By Amy Mendoza, Provider Magazine, May 26 2020
The number of reported cases of individuals in skilled nursing facilities (SNFs) with COVID-19 will likely more than double due to the data forthcoming from the National Healthcare Safety Network (NHSN), said an expert from the American Health Care Association (AHCA).
As previously reported, SNFs are required to report to NHSN on all cases of COVID-19 among residents and staff, as well as to provide notifications to residents, their representatives, and families. This is happening at a time when states, the Centers for Medicare & Medicaid Services, and the Centers for Disease Control and Prevention (CDC) are recommending that all residents and staff be tested.
“We expect to see an increase in the number of COVID cases when NHSN reports its data, compared to what has been released to date by the states,” said David Gifford, MD, AHCA chief medical officer and senior vice president of quality and regulatory affairs. In an exclusive interview with Provider, Gifford said the impetus for the spike has much to do with the lack of testing.
“The reason for the increase is that testing has not been widespread and available,” said Gifford. “Up to this point, positive cases have been mainly individuals who develop symptoms and/or go to the hospital who have gotten tested, and mainly it has been those who have gone to the hospital. However, over half of nursing home residents who get tests have no symptoms at all.”
Wider testing that is being recommended by states and the federal government coupled will pick up many of these asymptomatic but infected residents, which is a good thing, but it has been happening right when reporting to the NHSN is occurring, Gifford said. “What that means is now that everyone is starting to test and report at the same time, you’re going to see a dramatic jump in the number of cases.”
Another reason for the spike is that not all states have released information. “Even though nursing homes have been submitting data to local and state health departments for months, some states haven‘t been releasing information, and therefore now you’re going to see cases from all nursing homes everywhere in the country reporting their data directly to the federal government,” said Gifford.
Though increased testing and reporting are happening, it is still not always clear who has COVID and who does not. “What we do know from CDC and other reports is that more than half of the residents who test positive do not have symptoms,” said Gifford. AHCA members that have done testing in buildings have often reported this to be the case among residents and staff, he said.
“For example, the building may have no identified COVID cases, and then they test everyone and they’ll find four people with COVID,” said Gifford. “Or they will have one person with symptoms and will then test everyone, and they’ll find two or three more people who have COVID but didn’t have symptoms.”
Gifford also pointed out that registration, uploading, and submitting the data to NHSN is taking time. What will be important going forward is to watch what happens over time, he said. “Once we start testing everyone and testing on a regular basis, then it will be important to watch how the numbers go,” he said. “But right now, we’re going to see dramatic increases, and it could be as much as a doubling or tripling of the numbers.”
When facilities detect new cases, they need to implement droplet precaution procedure, keeping residents isolated from other individuals and sending staff home, Gifford said.
Vigilance Needed as States Reopen
Gifford pointed out that as states begin to reopen, many cities and communities still have COVID-19 cases, which increases the risk of it spreading to long term care (LTC) facilities in those areas. As states reopen businesses and public areas, more individuals in the community are likely to contract COVID-19, and that increases the likelihood that individuals who work and visit LTC facilities will also contract it.
What should providers do? Continue to be vigilant, Gifford advised. “We need to be very diligent about screening people coming in and wearing source control masks and honoring social distancing, even within the building,” he said. “That said, we know that social distancing works and the better the weather that there should be ways to allow family members to visit with their loved ones. Excluding them in perpetuity going forward is not a good thing.”
Facilities with the capability to reconfigure common areas to allow social distancing during visits should do so, Gifford said. “We need to think about how to reconfigure the entryways, the foyers, or common areas so that you can allow visitors to come in.” He encouraged providers to be cautious and honor the practices that prevent the spread of the virus, including wearing source control masks, practicing social distancing, screening visitors, and minimizing the number of direct interactions with residents.
“Now, this is going to be more problematic for those facilities that don’t have large common areas or an easy way to take residents outside or let a visitor in without interacting with staff,” he said. “If people are close together, if the building design forces COVID patients to be moved through COVID-negative areas in the building, or if COVID patients must ride on elevators where they could be coughing on staff who don’t have the right personal protective equipment, that’s not good. We need to be hyper focused on how this virus spreads and in honoring the measures that help prevent the spread.”