A Nursing Home Appeared COVID-Free. Testing Revealed 85% Positive in Four Days

In perhaps the starkest illustration yet of the need for routine testing in long-term care, a new analysis reveals how one nursing home went from zero suspected cases to an 85% positive rate in four days.

A team of researchers looked at the isolated case of a single facility in Massachusetts, which the state government had eyed in April as a COVID-only building under an early cohorting plan.

As of April 1, not a single one of the 97 residents displayed symptoms as defined by daily screening protocols. Management had already implemented a “strict visitation and staff screening policy,” which consisted of daily temperature and symptom checks; staff had also been working under universal masking protocols and new admissions had been nearly halted. Residents were required to wear masks before leaving their individual rooms.

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Even with all of those restrictions in place, the initial two rounds of universal testing revealed an 85% positive rate among residents by April 4; nearly 40% of the facility’s staff also tested positive, prompting the facility to more actively divide the facility into positive and negative cohorts.

The team floated several reasons for the widespread prevalence of COVID-19 in the facility, which is divided into three units: short-term, long-term, and memory care. The latter unit saw the highest rate of positives among its residents, at a full 75% — compared to 53.3% for the short-term unit and the 34.3% for the long-term area.

“Despite social distancing policies, residents continued to intermingle due to difficulty restricting patient movements,” the researchers observed. “This was a particular challenge in the memory unit, likely contributing to a significantly higher prevalence of disease.”

As with other previous analyses of asymptomatic spread in nursing facilities, the Massachusetts team highlighted the role that unwitting staffers may play in introducing the novel coronavirus into long-term care settings — as well as a fear of losing out on work.

“Staff may have been disincentivized to report symptoms due to fears of work loss, and staff working multiple jobs may have facilitated spread of
infection between facilities,” the group noted. “Further, insufficient training in appropriate PPE technique may have contributed. While appropriate PPE policies were in place, adherence cannot be confirmed.”

While the report’s authors note that it’s difficult to draw sweeping conclusions from the experience of one facility, the analysis adds to the growing body of research showing the power of asymptomatic spread of COVID-19 in congregate care settings.

As states across the country struggle with spiking case counts, staffers will be at elevated risk for exposure during their daily lives, making the testing component crucial for preventing future outbreaks across the South and Sun Belt.

“As long as we still see the positivity rate in Florida at 18%, 19%, and as we continue to see cases climb, we must provide testing for both our staff and our residents,” Jay Solomon, CEO of Florida senior living community. Aviva — A Campus for Senior Life, said during a LeadingAge press conference held earlier week. “That’s the only mechanism that we have right now to ensure that we’re keeping everybody safe.”

The Massachusetts researchers agreed.

“Until preventative and curative therapies become available, increased testing, meticulous infection control, and advance care planning are essential in caring for this vulnerable population,” they concluded. “Simply screening for symptoms is no longer enough.”

The paper, published in the journal Clinical Infectious Disease, had a host of authors from institutions such as Brigham & Women’s Hospital, Massachusetts General Hospital, and Harvard Medical School, all of Boston; the corresponding author was Dr. Scott Goldberg of Brigham & Women’s.