The Numbers of Asymptomatic LTC Residents with COVID Suggest Urgency for Universal Testing

October 21, 2020

From the start, COVID-19 presented many challenges for long-term care (LTC) facilities, partly because there were so many unknowns about the virus. Even as more has been learned, limited information still exists on the symptoms/signs and clinical course of COVID-19 in this patient population. A new study in the October issue of JAMDA suggests that among LTC residents with the virus, many were asymptomatic at the time of diagnosis. Predictors of the infection included male sex and bowel incontinence. The authors concluded that universal testing of both patients and staff in all communities with high COVID-19 rates is essential to mitigating outbreaks.

In Risk Factors, Presentation, and Course of COVID-19 in a Large, Academic Long-Term Care Facility, the authors followed patients in a Boston, MA-based facility by characteristics and clinical symptoms via electronic medical records and Minimum Data Set information. They found that 146, or 37.5%, of residents they studied tested positive for COVID-19. At the time of their diagnosis, 45.5% were asymptomatic. In the subsequent course of the illness, most common symptoms included anorexia and delirium. During follow-up, 30.1% of residents with diagnosed virus died. Mortality increased with frailty; male sex, bowel incontinence, and staff who live in a community with a high prevalence of coronavirus were significant predictors of a COVID-19 diagnosis.

The authors observed, “Our results demonstrate that even in a frail long-term care population, the prevalence of asymptomatic carriers of COVID-19 is substantial. We found a slightly greater proportion of residents remained asymptomatic over 3 weeks.”

Universal testing is essential, the authors stressed. “Without universal testing, asymptomatic residents would go undiagnosed and may continue to spread the disease,” they noted. “It is challenging to prevent spread of the virus in LTC given the high prevalence of moderate to severe cognitive impairment.”

This study was conducted by researchers at the Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA; and Hebrew SeniorLife, Department of Medicine, Boston, MA.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.