{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:28:38Z","timestamp":1753892918396,"version":"3.41.2"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> COVID-19 outbursts have been registered worldwide within care homes with asymptomatic transmission combined with shortage\/inaccuracy of diagnostic tests undermining the efforts at containment of the disease. Nursing facilities in Lombardy (Italy) were left with no, or limited, access to testing for 8 weeks after the outbreak of COVID-19.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This study includes 246 residents and 286 workers of three different nursing homes in Brescia-Lombardy. Clinical questionnaires and rapid serology tests were devised to integrate the data of the first available RT-PCR screening. Follow-up serology after 60-days was performed on 67 of 86 workers with positive serology or clinically suspicious.<\/jats:p><jats:p><jats:bold>Findings:<\/jats:bold> Thirty-seven residents and 18 workers had previous positive RT-PCR. Thorough screening disclosed two additional RT-PCR-positive workers. Serology screening revealed antibodies in 59 residents and 48 workers, including 32\/37 residents and all workers previously positive at RT-PCR. Follow up serology disclosed antibodies in two additional workers with recent symptoms at the time of screening. The professionals in close contact with residents had more infections (47\/226\u201320.79% vs. 1\/60\u20131.66%; <jats:italic>p<\/jats:italic> = 0.00013 Fisher exact-test). A suspicious clinical score was present in 44\/64 residents and in 41\/50 workers who tested positive with either method with totally asymptomatic disease more frequent among residents 28.1 vs. 10.0% (<jats:italic>p<\/jats:italic> = 0.019 Fisher exact-test).<\/jats:p><jats:p><jats:bold>Interpretation:<\/jats:bold> Based on the available RT-PCR \u00b1 results at the time of symptoms\/contacts, our integrated clinical and serological screening demonstrated sensitivity 89% and specificity 87%. This multimodal assessment proved extremely useful in understanding the viral spread in nursing homes, in defining its stage and in implementing protective measures. Rapid serology tests demonstrated efficient and particularly suited for older people less able to move\/cooperate.<\/jats:p>","DOI":"10.3389\/fpubh.2021.649524","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T07:15:20Z","timestamp":1624518920000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Rapid Point-Of-Care Serology and Clinical History Assessment Increase Protection Provided by RT-PCR Screening: A Pilot Study Involving Three Nursing Homes in Brescia, a Hotspot of Lombardy"],"prefix":"10.3389","volume":"9","author":[{"given":"Antonella","family":"Savio","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Calza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianbattista","family":"Guerrini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Romano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonora","family":"Marchina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the chinese center for disease control and prevention","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA."},{"key":"B2","doi-asserted-by":"publisher","first-page":"m1052","DOI":"10.1136\/bmj.m1052","article-title":"Bearing the brunt of covid-19: older people in low and middle income countries","volume":"368","author":"Lloyd-Sherlock","year":"2020","journal-title":"BMJ."},{"key":"B3","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1016\/S0140-6736(20)30567-5","article-title":"How will country-based mitigation measures influence the course of the COVID-19 epidemic?","volume":"395","author":"Anderson","year":"2020","journal-title":"Lancet (London, England)."},{"key":"B4","doi-asserted-by":"publisher","first-page":"8870249","DOI":"10.1155\/2020\/8870249","article-title":"The impact of COVID-19 pandemic on long-term care facilities worldwide: an overview on international issues","volume":"2020","author":"Thompson","year":"2020","journal-title":"BioMed Res Int."},{"key":"B5","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1093\/pubmed\/fdaa165","article-title":"COVID-19 in Italy: an analysis of death registry data","volume":"42","author":"Ciminelli","year":"2020","journal-title":"J Public Health (Oxford, England)."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1016\/S0140-6736(20)30627-9","article-title":"COVID-19 and Italy: what next?","volume":"395","author":"Remuzzi","year":"2020","journal-title":"Lancet (London, England)."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1935","DOI":"10.1093\/cid\/ciaa510","article-title":"Role of serology in the coronavirus disease 2019 pandemic","volume":"71","author":"Stowell","year":"2020","journal-title":"Clin Infect Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"101623","DOI":"10.1016\/j.tmaid.2020.101623","article-title":"Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis","volume":"34","author":"Rodriguez-Morales","year":"2020","journal-title":"Travel Med Infect Dis"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.1111\/all.14289","article-title":"Eleven faces of coronavirus disease 2019","volume":"75","author":"Dong","year":"2020","journal-title":"Allergy."},{"key":"B10","doi-asserted-by":"publisher","first-page":"104357","DOI":"10.1016\/j.jcv.2020.104357","article-title":"Epidemiology and clinical features of COVID-19: a review of current literature","volume":"127","author":"Siordia","year":"2020","journal-title":"J Clin Virol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1756286420917830","DOI":"10.1177\/1756286420917830","article-title":"Potential neurological symptoms of COVID-19","volume":"13","author":"Wang","year":"2020","journal-title":"Ther Adv Neurol Disord."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1518","DOI":"10.1002\/jmv.25727","article-title":"Development and clinical application of a rapid IgM-IgG combined antibody test for SARS-CoV-2 infection diagnosis","volume":"92","author":"Li","year":"2020","journal-title":"J Med Virol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"362","DOI":"10.7326\/M20-3012","article-title":"Prevalence of asymptomatic SARS-CoV-2 infection: a narrative review","volume":"173","author":"Oran","year":"2020","journal-title":"Ann Intern Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"Doc26","DOI":"10.3205\/dgkh000361","article-title":"COVID-19 in long-term care facilities in Frankfurt am Main, Germany: incidence, case reports, lessons learned","volume":"15","author":"Heudorf","year":"2020","journal-title":"GMS Hyg Infect Control."},{"key":"B15","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.jinf.2020.05.073","article-title":"SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes","volume":"81","author":"Graham","year":"2020","journal-title":"J Infect."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1007\/s41999-020-00352-9","article-title":"Atypical clinical presentation of COVID-19 infection in residents of a long-term care facility","volume":"11","author":"Blain","year":"2020","journal-title":"Eur Geriatr Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1093\/ageing\/afab050","article-title":"Atypical symptoms, SARS-CoV-2 test results and immunisation rates in 456 residents from eight nursing homes facing a COVID-19 outbreak","volume":"50","author":"Blain","year":"2021","journal-title":"Age Ageing."},{"key":"B18","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1056\/NEJMoa2008457","article-title":"Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility","volume":"382","author":"Arons","year":"2020","journal-title":"N Engl J Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2005","DOI":"10.1056\/NEJMoa2005412","article-title":"Epidemiology of covid-19 in a long-term care facility in King County, Washington","volume":"382","author":"McMichael","year":"2020","journal-title":"N Engl J Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2158","DOI":"10.1056\/NEJMe2009758","article-title":"Asymptomatic transmission, the Achilles' heel of current strategies to control covid-19","volume":"382","author":"Gandhi","year":"2020","journal-title":"N Engl J Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1001\/jamainternmed.2020.2233","article-title":"Outbreak investigation of COVID-19 among residents and staff of an independent and assisted living community for older adults in Seattle, Washington","volume":"180","author":"Roxby","year":"2020","journal-title":"JAMA Intern Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1007\/s41999-020-00405-z","article-title":"August 2020 interim EuGMS guidance to prepare European long-term care facilities for COVID-19","volume":"11","author":"Blain","year":"2020","journal-title":"Eur Geriatr Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1001\/jama.2020.3786","article-title":"Detection of SARS-CoV-2 in different types of clinical specimens","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2027","DOI":"10.1093\/cid\/ciaa344","article-title":"Antibody responses to SARS-CoV-2 in patients with novel coronavirus disease 2019","volume":"71","author":"Zhao","year":"2020","journal-title":"Clin Infect Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1001\/jama.2020.6170","article-title":"The promise and peril of antibody testing for COVID-19","volume":"323","author":"Abbasi","year":"2020","journal-title":"JAMA."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1001\/jama.2020.6572","article-title":"From mitigation to containment of the COVID-19 pandemic: putting the SARS-CoV-2 genie back in the bottle","volume":"323","author":"Walensky","year":"2020","journal-title":"JAMA."},{"key":"B27","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1016\/S2213-2600(20)30315-5","article-title":"Point-of-care serological assays for delayed SARS-CoV-2 case identification among health-care workers in the UK: a prospective multicentre cohort study","volume":"8","author":"Pallett","year":"2020","journal-title":"Lancet Respir Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"CD013705","DOI":"10.1002\/14651858.CD013705","article-title":"Rapid, point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection","volume":"8","author":"Dinnes","year":"2020","journal-title":"Cochrane Database Syst Rev."},{"key":"B29","doi-asserted-by":"publisher","first-page":"e245","DOI":"10.1016\/S1473-3099(20)30517-X","article-title":"Serology testing in the COVID-19 pandemic response","volume":"20","author":"Peeling","year":"2020","journal-title":"Lancet Infect Dis."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e39","DOI":"10.1016\/j.jinf.2020.05.077","article-title":"Detection of SARS-CoV-2 antibodies using commercial assays and seroconversion patterns in hospitalized patients","volume":"81","author":"Tuaillon","year":"2020","journal-title":"J Infect."},{"key":"B31","doi-asserted-by":"publisher","first-page":"e6","DOI":"10.1016\/j.jinf.2020.04.033","article-title":"Dynamic profile for the detection of anti-SARS-CoV-2 antibodies using four immunochromatographic assays","volume":"81","author":"Demey","year":"2020","journal-title":"J Infect."},{"key":"B32","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/S0140-6736(20)31483-5","article-title":"Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study","volume":"396","author":"Poll\u00e1n","year":"2020","journal-title":"Lancet (London, England)."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1016\/S1473-3099(20)30589-2","article-title":"Risk of COVID-19 in health-care workers in Denmark: an observational cohort study","volume":"20","author":"Iversen","year":"2020","journal-title":"Lancet Infect Dis."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1754538","DOI":"10.1080\/20008686.2020.1754538","article-title":"Evaluation of a COVID-19 IgM and IgG rapid test; an efficient tool for assessment of past exposure to SARS-CoV-2","volume":"10","author":"Hoffman","year":"2020","journal-title":"Infect Ecol Epidemiol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e38","DOI":"10.1056\/NEJMp2015897","article-title":"False negative tests for SARS-CoV-2 infection\u2014challenges and implications","volume":"383","author":"Woloshin","year":"2020","journal-title":"N Engl J Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1016\/j.cmi.2020.05.023","article-title":"Diagnostic performance of seven rapid IgG\/IgM antibody tests and the Euroimmun IgA\/IgG ELISA in COVID-19 patients","volume":"26","author":"Van Elslande","year":"2020","journal-title":"Clin Microbiol Infect."},{"key":"B37","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1038\/s41591-020-0897-1","article-title":"Antibody responses to SARS-CoV-2 in patients with COVID-19","volume":"26","author":"Long","year":"2020","journal-title":"Nat Med"},{"key":"B38","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1016\/S1473-3099(20)30273-5","article-title":"Connecting clusters of COVID-19: an epidemiological and serological investigation","volume":"20","author":"Yong","year":"2020","journal-title":"Lancet Infect Dis."},{"key":"B39","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1016\/j.jagp.2020.04.027","article-title":"Ethical and logistical considerations of caring for older adults on inpatient psychiatry during the COVID-19 pandemic","volume":"28","author":"Fahed","year":"2020","journal-title":"Am J Geriatr Psychiatry."},{"key":"B40","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1016\/j.jagp.2020.04.025","article-title":"Achieving safe, effective, and compassionate quarantine or isolation of older adults with dementia in nursing homes","volume":"28","author":"Iaboni","year":"2020","journal-title":"Am J Geriatr Psychiatry."},{"key":"B41","doi-asserted-by":"publisher","first-page":"101649","DOI":"10.1016\/j.ijlp.2020.101649","article-title":"Isolating residents including wandering residents in care and group homes: Medical ethics and English law in the context of Covid-19","volume":"74","author":"Liddell","year":"2021","journal-title":"Int J Law Psychiatry."},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.6042","article-title":"Spike antibody levels of nursing home residents with or without prior COVID-19 3 weeks after a single BNT162b2 vaccine dose","author":"Blain","year":"2021","journal-title":"JAMA"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.649524\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T07:15:23Z","timestamp":1624518923000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.649524\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,24]]},"references-count":42,"alternative-id":["10.3389\/fpubh.2021.649524"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2021.649524","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2021,6,24]]},"article-number":"649524"}}