Fauci: Nursing Homes Need ‘Pristine, Unassailable’ Infection Control Amid COVID-19

The top medical official in charge of the federal government’s coronavirus task force on Tuesday advocated for stricter COVID-19 controls in the nation’s nursing homes, one day after the president and vice president announced a desire for expanded testing in long-term care.

“I’m not sure you could practically do testing every day,” Dr. Anthony Fauci said during a Senate hearing on the administration’s coronavirus response. “That, I don’t think, would be feasible. But something that is much more aggressive than has been done in the past, I believe, should be done.”

Fauci, director of the National Institute of Allergy and Infectious Diseases, was responding to a question from Sen. Maggie Hassan of New Hampshire, who asked whether nursing homes could receive the same kind of daily COVID-19 testing that the White House has provided for people who routinely come in contact with President Trump.

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“I think there should be a system in place for the optimal protection of people in nursing homes, and that would be not necessarily testing every person every day,” Fauci said. “That’s one approach that might not be practical when you think of all the nursing homes in the country.”

Instead, Fauci advocated for “intermittent” testing of staff to prevent the introduction of COVID-19 into facilities, as well as continued restrictions on who may enter nursing homes.

The hearing came in the wake of Monday reports that Vice President Mike Pence and White House Coronavirus Task Force coordinator Dr. Deborah Birx had issued a “strong recommendation” to states, urging them to test all nursing home residents in the country within two weeks.

President Trump doubled down on that imperative during a Monday press conference, announcing a $1 billion grant to states to support expanded nursing home testing, and the distribution of millions of testing supplies.

“I will mandate it if you’d like,” Trump said in response to a reporter’s question about why Pence’s direction was merely a recommendation and not an order. “I think it’s important to do, and I think frankly some of the governors were very lax with respect to nursing homes.”

Hassan praised the Pence-Birx order as a positive short-term step, but pressed Fauci on his longer-term vision for infection control in nursing homes amid COVID-19 and beyond.

“In the long range, we will have to have infection-control capabilities in nursing homes that are really pristine and really unassailable,” Fauci said, adding that nursing homes must have the ability to remove COVID-19-positive residents to alternate sites in order to prevent further spread of the disease.

Fauci also emphasized the importance of surveillance efforts to track COVID-19 cases related to nursing homes.

Tracking the spread was a key thrust of a joint Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control & Prevention (CDC) order requiring nursing homes to provide weekly data about COVID-19 infections, deaths, and other important metrics.

During Tuesday’s hearing, Sen. Bob Casey of Pennsylvania expressed frustration that CMS and CDC had not yet begun reporting that data to the public.

“I need to hear from you today: Why has there been a delay — a three-month delay — in basic information that families and people within a community need about the outbreaks in nursing homes, the number of cases, what is happening in nursing homes?” Casey said in a question directed at CDC director Robert Redfield. “Tell us when we’re going to see that information.”

CMS last week announced a timeline that gave operators until this coming Sunday to make their first submissions to a newly created database; fines for failure to comply do not kick in until early June.

Redfield called the delay “operational,” and emphasized that data collection had begun — while also calling the death toll in nursing homes “one of the great tragedies that we’ve all experienced together.”

Along with testing, Hassan expressed hope that the government could provide more personal protective equipment (PPE) to operators in the space.

“I would say that if we are able to get masks to everybody in the White House, I hope we could get masks to every nursing home employee who needs it,” she said.

Trump in late April announced a plan to send two shipments of PPE to all nursing homes in the country by July 4 through the Federal Emergency Management Agency (FEMA) — a move that at least one industry leader decried as “wholly insufficient.”

“Our hopes were up when we heard that FEMA was stepping in with PPE, but they were soon dashed when it was announced that nursing homes would receive a grand total of two weeks’ worth of supplies, and shipments would not be completed until sometime in July,” LeadingAge CEO Katie Smith Sloan said last week. “This is just a drop in the bucket.”