aCorporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania bUniversity of Pennsylvania, Philadelphia
Author disclosures
The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Ethics and consent
The Corporal Michael J. Crescenz Veterans Affairs Medical Center Institutional Review Board reviewed and approved this study.
Veterans, as a population, are more susceptible to poor health outcomes and morbidity compared with similar civilian counterparts. 2,14-16 Veteran CLC patients likely would experience worse outcomes with COVID-19, including more infections, expiration, and morbidity compared with similar general population nursing homes. Similar to what had been reported for the civilian population, a trend (high CT/CN values early in the disease course with repeat testing needed to detect all positives followed by lower CT/CN value to correlate with increased viral load and then increased CT/CN value as the infection resolved) also was observed in this veteran population.
It has been extensively documented that minority groups experience decreased health care access and worse health outcomes. 28-30 Considering the critical medical supply shortages, including personal protective equipment, ventilators, and even testing supplies, there is the potential for a resource access disparity by ethnicity. 28-31 Because the VA does not depend on measures of wealth and privilege such as health insurance, there was no disparity noted in access to testing by race or ethnicity at the VAMC CLC. When considering the health outcome of viral load from the measured CT/CN value, the viral loads of African American patients and those of other ethnicities was not significantly different in this study.
Conclusions
This is the first study to bring up critical points including serial CT/CN value correlation in RT-PCR tests, demographic distributions demonstrating easy and equal access in a veteran nursing home to COVID-19 testing, and clinical laboratory signs related to disease pathophysiology. Unlike other populations who have undergone serial CT/CN monitoring, nursing homes represent a particularly vulnerable population who require measures to prevent the spread and mitigate outbreaks of COVID-19. 2,4,5 Test measurements obtained such as the CT/CN value during routine clinical care can provide useful information for public health, epidemiologic, or clinical purposes with appropriate correlation to clinical and other laboratory parameters. This study demonstrates early intervention of serial testing of an outbreak in a veterans nursing home with CT/CN value correlation.
