We need to get creative to protect nursing home residents during a pandemic. Here’s how | Simon F. Haeder

May 27, 2020 6:30 am

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By Simon F. Haeder

The current coronavirus pandemic has transformed lives around the globe. Unquestionably, things are much worse than they had to be if we had been better prepared. Many fingers can be pointed. Could China have been more forthcoming: yes.

Could the Trump administration have done more to be better prepared for an inevitable pandemic: yes. The same holds for state and local governments.

Could we have invested more in public health: yes. Could we have transformed our healthcare system to make it less costly and more equitable: no doubt! There are very few individuals and entities looking good in this mess.

Yet, we are where we are.

One of the hardest hit population have been, unsurprisingly, residents of nursing homes. Without vaccine or effective treatment, the best we can offer them is frequent testing to quickly isolate carriers. Yet, with testing capacity significantly limited, it is time for a pragmatic solution for the time being: group testing.

The epicenter of the pandemic: Nursing Homes

And while we still don’t know everything about the novel coronavirus and COVID-19, we are pretty sure about a number of things. For one, we know that the vast majority of people, on average, will recover when they get infected.

At the same time, we know that others like the aged, those with certain pre-existing conditions like chronic obstructive pulmonary disease (COPD) or serious heart conditions, for example, exhibit relatively high rates of fatalities (Of course, this is not to say that even individuals who do not fall into these categories may become really ill and even die). We also know that many individuals can be asymptomatic or pre-symptomatic and still spread the disease.

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Given these realities, it comes as no surprise that nursing homes have been particularly hard hit by the pandemic. The care setting in nursing homes is inherently intimate and involves lots of close contact.

Personal protective equipment is scarce and costly. Staff are often underpaid and have to rely on public transportation. And to be sure, as everyone who studies nursing home quality knows, the nursing home industry is beset by quality of care problems.

Yet the numbers are staggering. Nationwide, nursing residents account for a staggering 33,000 deaths. The number increases significantly daily and is most certainly an undercount. In Pennsylvania, nursing home residents make up roughly two-thirds of the states’ fatalities, although there has been a lack of transparency.

Increasing testing in nursing homes

Nursing home residents are in nursing homes for good reasons. They usually need extensive and professional care. This also means that their family members, should they have any, cannot simply pull them out and care for them at home. So how can we better protect them?

For most healthy individuals, it makes little difference if they get actually diagnosed with COVID-19. If they get sick, they should isolate themselves and wait until they get better. If they deteriorate, they should seek medical care. There is little else we can do at this point.

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Yet for nursing home residents, the calculus is much different. Time is of the essence. Ideally, we would know right away if someone is sick so that we can isolate them and potentially all other residents in the facility.

In a perfect world, we would thus test every nursing home resident and staffer once, perhaps multiple times, per day.

We are far from that. In Pennsylvania, we have more than 700 nursing homes with more than 88,000 beds. For comparative purposes: since the beginning of the pandemic we have conducted around 350,000 in Pennsylvania in total. Unless there is a miracle, the federal government doesn’t look anywhere close to being capable of producing the number of tests needed.

Trying to walk the line between these two realities, limited testing capacities and dire consequences for nursing home residents when exposed to the novel coronavirus, the Wolf Administration recently announce weekly universal testing in nursing homes and long-term care facilities.

A canary in the coal mine approach

The Wolf Administration’s efforts are commendable but hardly enough to significant bring down nursing homes deaths. Yet there is an alternative, while imperfect, that could alleviate our immediate shortages and better protect vulnerable seniors: group testing.

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The concept is rather simple. When resources are scarce and time is crucial why not simply take samples from a number of individuals, throw them together, and then test the whole batch at once. If it comes back all clear, no further testing is needed. If it comes back negative, individuals should get isolated and tested in smaller batches until all sick individual are identified.

The approach is clever, and it works. We have done it before, albeit in less daunting circumstances, to screen Army recruits during World War II for syphilis. To be sure, we need to adjust protocols and testing materials, but several entities around the country are working on it. Pennsylvania should jump on board and utilize the resources of its great universities to do so, quickly.

Sure, group testing is not ideal, and it conflicts with some American medical norms. Some may raise ethical concerns. Yet, we are where we are, and it’s time to think pragmatically. Pennsylvania’s nursing home residents would appreciate it, I am pretty sure.

As an additional benefit, once we have pioneered the approach in nursing homes, the it can easily be adapted to other places that we will need to open to get Pennsylvania back on track. Think daycares. Schools. Universities.

Opinion contributor Simon F. Haeder is an Assistant Professor of Public Policy at Penn State University’s School of Public Policy. He is also a Fellow in the Interdisciplinary Research Leaders Program, a national leadership development program supported by the Robert Wood Johnson Foundation. His work appears frequently on the Capital-Star’s Commentary Page.

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