Universal COVID-19 testing in nursing homes may limit transmission


Registered nurses with the Florida Department of Health perform a specimen collection on a patient at a nursing home in Florida on May 1. "Universal" testing can help better spot COVID-19 outbreaks in long-term care facilities, a new analysis finds. Photo by Sgt. Michael Baltz/Flickr
July 14 (UPI) -- "Universal" testing of nursing home and assisted living residents is "critical" to identifying asymptomatic cases of COVID-19 and curbing virus transmission, according to the authors of an analysis published Tuesday by JAMA Internal Medicine.

The assessment of coronavirus testing protocols at 11 long-term care facilities in Maryland revealed that checking only those residents with symptoms of COVID-19 -- cough, diarrhea, fever and shortness of breath -- yielded 153 confirmed cases within a population of 893, said researchers at Johns Hopkins University School of Medicine.

However, subsequent testing of all 893 residents of these care homes -- regardless of whether they had symptoms of COVID-19, the disease caused by the new coronavirus, SARS-CoV-2 -- identified another 354 confirmed cases, the researchers said.

"We are getting more and more evidence that universal screening, particularly in congregate living facilities where there are identified cases or exposures, is incredibly important to stem transmission," Dr. Morgan Katz, assistant professor of infectious disease medicine at Johns Hopkins, told UPI.

"We have underestimated the burden of people who are asymptomatic with SARS-CoV-2 because our testing has thus far been focused only on people with symptoms," she said.

On Tuesday, the American Health Care Association and the National Center for Assisted Living wrote to the National Governors Association to warn of imminent outbreaks at nursing homes and assisted-living facilities.

Given spikes in new cases in several states across the country, the organizations pointed to "serious" personal protective equipment shortages and significant delays in obtaining test results for long-term care residents and staff members.

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"We are asking governors and public health agencies to help expedite the delivery of test results and work toward a solution to provide on-site testing with rapid results," the groups wrote.

Universal testing for an infectious disease essentially entails testing an entire population, regardless of whether symptoms are evident.

Although the U.S. Centers for Disease Control and Prevention initially mandated testing only people with symptoms of COVID-19, several states implemented universal testing of long-term care facility residents after multiple case clusters popped up.

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Through the end of June, more than 126,000 residents of long-term care facilities -- including nursing homes and assisted-living complexes -- across the country tested positive for COVID-19, and well over 35,000 have died from the disease, according to the CDC.

Overall, as of Tuesday morning, nearly 3.5 million Americans have been infected and nearly 136,000 have died, based on estimates from Johns Hopkins University.

Katz and her colleagues identified 507 total cases -- 153 on symptomatic testing plus 354 on universal testing -- at the 11 nursing homes they assessed. Two-week follow-up data was available for 177 of the positive cases confirmed via universal testing, the researchers said.

Of these, 154 were asymptomatic at testing, they said. But 20 eventually became sick enough to require hospitalization and seven died within 14 days of testing, according to the researchers.

"My suggestion would be to supply facilities with a cache of rapid turnaround tests that they can have on site to respond to any potential exposure [to a] symptomatic resident," Katz said.

"If this broad based testing yielded any positives, I would then follow with universal testing of the entire facility."