14 Jul Report Underscores Importance of Universal COVID-19 Testing in Nursing Homes
MedicalResearch.com Interview with:
Morgan Katz, MD, MHS
Director of Antimicrobial Stewardship, Johns Hopkins Bayview
Assistant Professor Infectious Disease
Johns Hopkins University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In this report, we provided universal testing across 11 long-term care facilities with prior cases in the facility identified by symptom based testing alone.
With widespread testing, we identified 893 residents (39.6% of all residents tested) who were positive for Sars-CoV-2 and would likely not have been caught with symptom based testing alone.
Additionally, in the positive residents we identified by point prevalence testing, we actually saw a lower mortality rate than we have thus far seen in the literature on nursing home residents. This may suggest that with a larger denominator (i.e. a higher number of positive cases that otherwise are not identified), mortality may be lower.
MedicalResearch.com: What should readers take away from your report?
Response: This report underscores the importance of universal testing in long-term care settings.
We now have more evidence that once there is a case in the facility, it is critical to rapidly enact widespread testing so that positive cases can be identified and isolated before more transmission occurs.
At a minimum, facilities should be given access to a supply of rapid turnaround tests in order to immediately contact trace if an exposure is identified in the facility; this should be followed by repeated, universal testing if cases are identified.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We need more data in the nursing home setting that will help us to identify highest risk residents for decompensation as well as validation of more comfortable testing procedures (such as saliva tests). Repeated nasopharyngeal swab testing can be very uncomfortable, particularly for frail older residents, and it would be nice to have some alternative options.
MedicalResearch.com: Is there anything else you would like to add?
Response: Testing resources continue to be limited, particularly now that more policies require regular surveillance screening of staff. We need to make sure that policies or mandates are paired with the resources to perform these activities, otherwise we will see a backlog in obtaining the results of tests. Rapid turnaround time in the long-term care setting is exceedingly important, as transmission in this setting can be rapid.
Bigelow BF, Tang O, Barshick B, et al. Outcomes of Universal COVID-19 Testing Following Detection of Incident Cases in 11 Long-term Care Facilities. JAMA Intern Med. Published online July 14, 2020. doi:10.1001/jamainternmed.2020.3738
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