Symptom-independent COVID tests can drastically reduce the number of cases in nursing homes and senior care communities
On August 7, the department of Health and Human Services announced that it would allocate $5 billion to nursing homes through the CARES Act Provider Relief Fund (PRF). This initiative aims to protect residents of nursing homes and long-term care facilities from the impact of COVID-19. An initial $2.5 billion was already distributed to providers in mid-August 2020 to support increased testing, staffing and PPE needs, and provide funding for establishing COVID-19 isolation facilities. In alignment with the several principles emerging from the Administration’s recent work in creating a new “Quality Roadmap”, the remainder of the funding will be distributed based on the nursing home’s performance in controlling COVID-19. This second wave of funding will be based on factors such as the nursing home’s ability to minimize COVID-19 spread and COVID-19-related fatalities among its residents. The prevalence of the virus in the facility’s local geography will also be taken into account.
Here is the catch: relying solely on human testing while following the new CDC recommendation to not test asymptomatic people will likely jeopardize nursing homes eligibility for this funding and contribute to the already visible increase in COVID-19 cases. Here’s why.
- New COVID-19 infections in locked-down nursing homes, senior care and long-term care facilities are likely started by non-symptomatic carriers (staff or outside providers).
- COVID-19 spreads extremely rapidly in those at-risk communities
When it comes to COVID-19 infection control, nursing homes, just like senior and long-term care communities, have faced countless obstacles. Despite already limited financial support, they have been deploying an immense effort to quickly adapt to ever changing information available about the virus and new regulations and recommendations from health authorities. Following those guidelines involves constant monitoring of each community and requires rapid access to human molecular tests. Most communities focus on detecting symptoms such as cough and fever. This approach does not address the increasingly obvious high infectivity of non-symptomatic carriers, who represent more than half of COVID-19 infected individuals, according to the CDC. The recent uptick in COVID-19 outbreaks shows that symptom-based screening fails to prevent outbreaks. Even when willing to implement policies to test asymptomatics, senior and long-term care communities are often unable to enforce such policies when it comes to outside providers. Yet it is known that in communities where patients do not move in and out of the facilities and that are closed to visitors, staff and outside providers are the number one vectors of the virus. We also know that once the virus enters an at-risk community, it can result in an exponential increase in cases. In August a survey led by the Yale School of Public Health and the Connecticut Department of Health found that of the 2,117 residents tested in 33 nursing homes, 28.3% were infected with the virus.
“ All SARS-CoV-2–positive residents were asymptomatic or presymptomatic at the time of testing in 45.5% of Nursing Homes” – Parikh et al, 2020
So how can nursing homes and long-term care communities secure the portion of the PRF that depends on the “ability […] to minimize COVID spread and COVID-related fatalities among its residents”? According to the HHS website, recipients of the fund will not need to report directly, but HHS will require recipients to submit future reports on how the funds were used. So communities will need to provide proof that they took innovative actions to reduce COVID-19 infections specifically and ensure that if the virus is introduced into the community, it does not spread through the resident population.
“We anticipate that linking payment to performance will be an effective means of holding nursing homes accountable, stimulating innovation, and encouraging them to reach beyond their own walls for infection control expertise and support” – Thomas Engels, Administrator of HRSA.
There are no magic bullets when it comes to detecting the invisible threat of COVID-19. All the tests currently available have important drawbacks. However, by combining the tools and technology currently available, it is absolutely possible to detect SARS-CoV-2 as soon as it is introduced into a nursing home or in a senior or long-term care community. Let’s take the example of 2 similar communities, both located in a high-risk area. Community A chooses to use human COVID tests, while Community B pairs human COVID tests with a COVID-19 surveillance program doing weekly COVID surface tests. Both communities diligently test 25% of their staff and residents each week in order to cover 100% of the community members every month. Now let’s say that a Medicine Aid contracted COVID-19 during their shift in another community a couple of days prior. They are not yet exhibiting symptoms and they part of the cohort that was tested 2 weeks ago. In community A, this staff member will continue to interact with their patients for up to 2 weeks, until they develop symptoms or until they are tested again and correctly identified (not a false negative). Community B however receives an alert from Enviral Tech within 24 hours of receiving the surface test samples, letting them know that the virus is currently present in their environment. Community B immediately switches their testing schedule to prioritize the community members who have access to the COVID-positive surfaces in order to quickly identify and isolate the carrier. These 2 scenarios illustrate the power of COVID-19 surveillance, especially in complement to human testing to reduce or eliminate COVID-19 spread in nursing home, senior and long-term care communities.