Added value of anti-SARS-CoV-2 antibody testing in a Flemish nursing home during an acute COVID-19 outbreak in April 2020.

OBJECTIVES: To examine the added value of anti-SARS-CoV-2 antibody testing in a nursing home during an acute COVID-19 outbreak. RT-PCR is the gold standard, but can be false-negative. METHODS: 119 residents and 93 staff members were tested with RT-PCR test and/or a rapid IgM/IgG test. Of these participants, 176 had both tests, 24 only RT-PCR, and 12 only IgM/IgG in the period April 14 to 16 April 2020. RESULTS: 40 (34%) residents and 11 (13%) staff were PCR-positive. Using a rapid IgM/IgG test, 17 (17%) residents and 18 (20%) staff were positive for IgM and/or IgG (IgM/IgG). Thirty-two PCR-positive residents had an IgM/IgG test: 9 (28%), 11 (34%), and 13 (41%) were positive for IgM, IgG, and IgM/IgG. Ten PCR-positive staff had an IgM/IgG test: 3 (30%), 6 (60%), and 6 (60%) were positive for IgM, IgG, and IgM/IgG. Additional IgM/IgG tests were performed in 9 residents 11 to 14 days after the positive RT-PCR test. Of those, 7 (78%) tested positive for IgM/IgG. When retested 3 weeks later, the 2 remaining residents also tested positive. Of the 134 PCR-negative participants who had an IgM/IgG test, 15 were positive for IgM/IgG (8% of the 200 participants tested with RT-PCR). CONCLUSIONS: During an acute outbreak in a nursing home, 26% of residents and staff were PCR-positive. An additional 8% was diagnosed using IgM/IgG antibody testing. The use of RT-PCR alone as the sole diagnostic method for surveillance during an acute outbreak is insufficient to grab the full extent of the outbreak.

The management of dementia by flemish GPs: it remains a difficult job.

Objective: The following study examines how GPs in Flanders deal with dementia in terms of detection, diagnosis, care diagnosis and treatment.Methods: An online survey was sent out by mail to 5113 Flemish GP's. Data were collected in 2016. The results were processed in a univariate and multivariate analysis with SAS 9.4Results: 331 GPs completed the survey in full (response rate 6.47%). The results are representative of GPs of the Flemish Region in terms of distribution across the provinces and university of graduation. 82.78% use the MMSE and 5.44% the DSM criteria. A blood analysis was performed by 80.97%, aCT or MRI by 23.56% and 17,22% respectively. Nine out of 331 mapped out the full care planning. The Katz scale was used rarely or never by 25.38%. The physical condition of the caregivers was enquired about by 91.69% and their mental state by 96.92%. Acetylcholinesterase inhibitors were prescribed by 94.56%, memantine by 57.70%, ginkgo biloba by 49.85%. 89.73% prefers a medical approach for hallucinations and delusions, 65.26% for aggression, 50.78% for agitation, 71.30% for depression and 48.34% for sleep disorders. Older GPs felt their knowledge was insufficient and used more pharmacological treatments.Conclusion: GPs are unfamiliar with available detection and diagnostic possibilities. GPs include history taking of carers but underuse available support tools, biochemical analyses and imaging. Post diagnostic care is mapped out insufficiently, despite the fact that GPs focus adequately on their patients' caregivers. In the pharmacological treatment there is a notable discrepancy between what GPs think and do. Pharmacological policy in behavioural bymptoms is most common. GPs highly value the possibility of receiving support by reference physicians.

Early experiences with antibody testing in a Flemish nursing home during an acute COVID-19 outbreak: a retrospective cohort study.

objectivesto assess the prevalence of COVID-19 (PCR-test) in residents and staff of a nursing home. To examine the presence of IgM and IgG antibodies in the sample and the relation between PCR and antibody test results. designcross-sectional and (retrospective) cohort study settinga nursing home for the elderly Bessemerberg in Lanaken (Belgium) with up to 130 beds. Lanaken is situated in the Belgian province with the highest COVID-19 prevalence. participantsresidents (N=108) and staff members (N=93) of the nursing home outcomesPCR, IgM and IgG resultsthe prevalence of COVID-19, based on PCR test was 34% (N=40) for residents and 13% (N=11) for staff members, respectively. Of the residents, 13% showed positive IgM results and 15% positive IgG results. In 17% of the residents, at least one of the antibodies was positive. In total 13% of the staff members had positive IgM and 16% had a positive IgG. In 20% of the staff members at least one of these antibody tests was positive. In PCR positive residents, the percentage of IgM positive, IgG positive, and at least one of both was 28%, 34%, and 41%. In PCR positive staff, we found 30%, 60%, and 60%. Additional antibody tests were performed in nine residents between day 11 and 14 after the positive PCR test. Of those, 7 (78%) tested positive on at least one antibody. When retesting three weeks later, all remaining residents also tested positive. conclusionsRecently it was reported that in Belgium antibodies are present in 3-4% of the general population. Although, the prevalence in our residents is higher, the number is largely insufficient for herd immunity. In staff members of the regional hospital the prevalence of antibodies was 6%. The higher prevalence in nursing home staff (21%) may be related to the complete absence of good quality protection in the first weeks of the outbreak. Article summaryO_LSTStrengths and limitations of this studyC_LST- This is the first study in Belgium examining the prevalence of COVID-19 and the presence of antibodies in residents and staff members of a nursing home - The internal procedural control was positive -with one exception- in all tests, which suggests good quality sampling and testing. - Some degree of selection bias should be assumed in residents, since some residents were absent; mostly from hospitalisation or death which can be related to the presence of COVID-related disease. - The study was set up in one nursing home and is consequently not representative for the whole of the Flemish community