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Here are the basic reasons that I’m writing this column:
Based on U.S. Centers for Disease Control and Prevention guidelines, nursing homes and even hospitals, are discouraged from testing asymptomatic COVID exposure cases.
Testing of patients and staff members with mild symptoms is still not encouraged by the state CDC.
The guidelines are in part based on testing shortages, and not entirely on science, with no disclaimer to indicate that.
In the past month, there has been a spike in COVID cases, and outbreaks, in nursing homes, yet the testing guidelines have not changed. Geriatric doctors still have to fight to test the mildly symptomatic cases, and the high-risk asymptomatic exposure cases in nursing homes, which should be a common sense escalation in our mitigation plans.
Given the benefits of testing, we can only interpret the current CDC guidelines to be driven, in part, by the shortage of testing. Yet it carries no such disclaimer.
The watered-down CDC guideline that offers a way out of testing due to shortages of tests, is akin to the Federal Aviation Administration decreasing or eliminating a maintenance protocol for airplanes due to shortage of essential spare parts. We can expect the results to be deadly in either case.
Many doctors look at guidelines as Scripture to quote and follow. In this case, however, if we blindly follow these watered down commandments, we would inadvertently place our staff and our nursing home residents in mortal danger.
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To illustrate, in real time, what all this means to the front line staff in nursing homes, I would like to share two close calls we had in one of our facilities.
At the end of March, a hospital employee came to visit her dying mother who lived in one of our facilities. The vigilant staff checked her temperature and she had a fever. It turned out that she had a COVID exposure at the hospital where she worked, and instead of testing, they followed guidelines and sent her home for 14 days. That decision almost caused an outbreak at our nursing home facility.
We will never know how many cases this untested person caused within her own work setting, her own family or the community. In short, there can’t be any meaningful contact tracing and secondary containment in this situation, since the source case was never confirmed positive through testing.
The second example involves an actual positive case in one of my facilities on April 4. The staff member lived with a partner who tested positive that day for COVID and was still at home. We tested her and she was positive. We subsequently tested 12 staff members with secondary exposure who had mild to moderate symptoms.
If we had followed the CDC guidelines, Maine Health guidelines or national organizations guidelines, we wouldn’t have tested our first case of COVID, and would have allowed the staff member to return to work in 14 days without follow up testing. Incidentally we did do follow-up testing and the test was still positive.
If doctors are told to note that the CDC recommendations are highly influenced by the shortage of testing and PPEs, they may be more likely to decide, on a case-by-case basis, to override the guidelines and test a few more cases to avoid catastrophe.
I want to stress that I am not advocating for routine mass testing. Medical directors want to be able to test patients who have cold or flu-like symptoms, not just COVID symptoms that meet guidelines, and we want to test and retest our high exposure cases among our staff and residents.
Incidentally, mass testing is what the CDC does when we don’t do enough testing and facilities develop a full blown outbreak.
We appreciate the tireless work of the Maine CDC and the governor, but we need them to do more on the less glamorous geriatric front.
This month, nursing homes are in the eye of the storm and are facing maximum danger. We need everyone in government to change policies to push the limits of our testing capacity to save lives.
Jabbar Fazeli, MD, is a geriatrician in southern Maine and the vice president and spokesperson for the Maine Medical Directors Association, a small organization representing nursing home medical directors.
Watch: Should you remove loved ones from care facilities during the outbreak?