There are many recommendations to prevent the spread of COVID-19 in long-term post-acute care settings, including screening everyone entering the building, performing proper hand hygiene, using personal protective equipment and physical distancing. What has also been proven to prevent the spread of COVID-19 in nursing homes is serial testing of staff. Until the widespread administration of the COVID-19 vaccines began to bring down the community positivity rate, this meant testing staff at least weekly for most centers, if not twice a week.
Recently revised guidance from the Centers for Medicare & Medicaid Services (CMS) issued on April 27, 2021, indicates that vaccinated staff do not need to be routinely tested, which may seem like a reprieve. But how comfortable are you with the risk? Once the virus gets into the building, spread results in more cases and more deaths. And who typically brings the virus into the building? Generally, it is transmitted by an asymptomatic or pre-symptomatic staff member. The best way to identify this infected person is proactive serial testing of staff and using rapid result antigen test kits so exposure risks and transmission of the disease can be prevented within the center.
So don’t let your guard down too soon. There are reasons to continue routine testing (at least once a week) for the foreseeable future, despite lower county positivity rates and higher vaccination uptake.
Consider the following:
- Although the vaccines are effective at preventing symptomatic and severe illness that results in hospitalization, they are not 100%, and people can still get sick. Breakthrough cases after being fully immunized (>2 weeks post-vaccine) are being reported across the country. The good news is, the vast majority of these people are not becoming critically ill or requiring hospitalization, which is strong evidence that the vaccine is doing its job. The bad news is, people are still getting infected, and it is unknown if they can transmit the virus to others.
- It is unknown how long the vaccines provide protection. The Centers for Disease Control and Prevention (CDC) recommends people who are vaccinated still take the same precautions in indoor public spaces as they did before being vaccinated.
- Not all staff in the centers are fully vaccinated. And staff are the most likely to carry the virus into the building. The March 2021 outbreak in Kentucky was linked to an unvaccinated, symptomatic staff member and identified during routine testing.
- As more communities relax restrictions and masks are worn less, the risk of potential exposure increases. Many are becoming less concerned with hand hygiene, masks and physical distancing.
- Visitation is opening up to support the emotional, social, physical and cognitive well-being of residents, and rightly so. This increases risk of exposure for residents as loved ones reach out and actually touch each other.
When these elements are combined with a decline in staff testing (regardless of vaccination status), the door is left open for a potential outbreak in the center.