Looking for fever in nursing home residents with COVID-19: A false friend?

Objectives: Residents in nursing homes represent a frail, elderly population, and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can spread easily in this setting. Despite a frequent severe evolution of coronavirus disease 2019 (COVID-19), these patients often present an atypical course with mild initial symptoms. The aim of this study was to assess the occurrence of fever in elderly patients with COVID-19 residing in nursing homes. Methods: Two hundred and thirty-one elderly patients from three nursing homes in Pavia and surrounding area were enrolled in April-May 2020. SARS-CoV-2 infection was diagnosed using real-time reverse transcription polymerase chain reaction with nasopharyngeal swab and/or serological assay (LIAISON (R) SARS-CoV-2 S1/S2 IgG). Patients with a positive result on RT-PCR or serology were classed as positive. Results: In total, 170 patients (74%) were SARS-CoV-2-positive on RT-PCR and/or serology, and 61 patients (26%) had negative results on both tests. Fever (body temperature >37.5 degrees C) was observed in four patients (1.7%): three in the SARS-CoV-2-positive group (1.8%) and one in the SARS-CoV-2-negative group (1.6%). Conclusions: The prevalence of fever was extremely low in this population of nursing home residents with COVID-19. This finding must be taken into consideration when screening patients without fever in nursing homes. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.