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On the same day that the state’s public health agency tested more than 200 residents and employees at a Skowhegan nursing home where one resident had tested positive for COVID-19, it refused to conduct a smaller number of tests for a nursing home in Kittery that also had a single confirmed case.
The willingness to test residents and staff members at one facility and not another highlights an inconsistency with testing as the Maine Center for Disease Control and Prevention prepares to deploy expanded testing capacity later this month.
The CDC’s director has said that a top priority with expanded testing capacity is to “zero in” on nursing homes and other congregate care settings where medically vulnerable residents live in close quarters and the coronavirus spreads easily. Maine has seen coronavirus outbreaks at seven nursing homes, and more than half of the state’s coronavirus deaths have been nursing home residents.
On Wednesday, after a resident’s test for COVID-19 came back positive, the medical director of the Durgin Pines nursing home in Kittery decided to collect swabs from 50 staff members and 12 residents who had been exposed to the resident.
The facility has 68 residents and 148 staff members in total, said Dr. Jabbar Fazeli, the medical director. The nursing home collected specimens only from the residents and staff members who live and work in the infected resident’s wing of the nursing home or who had shown coronavirus-like symptoms, he said.
With the specimens in hand, multiple staff members from Durgin Pines reached out to the Maine CDC to ask if the state’s lab would test the samples. Under the impression that the facility was asking to test all its residents and staff, a field epidemiologist in the infectious diseases division of the state agency refused to test the samples.
“Our protocol for universal testing in long-term care facilities states we cannot conduct universal testing when the long-term care facility has only one positive,” the epidemiologist wrote in an email to Jessica Lucia, Durgin Pines’ assistant director of nursing.
Lucia wrote back to clarify that Durgin Pines wasn’t asking for universal testing, and explained that the nursing home had only collected swab samples from residents and staff who were exposed to the infected patient.
“Those individuals need to go see their Primary Care Physician to be assessed,” the field epidemiologist responded.
The Maine CDC’s protocol is to recommend universal testing — of all residents and staff — once a long-term care facility has confirmed an outbreak, which is three or more epidemiologically linked cases of COVID-19, said CDC spokesperson Robert Long.
Long also said that the Maine CDC lab doesn’t refuse to do testing, although the email exchange between Durgin Pines staff and the CDC epidemiologist that nursing home staff shared with the BDN shows the CDC refusing to accept the already collected test samples.
“The decision to recommend testing rests with the facility’s medical director,” Long said in an email. “If the medical director or administration at Durgin Pines determines that universal testing is warranted and arranges for sample collection and transport, Maine CDC would assist in getting those samples tested.”
While the CDC epidemiologist cited the agency’s protocol as the reason for declining to run Durgin Pines’ tests, Maine CDC Director Nirav Shah said during a press briefing on Thursday that the protocol can be flexible. Whether the agency moves ahead with universal testing at a long-term facility depends on the specifics of the situation, he said.
The timing of tests is also important, he said. If someone who has just arrived at a facility tests positive, he said, “it takes a little while for the virus to develop and show signs and symptoms in people that can be detected by the laboratory tests.”
The Durgin Pines resident who tested positive hadn’t just arrived at the facility. She had been admitted in April and tested negative at the hospital before admission. She then tested negative again five days later on April 30 before she developed a low-grade fever this week and tested positive, according to Fazeli.
The CDC has recommended universal coronavirus testing at the seven long-term care facilities where outbreaks have been confirmed. Shah for weeks has touted Maine’s policy of recommending and facilitating universal testing once an outbreak is detected.
On Wednesday, Shah shared news that the CDC was helping a nursing home in Skowhegan, Cedar Ridge Center, with universal testing of its residents and staff even though only one resident — not three — had tested positive.
Administrators at that facility decided to conduct universal testing and arranged to have samples collected and transported to the Maine CDC lab, Long said.
The Cedar Ridge Center, Shah clarified Thursday, also was experiencing a simultaneous outbreak of another infectious disease.
“We needed to have clarity about what we were seeing, and whether it was COVID-related or related to the other infectious disease that was already ongoing,” he said.
At Durgin Pines, the nursing home started looking for an alternative way to test the specimens it had collected from residents and staff members after the state lab declined to test them.
“I’m really surprised that the CDC is denying that they gave that information [about declining to test Durgin Pines’ test samples] because I got that verbally, and then I also got that via email,” Lucia said.
Shelly Hayden, the director of clinical operations at Durgin Pines’ parent company, Continuum, also reached out to the field epidemiologist with whom Lucia had been in touch.
“I reiterated again to ask, ‘So, is this your position, that you cannot help us right now?’ And he said yes,” Hayden said. “I have to say that it’s a very disappointing situation, knowing what’s happening in nursing facilities all across the country and within our state that our own CDC lab wouldn’t assist us with the testing.”
To run the tests, Hayden reached out to NorDx, the lab affiliated with the MaineHealth hospital system that had run the test on the facility resident who had become infected.
NorDx agreed to run the tests for 63 staff members and 12 residents. (Durgin Pines had since decided to test additional staff members.) All residents tested negative, while one staff member tested positive, Fazeli said.
Six more staff members will be tested Thursday, Fazeli said, including two who have common symptoms of COVID-19.
The nursing home had to pay $102 per test whereas the state lab conducts testing at no cost, Fazeli said.
“I feel that what happened yesterday was a dereliction of duty on part of the Maine CDC, and the Department of Health and Human Services should be concerned that they left one of our Maine homes to fend for themselves at their hour of need,” Fazeli said. “Imagine if we had stopped testing due to their denial. Who would have taken responsibility for any lives lost?”
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