Birx Defends Testing Progress: ‘We Only Have 1M Nursing Home Residents’

The coordinator of the White House Coronavirus Task Force on Friday defended the federal government’s progress in encouraging universal COVID-19 testing in nursing homes, asserting that the nation has the capacity to test more people than currently live in long-term care facilities.

“We only have a million nursing home residents,” Dr. Deborah Birx said during a Friday press conference at the White House. “We’re testing way over a million people per week, getting closer to over two million people a week. So over that four million per two weeks, I was hoping that a million of those could be our nursing home residents.”

There are about 1.3 million residents in the nation’s nursing homes, according to census data and the Kaiser Family Foundation; during the week of May 10 to May 16, labs processed 1.1 million COVID-19 tests in the U.S., according to the Centers for Disease Control & Prevention (CDC).

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Birx was responding to a question from a reporter about why there hasn’t been more progress toward the White House’s suggested goal of testing all residents and staff, first reported on May 11.

What began as a comment by Birx and Vice President Mike Pence in a phone call to state governors — as reported by the Associated Press — expanded into a recommendation by President Trump later that same day; the president also indicated that he could make the benchmark mandatory “if you’d like.”

The Centers for Medicare & Medicaid Services (CMS)issued more formal guidance around universal testing this week, indicating that it would be a prerequisite for lifting the ban on non-essential nursing visits that has been in place since the start of the pandemic. CMS also recommended nursing homes test all staff members once per week.

While operators largely welcomed the emphasis on testing, leaders asserted that achieving the goal would be difficult without additional federal support: Just testing every single nursing home resident and staff member once would cost about $440 million, according to an estimate from the American Health Care Association (AHCA), while ongoing weekly tests of staffers will cost about $1 billion per month.

CMS administrator Seema Verma has repeatedly asserted that states have sufficient — and even excess — testing capacity for nursing homes, but experts have argued that the edicts don’t mean much unless the federal government and states physically provide the requisite numbers of testing kits, along with sufficient laboratory capacity.

“Saying states should be doing regular testing at nursing homes, I don’t think that this is going to move the needle in a major way, just because most states don’t have testing,” Harvard Medical School professor David Grabowski told SNN this week. “I don’t know how any of these actors, at a state or federal level, believe this is actually going to meaningfully change testing unless they actually go in and make those tests available.”

Birx on Friday acknowledged that the testing reality has not yet matched the rhetoric from Washington.

“I’m a very aspirational and hopeful person that likes to put out challenges, because I think that’s what needs to be done,” she said.

The total number of tests performed is less important than tailoring testing efforts to specific at-risk groups, Birx said.

“We have a lot of worried well that will come back frequently to get tested,” she said. “We want to test, and we want states testing, in areas where we know there’s higher vulnerability, to susceptibility to worse outcomes, like our nursing homes.”

Without pointing to specific examples, Birx said that some states have been successful at rolling out widespread testing programs, adding that state governors are encouraged on regular calls with federal officials to share best practices with their counterparts elsewhere in the country.

“We should never be discouraged by those who can’t get it done,” Birx said. “We should be encouraged by those who have shown us that it can be done.”