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Harnessing the Power of Testing, Treatment, Timely Response During a COVID-19 Outbreak In Long-Term Care Facilities

Harnessing the Power of Testing, Treatment, and Timely Response During a COVID-19 Outbreak in Long-Term Care Facilities

Harnessing the Power of Testing, Treatment, and Timely Response During a COVID-19 Outbreak in Long-Term Care Facilities

Throughout the pandemic, COVID-19 outbreaks have presented significant challenges to Long- Term Care (LTC) Facilities. Even after the expiration of the public health emergency on May 11, 2023, 53% of LTCs in Illinois experienced at least a 2% COVID-19 positivity among their residents, as reported by the Centers for Medicare (as of February 18, 2024). For LTCs, having an optimal outbreak management strategy that proactively detects infections and optimizes the use of limited time is critical. This paper discusses key considerations for long-term care management teams looking to adopt best practices:

  • Mobilize to implement testing, isolation, and treatment protocols within 24-48 hours of a suspected outbreak.
  • Select best in class technology for convenient and comfortable sample collection options attuned to staff and resident needs, while screening for common respiratory ailments, including COVID-19, Influenza A/B, and RSV.
  • Coordinate comprehensive medical care incorporating the use of Test to Treat efficiently

Prism Health Lab presents these considerations after managing numerous outbreaks in LTC facilities and other congregate settings. Give us a call at (888) 977-4086 or send an email to LTCSTAT@prism.org to learn more.

Introduction

Long-term care (LTC) is key to maintaining and improving the quality of life of vulnerable aging populations, both in residential and home care settings. The rising proportion of elderly individuals in the population has resulted in a consistent rise in the demand for long-term care services. They often require intimate care and support, which leaves them susceptible to easily transmitted infections like COVID-19. Understanding the unique characteristics of the LTC population is important because the proportion of COVID-19 deaths and infections that occurred in nursing homes is high [2]. Early in the pandemic, advancing age was identified as a strong risk factor for COVID-19 mortality. Overall, in the United States, it was reported that approximately 80% of deaths from COVID-19 were in individuals over the age of 65 [3].

The LTC STATeam Outbreak Protocol

The LTC STATeam’s Outbreak Protocol is simple and non-invasive, with three main phases:

 

  1. Early detection

  2. Immediate isolation and containment

  3. Treatment and recovery

The first phase involves universal serial PCR testing, serving as our first line of defense against disease spread. In line with IDPH’s guidelines, we begin by testing within 24-48 hours of a suspected outbreak and continue every 3-7 days until no new positive cases are identified for 14 days. Conducting testing on an affected floor/unit or facility-wide proves to be an effective measure in preventing COVID-19 outbreaks [4]. With the help of PCR testing, we are able to swiftly identify both symptomatic and asymptomatic cases, reducing further transmission and enabling subsequent phases of the protocol.

 

Rapid outbreak testing results (less than 24 hours turnaround from lab receipt) help the LTC STATeam advise LTC facilities on phase 2 protocols. As cases are identified, it is important to move residents into isolation and perform contact tracing. Cohort isolation for positive residents alongside widespread screening has also been acknowledged as an efficient approach to curb the spread of the virus [5].

 

In the final phase, recovery includes monitoring, treating, and eventually vaccinating residents and staff. Throughout the pandemic, several proposed treatment options have been identified and utilized. Emergency Use Authorization was granted to Paxlovid, a combination medication composed of nirmatrelvir and ritonavir. A large retrospective cohort study looking at high-risk COVID-19 patients in Israel, demonstrated Paxlovid as being highly effective at reducing severity of illness [9]. Therefore, timely and appropriate treatment not only improves prognosis for individuals with the disease but also curtails the overall duration of the outbreak by reducing the period of infectiousness. A study published in The Lancet, Global Health, “Use of antiviral drugs to reduce COVID-19 transmission” found that the use of antiviral drugs shortly after symptom onset reduced infectiousness by reducing viral shedding [6]. Targeted prophylactic treatment of contacts even reduced the risk of becoming infected.

 

Once residents have recovered from COVID-19 and the outbreak has been quelled, it is critically important to discuss vaccination status and the most up to date recommendations to protect these vulnerable populations. Vaccine status and herd immunity within a LTC facility remains a pivotal component in completion of treatment plans. Several studies describe robust protection against severe COVID-19 when vaccinated with three or four doses of mRNA vaccine [12, 13].

As shown above, the LTC STATeam launched its Outbreak Protocol within an impacted LTC immediately after a suspected outbreak. Two weeks after rapid deployment of testing, this LTC experienced a complete elimination of new COVID-19 cases, a full two weeks sooner than the national average of outbreak duration in LTCs across the United States [11]. Through diligently coordinated isolation and treatment plans, the team facilitated a smooth recovery process, enabling a seamless return to normal operations.

Technology and Data Make a Difference

Prism Health Lab offers anterior nasal swab collection and saliva collection methods, providing an easy and comfortable sample collection experience based on resident and staff needs. Samples are run on state-of-the-art high-throughput molecular platforms following a protocol pioneered by the Yale School of Public Health. When appropriate and indicated, a rapid respiratory panel that detects COVID-19, Respiratory Syncytial Virus, Influenza A, and Influenza B can be utilized. Additionally, automated robotic processing and efficient protocols allow for results to be available digitally within 24 hours of the lab’s receipt of samples.

 

We utilize reverse-transcriptase polymerase chain reaction (RT-PCR) testing to detect COVID-19. In a study that compared the sensitivity of rapid antigen kits and RT-PCR, it was demonstrated that RT-PCR tests are more effective at detecting COVID-19 [7]. The sensitivity of home antigen tests during the infectious period was only 50% compared to RT-PCR; even at its peak, four days after symptom onset, the sensitivity of the antigen tests only reached 77%. While it improved with a repeated test, it still did not match the effectiveness of RT-PCR.

 

Leveraging data on new COVID-19 cases from communities and LTCs (available on data.cdc.gov and data.cms.gov), we monitor outbreak occurrences. Understanding historical data and applying statistical analysis, we can identify trends and patterns in case rates, which helps us identify the potential for an upcoming outbreak.

Coordinated Care Matters

What makes the LTC STATeam unique is our ability to coordinate comprehensive care, allowing for seamless transition from Test to Treat. We offer a unique partnership to provide continuity of care throughout the entire course of an outbreak within a facility. As a physician-run group, we are able to facilitate decision making, placement of orders and prescriptions, and treatment plans to assist the LTC facility from beginning to end. Throughout our time serving various communities, key challenges have been identified:

 

  • Rapidly deploying staff / maintaining adequate staffing ratios to meet surge demands.
  • Pulling togethering various LTC stakeholders, including local health departments, the administrator/ executive director, the medical director, the director of nursing, facility staff, primary care physicians, residents, families, and third-party vendors.
  • Providing testing orders
  • Placing pharmacy orders
  • Seeking reimbursement from insurance
 

While there is concern about increased paperwork and administrative penalties, it’s worth considering the long-term benefits of a comprehensive testing strategy. Opting for rapid tests might seem like a cost-effective choice, but their lower accuracy could potentially result in broader outbreaks that are ultimately more difficult and expensive to manage. To mitigate administrative burdens, we handle all the reporting requirements and can collaborate with local health departments to establish an effective outbreak management strategy. Indeed, penalties are often tied to non-compliance rather than transparent reporting. Therefore, embracing accurate testing and thorough reporting works in your favor, aligning your facility with best practices in outbreak management.

 

It is well known that outbreaks add staffing pressures to LTC facilities. A study of nursing home workers and residents supports what Prism Health Lab has seen in the field, highlighting the increased workload, social pressure, and secondary traumatic stress among the long-term care community during an outbreak [10]. The study found that a lack of resources, particularly staff and personal protective equipment, directly correlated with increased fear of infection, especially among those who perceived a shortage of resources. The LTC STATeam provides all resources, including staff, necessary to carry out the LTC Outbreak Protocol, at no cost.

 

Prism Health Lab’s Approach

Prism Health Lab has been at the forefront of the fight against the ongoing pandemic, offering accessible and efficient COVID-19 services to individuals of all backgrounds. It is important to recognize that despite rising vaccination rates, outbreaks still occur. It is clear that ongoing preventative and mitigating measures are still required to safeguard our vulnerable populations. We are committed to providing LTC facilities with a COVID-19 outbreak management strategy.

 

 

We encourage LTC administrators to take a proactive approach to outbreak testing and treatment, and work together with public health agencies to prevent and contain outbreaks before they become a threat to public health.In our ongoing efforts to enhance outbreak services in long-term care facilities, we’ve introduced an innovative sample collection method using a saliva sponge. This technique enables symptomatic patients to self-collect samples with ease, minimizing healthcare worker intervention. The use of saliva sponges not only improves the comfort and convenience for patients but also significantly reduces the time from symptom onset to RT-PCR result delivery to approximately 36 hours. This rapid turnaround is crucial in controlling outbreaks efficiently, reducing the strain on staffing resources, and enabling quicker isolation and treatment of affected individuals. By streamlining the testing process, we are not only enhancing patient experience but also bolstering our outbreak containment efforts, ultimately contributing to the well-being and safety of both residents and staff in long-term care environments.

 

Programming is produced by Prism Health Lab and made accessible to long term care facilities at no cost, thanks to a grant from the Illinois Department of Public Health (IDPH). Give us a call at (888) 977-4086 or send an email to LTCSTAT@prism.org to learn more. If you suspect an outbreak or would like to learn more about our services, we invite you to book a call. Together, we can make a difference in the lives of those we serve.