Management

CDC: Guidance for Managing COVID-19, Influenza in Nursing Homes

The Centers for Disease Control and Prevention (CDC) have issued guidelines for the management of SARS-CoV-2 and influenza when they are cocirculating in a nursing home setting. The recommendations are as follows:

Symptomatic residents should be placed under COVID-19 precautions.

The symptoms of COVID-19 and influenza are similar, so it is difficult to distinguish between the 2 viruses based on symptoms alone. When possible, residents with COVID-19 or influenza symptoms should be moved to a single room (when available) or remain in their current room. Residents with symptoms should not receive a new roommate while awaiting results.

Additionally, the resident should not be preemptively moved to the COVID-19 unit. COVID-19 and influenza symptoms can manifest differently in older adults; they do not always manifest as fever or respiratory symptoms. Monitor for new or worsening malaise, headache, dizziness, nausea, vomiting, diarrhea, and loss of taste or smell.

Residents with symptoms of COVID-19 or influenza should be tested for both viruses.

As coinfection can occur, diagnosis of COVID-19 does not exclude an infection with influenza and vice versa. Nursing homes should notify the health department if there is:

  1. Suspected or confirmed case of COVID-19 or influenza in a resident or health care worker;
  2. A resident with a severe respiratory infection that results in hospitalization or death;
  3. Three or more residents or health care workers with new-onset respiratory symptoms within 72 hours.

 

COVID-19 can be tested for by respiratory specimens, nucleic acid detection, or antigen detection assays. Influenza can be detected by respiratory specimens or rapid influenza nucleic acid detection assays. If the resident tests negative for both COVID-19 and influenza, it is recommended to consider additional viral or bacterial tests.

Residents with COVID-19 should be moved to a COVID-19-dedicated unit.

If the resident is coinfected with COVID-19 and influenza, he or she should be moved to a single room within the COVID-19 unit or with a roommate who is also coinfected. If the resident only has influenza, he or she should be moved to a single room (if possible) or with a roommate who also has influenza. If this is not possible, measures should be taken to reduce transmission to the roommate.

Antiviral treatment should be prescribed to a resident who tests positive for influenza.

Antiviral empiric treatment can also be prescribed if results are pending and the resident is symptomatic. Antiviral chemoprophylaxis (oral oseltamivir) should immediately be issued to all exposed individuals (roommates) of the resident with confirmed influenza. If 2 or more residents become ill within 72 hours of each other, chemoprophylaxis should occur for all residents within the unit.

Remdesivir is the only approved treatment for COVID-19. However, it is only indicated for patients who are hospitalized. Currently there is no clinical management for nonhospitalized patients with COVID-19 that is approved by the US Food and Drug Administration (FDA). The FDA issued an Emergency Use Authorization (EUA) for bamlanivimab for the treatment of outpatients with mild to moderate COVID-19 who are at risk for hospitalization and/or progressing to severe disease.

Currently there is one clinical trial of bamlanivimab in skilled nursing residents. The FDA issued an additional EUA for the combination of casirivimab and imdevimab for patients with mild to moderate COVID-19 who are not hospitalized or receiving oxygen who are at high risk for hospitalization and/or progressing to severe disease.

—Audrey Amos

Reference:

Testing and management considerations for nursing home residents with acute respiratory illness symptoms when SARS-CoV-2 and influenza viruses are co-circulating. Centers for Disease Control and Prevention. Updated November 23, 2020. Accessed December 1, 2020.  https://www.cdc.gov/flu/professionals/diagnosis/testing-management-considerations-nursinghomes.htm