Officials: Nursing homes should test all patients, staff

Calling COVID-19 “a tricky virus,” Montgomery County officials recommended that long-term care facilities in the county test all residents and staff to determine who may be positive for the virus and asymptomatic in order to prevent the spread of the virus.

“We are recommending that they perform viral testing on every resident and every staff member,” county Commissioners’ Chairwoman Dr. Valerie Arkoosh said during a Monday news briefing at the county Emergency Operation Center.

Arkoosh revealed that last week, about four long-term care facilities voluntarily tested those

at their facilities and shared the data with county health officials “and not surprisingly, there are completely asymptomatic people who are testing positive.”

“And that has to be the case because that’s part of how this virus is spreading so quickly. This is a tricky virus and I think, particularly in these congregate care settings, you need to test everybody so that you can properly isolate people and quarantine people and have a chance of getting on top of this thing,” Arkoosh said.

Arkoosh said the county’s recent testing of all inmates and staff at the county correctional facility in Lower Providence underscores the importance of widespread testing at facilities where hundreds of people congregate.

During a 48-hour period ending last Friday, officials tested every inmate and staff member at the jail.

A total of 939 inmates were tested at the facility. As of Monday, officials had received 740 of those test results, indicating that 169 inmates tested positive. None of the positive individuals, who have been properly isolated, was experiencing symptoms of the virus as of Monday, officials said. About 683 other inmates are also in quarantine as a safety precaution.

Additionally, 327 staffers at the jail who are county employees, and 61 people employed by the jail’s medical provider, a total of 388 individuals, were tested. Officials received 249 tests results for those individuals, indicating 28 of them tested positive. One correctional officer is hospitalized and the other staffers are at home in isolation, officials said.

“I think these numbers really highlight the importance of testing everyone in a facility and that’s part of why we are recommending long-term care facilities test all of their residents and staff,” Arkoosh said.

“These are people that are without symptoms. We have been checking temperatures in the correctional facility twice a day now for weeks. These are not people with symptoms and it is these asymptomatic individuals who can really contribute to substantial spread,” said Arkoosh, who was joined at the news briefing by fellow commissioners Kenneth E. Lawrence Jr. and Joseph C. Gale, and Dr. Alvin Wang, regional EMS medical director, and Dr. Brenda Weis, administrator of the Office of Public Health.

“This is why we have been emphasizing, particularly to the long-term care facilities, that it’s important to test everybody,” Arkoosh strongly reiterated.

County health officials have consistently monitored coronavirus data from the 75 long-term care facilities in the county that are licensed by the Pennsylvania Department of Health as well as from “other congregate care settings that have overnight services” in the county, for a total of about 620 facilities. The first cases of the virus were identified in the county on March 7.

As of Monday, 89 of the facilities reported positive COVID-19 cases among residents and staff. Specifically, officials reported there were 1,013 cases among residents of the facilities and 390 cases among staff at the facilities, for a total of 1,403 positive individuals. Officials pointed out that not all of the individuals are from Montgomery County and that some are residents of other areas of the region.

“We’re reporting these numbers to help you get an understanding of the significant challenges being faced by long-term care and other congregate care settings,” Arkoosh explained.

Arkoosh added 159 of the county’s total 220 “confirmed positive” COVID-19 deaths were county residents who had been living at a long-term care facility, representing about 72-percent of the total “confirmed positive” deaths.

Officials also identified 62 COVID-19 “probable deaths” of county residents who were in a longterm care facility.

The long-term care facilities where the deaths occurred were not identified.

“We continue to do outreach to these facilities. Our field assessment and support team (FAST), which are teams of two that are going out to visit these facilities, will have made 15 visits by the end of the day (Monday). They are consulting with these facilities on the proper use of PPE (personal protective equipment), helping them talk through their infection control policies…and answering any questions that they may have,” Arkoosh said.

Earlier this month, the county partnered with a clinical analytics provider to better track cases of COVID-19 in long-term care facilities with the goal of improving health care outcomes. Real Time Medical Systems can provide round-the-clock electronic infectious disease surveillance of county nursing facilities that volunteer to share their data. The cloud-based software pulls data from electronic health records to identify potential infectious disease “hotspots.”

Twelve facilities are currently participating in the project, officials said.

Essentially, the facilities volunteer to share anonymous patient data, including the number of patients with fever or cough, with the county Office of Public Health with the goal of assisting the facilities with trend tracking and early response. The system detects infectious disease warning signs, looking for changes in temperature, respiratory rate, cough, diagnosis, and shortness of breath.

“We’re now starting to use this data to help guide the prioritization list for where our FAST team goes next. So, the goal would be to get ahead of this, to visit facilities just as they’re starting to see an uptick in cases or patients with symptoms and get a team in there from the outset or as close to the beginning as we can to help them and assist them in any way possible,” Arkoosh explained.

County officials also participated in a conference call on Monday with officials of the Pennsylvania Department of Health “to make sure that they understand how serious the situation is here in Montgomery County in long-term care facilities.”

“I remind you that it’s the Pennsylvania Department of Health that licenses and regulates these facilities and we are continuing to ask them for assistance in these facilities,” Arkoosh added.

“This is a tricky virus and I think, particularly in these congregate care settings, you need to test everybody so that you can properly isolate people and quarantine people and have a chance of getting on top of this thing.”

- Montgomery County Commissioners’ Chairwoman Dr. Valerie Arkoosh