Clinical Features of SARS-CoV-2 Infection in Italian Long-Term Care Facilities: GeroCovid LTCFs Observational Study

Our results are partly in line with those of previous studies. For instance, the frequency of hypertension among COVID-19 patients enrolled in other studies ranged between 15% and 35%. In our sample, the lower prevalence of hypertension found among SARS-CoV-2–positive residents compared to symptomatic or asymptomatic SARS-CoV-2–negative individuals, may be interpreted as part of the phenomenon of "reverse epidemiology”; that is, some degrees of hypertension may protect against all-cause mortality. On the other hand, asymptomatic SARS-CoV-2–negative residents with a history of close contact had the lowest prevalence of neurologic diseases, dementia, and malnutrition, whereas SARS-CoV-2–positive individuals appeared to be more likely to present such conditions. As already underlined by previous study, our data support the higher risk that individuals with dementia may have in getting SARS-CoV-2 infection. Finally, worthy of interest is the high mortality found among SARS-CoV-2–negative symptomatic residents, who were likely to have experienced non–SARS-CoV-2 infections or exacerbations of their chronic conditions. Overall, these findings suggest that attributing death to COVID-19 only based on epidemiologic or clinical criteria, without confirmation by nasopharyngeal swab test, may be misleading and probably contributed to overestimating COVID-19–related mortality in the LTC setting, especially during the first pandemic wave.