In Departure From Fed. Guidelines, Maine CDC Makes COVID-19 Testing At Nursing Homes Higher Priority

Mar 26, 2020

The Maine Center for Disease Control is now prioritizing COVID-19 test results for residents and employees in long-term care facilities and nursing homes. The change marks a departure from federal guidelines, which had originally ranked testing in such facilities as a lower priority. But the change comes amid concern that the federal test ranking was ignoring the risk of infection in nursing homes to both residents and staff.

Dr. Jabbar Fazeli, a geriatrician in southern Maine said he posted that video to illustrate what he sees as a growing problem in Maine's nursing homes and 200 long-term care facilities during the coronavirus pandemic.

"What we need is to be able to test, get the results within hours," Fazeli says. Instead, Fazeli says, test results for people are taking days, sometimes weeks.

Not only is that leaving residents and their families at these facilities feeling anxious, but it's also affecting the workers.

"It's exacerbating a nationwide shortage of PPE," says Shelly Hayden, director of clinical operations at Continuum Health Services, which operates four long-term care facilities in Maine with roughly 800 residents.

When Hayden mentions PPE, she's talking about personal protective equipment, which is used by health care workers to prevent getting infected with COVID-19. There's a national shortage of PPE, and Hayden says that when a resident in a long-term care facility shows symptoms of an infection, or is tested for it, workers have to use more of the gear until either that resident is transferred out of the facility or tests negative for the coronavirus.

And Fazeli says faster testing helps nursing home workers treat residents while also easing the workers' safety concerns.

"At this stage, when there's a pandemic, we need to be detecting those early. The negatives (results) help a lot," he says.

The root of the problem is a statewide backlog in testing that stood at 1,300 as of Thursday, March 26, and that is linked to a national shortage of a critical reagent used to complete the tests.

Maine CDC Director Dr. Nirav Shah says tests from nursing homes were delayed further because the state had been following federal guidelines that ranked the facilities as a lower priority to return results.

"The reason was that nursing homes can restrict the number of visitors and were thought to be a slightly lower risk," Shah says.

Because the state has already restricted visitation to nursing homes, the thinking was that the risk was lowered even more.

But Shah says that view changed this week after the federal CDC released a report showing a high transmission of COVID-19 on another closed, but congregate setting: cruise ships.

That report prompted the Maine CDC to on Wednesday elevate nursing home tests to the top tier, alongside health care workers, first responders and hospital patients who have a high fever or respiratory symptoms.

"It was pretty clear to us that congregate settings had a higher risk of transmission than we thought the U.S. CDC was attributing to them," he says. "And for that reason, as of yesterday afternoon, we've actually bumped them up to tier 1.”

Hayden says the higher priority for testing should make a big difference.

"I think this elevation in priority absolutely will help, and I'm really looking forward to that," she says.

Hayden says she has already seen a difference with one resident whose negative test result was returned in 24 hours. As for which nursing home residents should get tested, Shah says that decision is to be made by physicians, as it is for anyone else. But he advised against testing residents who don't show symptoms.

"Testing an individual who is not ill does not reveal information that is useful to either a clinician or a public health person," he says.

Shah also says that the Maine CDC is working on purchasing new equipment that should help ramp up testing and clear a backlog that he says is unacceptable.

Patty Wight contributed to this report.