gowned and masked, the facility properly cleaned and disinfected afterwards, and lung nodule evaluation be modified. 9 5. FDG PET/CT is highly sensitive for detecting inflammatory disease and is a potential modality to study the inflammatory components of SARS-CoV-2 infections, monitoring disease progression and treatment effects and potentially improving patient management. In addition, FDG PET/CT may elucidate cytokine storm, focusing not only on pulmonary inflammation but also other organs that have been reported to be involved (i.e., myocardium, pericardium, and intestine). 10

Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of a Region of Madrid

“…9 , 18 Particularly in Madrid, from March 8 to April 19, 2020, 19% of older patients (n = ∼8300 cases) living in these facilities died, a sixfold increase compared with the same period in previous years. 19 The high mortality we reported in our study (44.76%) is consistent with previous publications on hospitalized patients with COVID-19 aged 80 and older. 6 , 20 , 21 However, it contrasts with the 22.4% shown in a coordinated on-site medicalization program conducted in 4 care homes of Seville with 272 residents, where only 23.5% of patients were hospitalized, suggesting that the population did not present forms of COVID-19 as severe as ours.…”

Functional, cognitive, and nutritional decline in 435 elderly nursing home residents after the first wave of the COVID-19 Pandemic

“…These results, as well as the well-known mortality, should promote the search for different interventions or strategies at all levels so that health workers, managers and politicians may prevent, as far as possible, these results from being repeated and progressing if this infection persists worldwide [9,10,30]. Failure to perform an adequate intervention would have a great impact on the health of our institutionalized elderly with great associated costs down the road [10].…”

“…In addition, clinical symptoms in the elderly are atypical, so detection is challenging [8]. Other factors that explain the enormous impact of the first wave of COVID-19 in nursing homes are the fact that not enough tests were done [7,9]; health professionals, their training, and protection measures were scarce [7].…”

La Geriatría de Enlace con residencias en la época de la COVID-19. Un nuevo modelo de coordinación que ha llegado para quedarse

“…Pronto fue reconocido a escala mundial el papel de los geriatras en la atención a las PPMM con COVID-19 y la necesidad de reorganizar los sistemas de salud hacia un abordaje integral de la enfermedad en los ancianos 10 , 18 , 19 , 20 . En España, la SEGG emitió documentos con propuestas para el manejo de la epidemia y el papel de la especialidad en la coordinación con las residencias 16 , 21 .…”

“… Clasificación de residencias de la Sociedad Española de Geriatría y Gerontología 19 . Tipo A: tiene profesionales sanitarios suficientes con capacidad para prestar la atención que requieren estos pacientes y con posibilidad de aislar áreas del edificio para un aislamiento correcto.…”