Will long-term care facilities benefit from expanded testing?

Sauer Health Care
Sauer Health Care is seen Monday, April 20, 2020, in Winona, Minn. A coronavirus outbreak at the facility has killed several residents and infected others. Healthy residents at Sauer have been transferred to nearby Lake Winona Manor.
Mark Vancleave | Star Tribune via AP

As testing for the coronavirus expands, some question whether the extra capacity could help people living in long-term care facilities.  In several assisted living and nursing homes, COVID-19 has rocketed through residents and staff causing at a facility in Wayzata to close and others to deal with a dozen or more deaths in a short period of time.

As of Monday, 233 people from long-term care facilities, such as assisted living centers, had died of COVID-19. That’s nearly 80 percent of all deaths so far.

A plan from the University of Minnesota and Mayo Clinic estimates they could provide 20,000 diagnostic tests and 15,000 antibody tests per day.

Republican state Sen. Karin Housley, of St. Mary’s Point, said testing must include caregivers as well as residents.

“Those would be the people that should be tested continually. So, we can find out which of the staff members have the antibodies already and which ones are infected with it so they don't go infect anybody else,” Housley said.

Health Commissioner Jan Malcolm says despite the increased testing, the state is not ready to do widespread testing of everyone involved in long-term care.

“As we’re ramping up testing volumes we’re still in the position of needing to set some priorities for testing.” Malcolm said. “So it might be a laudable goal to move toward broader population testing in these particularly vulnerable settings, but in complete candor it would not be something we’d be able to do immediately with the available capacity.”

Malcolm stressed that all residents and employees showing symptoms are being tested and that those cases are a top priority for state lab tests. Minnesota health officials also are trying to figure out what more they can do to reduce infections.

For more than two weeks, a six-person team from the Centers for Disease Control and Prevention in Atlanta has been in Minnesota, taking a closer look at long-term care facilities and the spread of COVID-19 in them.

Dr. Ruth Lynfield, the state epidemiologist, said she wanted to learn what works to slow the spread and to keep older people from dying after being infected with the coronavirus.

"We can't put a bubble around them, I wish we could, that would be the best way to strengthen this very fragile and vulnerable group," Lynfield said.

One of the biggest worries is asymptomatic carriers of the coronavirus. While facilities have banned almost all visitors and are screening staff for symptoms each day, operators worry that people who live and work in these facilities are getting infected by silent carriers.

Lynfield says facilities must have plans in place to be able to group residents with COVID-19 together.

The CDC team is helping Minnesota health officials develop early warning systems when outbreaks begin, so they can identify cases early and put prevention measures in faster.

Many assisted living, nursing homes and other care homes have infection control measures, but those are designed to deal with the seasonal flu. Coping with a highly infectious, deadly disease brings on new challenges.

“Long-term care facilities, in general, are not used to putting into place the kind of measures that acute care [like a hospital] does,” Lynfield said. “They are not used to wearing all this personal protective equipment. And so there are lots and lots of changes and they're hard changes for these facilities to put into place.”

Lynfield said employees are taking on roles and risks they may not have expected to.

“These health care workers are heroes. There's a lot of understanding that the people working in the ICU and the people who work in the emergency department are heroes. And they absolutely are. But these folks are heroes, too,” she said.

Lynfield says the CDC team includes a behavioral scientist to help employees in long-term care settings handle the stress COVID-19 has added to their jobs.

COVID-19 in Minnesota

Health officials for weeks have been increasingly raising the alarm over the spread of the novel coronavirus in the United States. The disease is transmitted through respiratory droplets, coughs and sneezes, similar to the way the flu can spread.

Government and medical leaders are urging people to wash their hands frequently and well, refrain from touching their faces, cover their coughs, disinfect surfaces and avoid large crowds, all in an effort to curb the virus’ rapid spread. The Center for Disease Control and Prevention also recommends people wear cloth or fabric face masks when entering public spaces like grocery stores and public transit stations.

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