Does Universal Testing for COVID-19 Work for Everyone?

Abstract

The Coronavirus disease 2019 (COVID-19) pandemic has been especially devastating among nursing home residents, with both the health circumstances of individual residents as well as communal living settings contributing to increased morbidity and mortality. Preventing the spread of COVID-19 infection requires a multipronged approach that includes early identification of infected residents and health care personnel, compliance with infection prevention and control measures, cohorting infected residents, and furlough of infected staff. Strategies to address COVID-19 infections among nursing home residents vary based on the availability for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests, the incorporation of tests into broader surveillance efforts, and using results to help mitigate the spread of COVID-19 by identifying asymptomatic and presymptomatic infections. We review the tests available to diagnose COVID-19 infections, the implications of universal testing for nursing home staff and residents, interpretation of test results, issues around repeat testing, and incorporation of test results as part of a long-term response to the COVID-19 pandemic. We propose a structured approach for facility-wide testing of residents and staff and provide alternatives if testing capacity is limited, emphasizing contact tracing. Nursing homes with strong screening protocols for residents and staff, that engage in contact tracing for new cases, and that continue to remain vigilant about infection prevent and control practices, may better serve their residents and staff by thoughtful use of symptom- and risk-based testing strategies.

Keywords: SARS-CoV-2; Sentinel surveillance; infection prevention; long-term care; skilled nursing facility.

Fig. 1

General floorplan for the nursing home described in the case. White rectangles indicate entry points with screening stations for staff. Gray rectangles indicate exit point. The small dashed lines indicate distinct sections of the building connected by a common hallway. The large dashed line indicates the physical barrier put in place to separate the COVID-19 unit from remainder of the building.

Fig. 2

More detailed floor plan of Units 1 and 3 of the nursing home described in the case. (A) On April 1, the index resident (gray circle) developed symptoms that trigged testing for COVID-19 infection. Among the SARS-CoV-2 tests collected on April 2, 7 more residents tested positive for SARS-CoV-2 (white circle). All of these individuals were transferred to the COVID Unit. (B) From April 5 to 17, an additional 7 residents developed signs and symptoms of COVID-19 infection. All of the residents had negative tests from April 2 with subsequent positive SARS-CoV-2 tests when they became symptomatic.