Table 3 Signs, symptoms, comorbidity, laboratory findings, medical treatment and mortality among nursing home (NH) residents confirmed to have COVID-19

Arons et al. (2020) [21]

57

78.6 (9.5)

n = 48

Fever: 5 (10)

Cough: 16 (33)

Shortness of breath: 4 (8)

Confusion: 2 (4)

Nausea: 3 (6)

Diarrhoea: 2 (4)

Sore throat: 3 (6)

Malaise: 6 (13)

Rhinorrhoea or congestion: 1(2)

Dizziness: 2 (4)

Headache: 1 (2)

Asymptomatic at time of testing: 27 (56)

Remained asymptomatic: 3 (6)

n = 48

Cognitive impairment: 28 (58)

Cardiovascular disease: 39 (81)

Diabetes: 18 (38)

Chronic lung disease: 18 (38)

Renal disease: 18 (38)

Received haemodialysis: 3 (6)

Cerebrovascular accident: 19 (40)

Obesity: 11 (23)

Not informed

Not informed

n = 57

15 (26)—3

Atalla et al. (2021) [22]

111

Median: 87.0 (77.0–92.0)

n = 111

Fever: 89 (80.2)

Cough: 48 (43.2)

Shortness of breath: 16 (14.4)

Respiratory distress: 26 (23.4)

Hypoxemia (SpO2 < 94% in room air:106 (95.5)

Confusion: 16 (14.4)

Diarrhoea: 42 (37.8)

Lethargy: 47 (42.3)

Fatigue: 36 (32.4)

Loss of appetite: 68 (61.3)

Sore throat: 6 (5.4)

Nasal congestion or rhinorrhoea: 7 (6.3)

Altered mental state: 66 (59.5)

Myalgia: 14 (12.6)

Agitation or restlessness: 43 (38.7)

Headache: 6 (5.4)

Anxiety: 6 (5.4)

Asymptomatic: 10 (9.0)

Pre-symptomatic: 37 (33.3)

n = 111

Hypertension: 94 (84.7)

Alzheimer’s disease or other dementias: 76 (68.5) Cardiovascular disease: 94 (84.7)

Diabetes: 38 (34.2)

Chronic pulmonary disease: 33 (29.7)

Renal disease: 39 (35.1)

History of malignancy: 7 (6.3)

Obesity: 8 (7.2)

Liver disease: 1 (0.9)

n = 87

High WBC count (> 10 k/μL): 7 (8)

n = 82

Low Hb (< 12 g/dL): 47 (57)

Low platelet count (< 150 k): 18 (22)

High platelet count (> 400 k): 9 (11)

n = 81

Low WBC count (< 4 k/μL): 13 (16)

Low neutrophil count (< 2 k/μL): 13 (16)

Elevated AST (> 40 U/L): 13 (16)

n = 80

High neutrophil count (> 8 k/μL): 4 (5)

Elevated ALP (> 146 U/L): 4 (5)

n = 75

Low lymphocyte count (< 0.8 k/μL): 3 (4)

Elevated ALT (> 40 U/L): 3 (4)

n = 68

Elevated D-dimer (> 0.51 μg/mL): 54 (79)

n = 48

Elevated PCT (> 0.15 ng/mL):

5 (10)

n = 16

Elevated ferritin: 9 (56)

n = 10

Elevated CRP (≥ 5 mg/L): 4 (40)

n = 47

Abnormal chest X-ray: 27 (57)

n = 111

Supplemental oxygen or increased oxygen requirements: 49 (44.1)

Anticoagulation: 70 (63.1)

Enoxaparin: 53 (47.7)

Rivaroxaban: 6 (5.4)

Apixaban: 5 (4.5)

Coumadin: 5 (4.5)

Dabigatran: 1 (0.9)

n = 111

48 (43.2)—8

Beiting et al. (2021) [23]

172

75.4 (12.1)

n = 122

Fever > 99 °F: 79 (64.8)

Cough: 27 (22.1)

Shortness of breath: 14 (11.5)

Hypoxia < 93% or change from baseline: 42 (34.4)

Delirium: 60 (49.2)

Diarrhoea: 8 (6.6)

Nausea or vomiting: 7 (5.7)

Tachycardia > 100 bpm: 21 (17.2)

Fatigue: 48 (39.3)

Anorexia: 61 (50.0)

Sore throat: 5 (4.1)

Myalgia: 6 (4.9)

Hypotension < 100/60 or MAP < 65: 13 (10.7)

Anosmia or ageusia: 1 (0.8)

n = 172

COVID-19 positive and symptomatic: 103 (59.9)

COVID-19 positive and pre-symptomatic: 19 (11.0)

COVID-19 positive and asymptomatic: 50 (29.1)

n = 172

Hypertension: 157 (91.3)

Cognitive impairment or dementia: 120 (69.8)

Cardiac disease: 72 (41.9)

Diabetes mellitus: 71 (41.3)

Chronic pulmonary disease: 55 (32.0)

Obesity (BMI > 30 kg/m²): 31 (18.0)

Immunosuppressed: 17 (9.9)

n = 155

Leucocytosis (WBC > 10.8 1000/mm³): 13 (8.4)

Leukopenia (WBC < 4.8 1000/mm³): 61 (39.4)

Hypernatremia (Na > 145 mEq/L): 38 (24.5)

AKI (Cr > 0.03 mg/dL or 1.5 × baseline): 46 (29.7)

n = 147

AST > 22 U/L: 51 (34.7)

n = 146

ALT > 35 U/L: 22 (15.1)

n = 88

Abnormal chest radiograph: 27 (30.7)

n = 172

Oxygen supplementation: 47 (27.3)

Intravenous fluids: 32 (18.6)

Antibiotics: 37 (21.5)

Exposure to novel therapeutics: 7 (4.1) (e.g. steroids and hydroxychloroquine): 7 (4.1)

n = 172

27 (15.7)—4

Bielza et al. (2021) [24]

341 (in NH)

Median: 88 (83.5—92.5)

n = 341

Fever: 147 (43.1)

Cough: 67 (19.6)

Dyspnoea: 186 (54.5)

Abdominal pain: 1 (0.3)

Diarrhoea: 11 (3.2)

Vomiting: 8 (2.3)

Symptoms of upper respiratory tract: 10 (2.9)

Epileptic seizures: 4 (1.2)

Chest pain: 3 (0.9)

Arthromyalgia: 2 (0.6)

Headache: 3 (0.9)

Anosmia: 2 (0.6)

Severe case: 253 (74.2)

n = 341

Hypertension: 206 (60.4)

Dementia: 197 (57.8)

Heart failure: 34 (10.0)

Ischemic heart disease: 32 (9.4)

Diabetes: 52 (15.2)

COPD: 25 (7.3)

Chronic renal disease:

30 (8.8)

Cirrhosis: 1 (0.3)

Obesity: 20 (5.9)

Chronic neurological disease: 76 (22.3)

Chronic inflammatory disease: 6 (1.8)

Solid neoplasm: 30 (8.8)

Haematological neoplasm: 4 (1.2)

Sleep apnoea syndrome: 7 (2.1)

Not informed

n = 341

Antibiotic: 199 (58.4)

Fluid therapy: 168 (49.3)

Hydroxychloroquine: 11 (3.2)

Enoxaparin: 256 (75.1)

Inhalers: 259 (76.0)

n = 341

158 (46.3)—4

Brouns et al. (2020) [25]

67

84.4 (8.5)

Not informed

n = 67

Hypertension: 33 (49.3)

Dementia: 45 (67.2)

Myocardial infarction: 7 (10.4)

Congestive heart failure: 13 (19.4)

Diabetes mellitus, type 2: 9 (13.4)

Cerebrovascular accident or transient ischaemic attack: 20 (29.9)

Not informed

Not informed

n = 67

35 (52.2)—6

De Spiegeleer et al. (2020) [26]

154

85.9 (7.2)

n = 154

Asymptomatic during study period: 41 (27)

Serious COVID-19: 37 (24.0)

n = 154

Hypertension: 39 (25.3)

Diabetes mellitus: 28 (18.2)

Not informed

Not informed

Not informed

Graham et al. (2020) [27]

126

Median 83

n = 126

Fever: 30 (23.8)

Cough or breathlessness: 41 (32.5)

Confusion or altered behaviour: 43 (34.1)

Diarrhoea or vomiting: 2 (1.6)

Anorexia: 34 (27.0)

Asymptomatic: 54 (42.9)

Not informed

Not informed

Not informed

n = 126

21 (16.7)—8

Kittang et al. (2020) [28]

40

86.2

n = 40

Fever: 9 (23)

Cough: 17 (43)

Dyspnoea: 19 (48)

Acute confusion and/or change in behaviour: 20 (50)

Acute gastrointestinal symptoms: 16 (40)

Marked reduction in general condition: 34 (85)

New or increased risk of falling: 13 (33)

Muscular pain, sore throat, acute urinary incontinence or headache: 8 (20)

Asymptomatic at first test: 9 (27)

n = 40

Hypertension: 21 (53)

Cognitive impairment: 33 (83)

Chronic heart disease:

16 (40)

Diabetes: 12 (30)

Chronic pulmonary disease: 10 (25)

Chronic renal failure: 9 (23)

Previous or current smoker: 13 (33)

BMI > 30 or < 18: 11 (28)

Cancer: 9 (23)

 ≥ 3 comorbid conditions: 35 (88)

 ≥ 2 comorbid conditions: 38 (95)

Not informed

Not informed

n = 40

21 (53)—5

Lally et al. (2021) [29]

775

75.6 (10.8)

Not informed

n = 775

Dementia: 537 (69.3)

Diabetes: 308 (39.7)

Pulmonary disease: 264 (34.1)

Renal disease: 195 (25.2)

Obesity: 118 (15.2)

Hypothyroid: 91 (11.7)

Tumour: 131 (16.9)

Weight loss: 138 (17.8)

Alcohol use disorder: 96 (12.4)

Drugs use disorder: 60 (7.7)

Any substance use disorder: 125 (16.1) Psychiatric diagnosis: 541 (69.8)

Psychoses: 327 (42.2)

Depression: 330 (42.6)

Not informed

Not informed

n = 775

160 (20.6)—4

Panagiotou et al. (2021) [30]

5256

Median: 79 (69—88)

n = 5256

Fever: 2654 (50)

Shortness of breath: 582 (11)

Hypoxia: 979 (19)

Tachycardia: 900 (17)

n = 5256

Hypertension: 4116 (78)

Dementia: 2503 (48)

Cognitive impairment:

- Mild: 1179 (22)

- Moderate: 1547 (29)

- Severe: 463 (9)

Heart failure: 1201 (23)

Coronary artery disease: 1227 (23)

Type 2 diabetes: 2112 (40)

Asthma or COPD: 1366 (26)

Chronic kidney disease: 1385 (26)

Not informed

Not informed

n = 5256

1122 (21.3)—4

Patel et al. (2020) [31]

35

Median: 82 (75—92)

n = 35

Fever: 15 (43)

Cough: 9 (26)

Shortness of breath: 5 (14)

Hypoxia: 1 (3)

Loss of consciousness or delirium: 1 (3)

Fatigue: 9 (26)

Loss of appetite: 4 (11)

Sore throat: 3 (9)

Myalgia: 2 (6)

Chills: 1 (3)

Seizures: 1 (3)

Asymptomatic during follow-up: 13 (37)

n = 33

Asymptomatic at the time of testing: 14 (42)

Not informed

Not informed

Not informed

n = 35

10 (28.6)—4

Poloni et al. (2020) [32]

57

82.8 (6.8)

n = 57

Fever or other typical symptoms: 49 (86.0)

Delirium: 21 (36.8)

Asymptomatic throughout the clinical course: 8 (14.0)

n = 57

Hypertension: 31 (54.4)

Dementia: 57 (100.0)

Cardiovascular disease: 18 (31.6)

Diabetes mellitus: 11 (19.3)

Chronic pulmonary disease: 8 (14.0)

Malignancy: 6 (10.5)

n = 57

Lymphocyte count (1.5 – 4 × 10⁹/L) 50/57 (89.5):

1.3 (1.1–1.6)

CRP (2.9 – 76.2 nmol/L)

Overall: 50/57 (87.7): 152.4 (29.5–361.9)

Living group:

88.6 (29.5–269.5)

Deceased group:

367.6 (196.2–740.0)

Not informed

n = 57

14 (24.6)—3

Rutten et al. (2020) [33]

1538

84 (8.7)

n = 1455

Fever: 917 (63)

n = 1431

Cough: 900 (63)

n = 1373

Shortness of breath: 417 (30)

n = 1023

Decreased oxygen saturation: 453 (44)

n = 1288

Delirium, confusion or drowsiness: 372 (29)

n = 976

Sore throat: 94 (10)

n = 417

Nausea or vomiting: 48 (12)

Fatigue: 93 (22)

Diarrhoea: 74 (18)

Malaise: 73 (18)

Rhinorrhoea: 52 (12)

Common cold: 52 (12)

n = 1525

Dementia: 945 (62)

Cardiovascular disease: 763 (50)

Cerebrovascular disease: 625 (41)

Diabetes mellitus: 397 (26)

Chronic respiratory disease: 275 (18)

Reduced kidney function: 275 (18)

Parkinson disease: 92 (6)

Not informed

Not informed

n = 1538

646 (42.0)—4

Sacco et al. (2020) [34]

41

88.8 (7.0)

n = 41

Temperature changes: 28 (68)

- Normothermia: 13 (32)

- Hypothermia < 36 °C: 4 (10)

- Hyperthermia > 38 °C: 24 (59)

Cough: 20 (49)

Dyspnoea: 25 (61)

Polypnea: 17 (42)

- Between 23 and 29/minute: 8 (20)

- ≥ 30/minute: 9 (22)

Pulse oximetry under 90%: 19 (46)

Delirium (over- or hypoactive): 3 (7)

Diarrhoea: 5 (12)

Nausea: 2 (5)

Vomiting: 1 (2)

Asthenia: 14 (34)

Anorexia: 7 (17)

Myalgia or arthralgia: 3 (7)

Low blood pressure: 2 (5)

Fall: 6 (15)

Altered consciousness: 4 (10)

Rhinitis: 8 (20) Odynophagia: 2 (5)

Anosmia: 1 (2)

Conjunctivitis: 1 (2)

Other signs^b: 9 (22)

Not informed

Not informed

Not informed

n = 41

11 (27.0)—6

Shi et al. (2020) [35]

146

85.0 (9.3)

n = 146

Symptoms at time of testing:

Fever: 31 (21.4)

Cough: 35 (24.1)

Delirium: 27 (18.6)

Vomiting: 13 (9.0)

Diarrhoea: 9 (6.2)

Anorexia: 26 (17.9)

Asymptomatic: 66 (45.5)

Symptoms at any time:

Delirium: 83 (57.6)

Anorexia: 102 (70.8)

Fall: 22 (15.1)

Days of fever (M ± SD): 1.8 ± 2.0 (max. 9 days)

n = 146

Cognitive impairment

- None or mild: 46 (33.8)

- Moderate: 65 (47.8)

- Severe: 25 (18.4)

Congestive heart failure: 12 (8.6)

Diabetes: 25 (18.0)

COPD: 12 (8.6))

Not informed

n = 146

Required oxygen: 58 (40.0)

n = 146

44 (30.1)—7

Strang, Bergström et al. (2021)^c [36]

253

M = 86.6 (range: 63 -104)

Not applicable

Not informed

Not informed

p.r.n. prescriptions

(n = 253)^d

Strong opioid: 243 (96)

Tranquiliser: 242 (96)

Antiemetic: 238 (94)

Antimuscarinic: 243 (96)

Not applicable

Strang, Martinsson et al. (2021)^e [37]

1903

M = 86.7 (range: 57 -107)

n = 1811

Breathlessness: 556 (31)

n = 1676

Delirium: 423 (25)

n = 1797

Anxiety: 1015 (56)

n = 1867

Respiratory secretions: 956 (51)

Not informed

Not informed

n = 1889

Parenteral or enteral fluids, nutrition during on last day of life:

116 (6)

n = 1903

1903 (100.0)—34

Tang et al. 2020 [38]

752

Asymptomatic: 74.7

Symptomatic:

76.5

n = 328

Fever: 161 (49.1)

Cough: 195 (59.5)

Shortness of breath: 69 (21.0)

Vomiting: 14 (4.3)

Diarrhoea: 23 (7.0)

Sore throat: 7 (2.1)

Muscle aches: 28 (8.5)

Runny nose: 8 (2.4)

Nasal congestion: 12 (3.7)

Chest congestion: 24 (7.3)

Chills: 2 (0.6)

Shaking: 1 (0.3)

n = 752

Asymptomatic at time of testing: 424 (56.4)

Symptomatic at time of testing: 328 (43.6)

n = 752

Hypertension: 664 (88.3)

Dementia: 378 (50.3) Coronary heart disease: 240 (31.9)

Heart failure: 198 (26.3)

Diabetes: 380 (50.5)

Asthma: 54 (7.2)

COPD or emphysema: 146 (19.4)

Chronic kidney disease, stage 1–5: 200 (26.6)

End-stage kidney disease: 90 (12.0)

Cancer: 61 (8.1)

Atrial fibrillation: 146 (19.4)

Peripheral vascular disease: 168 (22.3)

DVT or PE: 107 (14.2)

Anaemia: 389 (51.7)

Hypothyroidism: 123 (16.3)

HIV: 10 (1.3)

Chronic hepatitis C: 21 (2.8)

Cerebrovascular disease: 277 (36.8)

Depression: 421 (56.0)

Not informed

Not informed

n = 242

155 (64) – 15

Tobolowsky, et al. (2021) [39]

101

Median: 83 (51–100)

n = 82

Fever (≥ 100.0 °F): 40 (49)

Low-grade fever (99.0–-99.9 °F): 24 (29)

Cough: 58 (71)

Shortness of breath: 29 (35)

Tachypnoea: 42 (51)

Change in oxygen status: 45 (55)

Change in mental state: 24 (29)

Nausea or vomiting: 8 (10)

Acute diarrhoea: 7 (9)

Tachycardia: 50 (61)

Sputum production: 26 (32)

Fatigue: 19 (23)

Lethargy: 15 (18)

Rhinorrhoea or nasal congestion: 5 (6)

Conjunctivitis: 4 (5)

Chills: 1 (1)

Headache: 1 (1)

Sore throat: 4 (5)

Myalgia: 1 (1)

n = 101

Asymptomatic: 4 (4)

Pre-symptomatic: 12 (11.9)

n = 101

Hypertension: (81)

Dementia: (46)

Cardiac disease: (65)

Diabetes mellitus: (33)

Pulmonary disease: (28)

Renal disease: (42)

Hepatic disease: (8)

Malignancy: (17)

Immunodeficiency: (1)

Obesity: (33)

Neurologic disease: (38)

Not informed

Not informed

n = 101

35 (34.7)—4