Cases of COVID-19 have erupted at several nursing homes in Maine over the past week. A total 24 staff and 86 residents have tested positive for the infection, and three residents have died.
The director of Maine’s Center for Disease Control cautions that what may seem like a sudden spike is due, in part, to more aggressive testing at these facilities. And advocates for nursing homes say that same aggressive testing should be expanded to all long-term care facilities in order to prevent further outbreaks.
The first outbreak was detected last week at Tall Pines Healthcare in Belfast, which currently has 23 confirmed cases among residents and staff. Next was the Augusta Center for Health and Rehabilitation, where confirmed cases grew from four on Friday to 55 by Sunday. And over the weekend, nine cases were identified at the Maine Veteran’s Home in Scarborough. By Monday, that number grew to 32.
“Everyone is on edge. There is no doubt about that,” says Rick Erb, president and CEO of the Maine Health Care Association, which represents 200 nursing home and assisted living facilities.
Erb says theses outbreak have occurred despite efforts to stop the spread of the virus.
“It’s very difficult to keep it out. We have taken steps to keep the number of visitors down in facilities, we have done screening of staff as they have come and go,” he says.
For at least a month, nursing homes have taken steps to prevent outbreaks. In mid-March, both state and federal agencies recommended that nursing homes significantly restrict visitors. In the weeks since, long-term care facilities in Maine were also encouraged to restrict communal gatherings, to review infection control polices and to make the best use of limited personal protective equipment. By the end of March, the Maine CDC elevated nursing home staff and residents to the highest priority for testing if they had symptoms of COVID-19.
Maine CDC director Dr. Nirav Shah says the latest numbers from these facilities do seem concerning, but says context is important.
“One of the things that we know in public health, is that when we look for things, we find them. And indeed, much of what we’re seeing here is just that,” he says.
During his daily press briefing Monday, Shah said that as soon as an outbreak is detected at a nursing home, the CDC immediately offers universal testing.
“Asymptomatic or not. Staff member or resident. Everyone is offered testing,” he says.
The Maine CDC defines an outbreak as at least three confirmed cases. But Erb says waiting for an outbreak — even for a single confirmed case — isn’t enough. His organization is pushing for universal testing at all nursing homes.
“We do know that there are people who are transferring the virus that are asymptomatic. And that makes it very difficult for facilities to deal with, because you really don’t know,” he says.
A recent report from the federal CDC that examined the rapid spread of the coronavirus at a long-term care facility in Washington state found that screening for COVID-19 based on symptoms could fail to identify about half of nursing home residents who have the infection. But Shah says universal testing raises a logistical challenge — namely, deciding when to re-test a person whose results have come back negative.
“Should we go back and test the next day, the next week, the next month? So it’s not as if we’re against it. We’re open to the idea. And our epidemiology team and I have discussed it. But we’ve got to have a plan in place,” he says.
Maine Health and Human Services Commissioner Jeanne Lambrew says the sheer numbers underscore the logistical challenge. She says there are about 6,800 people in nursing facilities and nearly 100,000 health care workers statewide across different settings. And Lambrew stresses that the state is stepping up its efforts to support nursing homes, including a check-in with each facility.
“To ascertain their level of preparedness, their gaps, and what more we could be doing together to prevent additional outbreaks,” she says.
Beyond universal testing, Erb says nursing homes’ other top need is personal protective equipment, something that’s in universally short supply.
