June 02, 2020
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Many nursing homes still haven’t tested any residents or staff for the coronavirus

Linda Coan O'Kresik | BDN
Linda Coan O'Kresik | BDN
Ruthe Gray sits on a lawn chair and talks with her mom, Estelle Pendleton, 81, on the phone as they visit each other through the window of Estelle’s room at Tall Pines in Belfast on April 22.

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A group of Maine doctors who oversee the medical care of residents at nursing homes and other long-term care facilities is urging the state to open up coronavirus testing to staff and residents who have any respiratory symptoms as a way to pre-empt additional outbreaks of the virus.

It is also pushing the state to provide long-term care facilities with more of the testing swabs and safety gear that’s needed to conduct those tests, after a recent survey of its members found that a number of them had few or no swabs.

[Our COVID-19 tracker contains the most recent information on Maine cases by county]

The push to allow more testing comes as outbreaks of the virus have been reported at six of Maine’s long-term care facilities, and more than half of the people in Maine to die after testing positive for coronavirus — 35 out of 61 — have been residents of those facilities, according to the Maine Center for Disease Control and Prevention.

Maine CDC has tried to prioritize the state’s limited number of coronavirus testing materials for several high-risk groups, including residents and workers in nursing homes and other congregate living settings. Once coronavirus outbreaks have been detected in those facilities, it has also been widely testing their residents and staff to determine how far the highly contagious respiratory infection has spread.

But the state’s approach has not encouraged the more preemptive level of testing that would be needed to prevent future outbreaks among the vulnerable residents of nursing homes, according to Dr. Jabbar Fazeli, a geriatrician in southern Maine who serves as spokesperson for the Maine Medical Directors Association, a small organization representing nursing home medical directors.

In particular, Fazeli said the state should promote wider testing of people in those places if they show any symptoms associated with colds, the flu or the coronavirus, so as to head off any outbreaks. Besides protecting the residents of those facilities, he argued that such an approach could also save precious testing materials by preventing the outbreaks that result in the rapid testing of many people.

Robert Long, a spokesperson for the Maine CDC, said that the medical directors of long-term care facilities can still order tests when they deem them to be clinically warranted. He added: “timing and frequency of testing at facilities where at least one case has been confirmed are more important than total number of tests as part of a strategy to limit potential spread of the virus.”

But Fazeli said the state’s guidelines can discourage testing for what could be mild cases of the coronavirus, or its early stages.

In a recent survey of his group’s members that had received 28 responses as of the start of this week, about 40 percent reported that they hadn’t tested any residents or staff for the coronavirus, and 15 percent reported that they were not testing for the virus after people exhibited cold, flu or gastrointestinal symptoms.

About a third of the respondents said they had none of the medical swabs necessary to test for the coronavirus, and almost two-thirds said they had fewer than eight.

The nursing homes that responded to the survey were scattered across much of the state, but the biggest initial responses came from Cumberland, York, Androscoggin and Kennebec counties. Almost half of the respondents reported that they were within 20 miles of another facility with positive cases of COVID-19, the disease caused by the virus.

A separate survey of long-term care facilities recently conducted by the state found that about half of them had staff who worked either in multiple units of the same facility or in other facilities.

The last formal guidelines released on the Maine CDC’s website on March 19 indicated that it would prioritize testing for people from high-risk groups — including congregate living residents, health care workers, the elderly and the hospitalized — who have either a fever or unspecified “respiratory symptoms.”

“They should rethink their policy and strategy that was formulated in March, and that doesn’t take into account that we have had six outbreaks at long-term care facilities,” Fazeli said. “The barriers are there, but at a time like this, we need more people saying what we’re saying instead of more people saying, ‘We’re short.’ We need to figure out a way to bridge that gap before we have more outbreaks.”

Nirav Shah, the director of the Maine CDC, has said that expanding testing in long-term care facilities is a priority. But on Tuesday, he was unable to identify when specifically Maine CDC would loosen its testing guidelines for those places. He said it will depend on the state having enough total resources to keep testing other priority groups as well.

“We are working very diligently on trying to expand our overall testing supply, which will be the real kingpin that’s necessary before we can move towards more expanded testing,” he said.

Shah also said that it’s “very difficult” to know whether universal testing of nursing home residents would have prevented some of the outbreaks that have already occurred.

“What we know about infection control is that testing is necessary,” but that it depends even more on “tried-and-true” practices such as handwashing and wearing protective equipment.

Watch: Should you remove loved ones from care facilities during the outbreak?

 

 


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