Study: Testing essential in nursing homes

NEW HAVEN — A lack of testing of nursing home residents who had not shown symptoms of COVID-19, combined with a shortage of personal protective equipment, contributed to the “horrific” number of cases at the start of the pandemic, a Yale School of Public Health professor said Wednesday.

Sunil Parikh is senior author of a study, published Monday in JAMA, which reported that 28.3 percent of people tested in 33 nursing homes in the state were infected with the coronavirus. In 19 of the facilities, more than half the residents tested positive when the testing was done, which provided a snapshot of the prevalence of the virus at one point in time.

“These were people who had not previously been identified as having COVID,” Parikh said. When those who had already tested positive were included, the number was even higher.

“If you want to control COVID in these nursing homes, the moment you have a case you need to go in and test,” he said.

From March 15, when the first case of COVID-19 was reported in a nursing home, through Aug. 4, there were 8,793 cases and 2,857 deaths, according to the state’s COVID-19 website.

The Department of Public Health, which sought assistance from Yale to help track and contain the pandemic in nursing homes, was “doing all they could,” Parikh said. “I can’t fault DPH.”

But recommendations from the Centers for Disease Control and Prevention did not include testing of people without symptoms, largely because testing was not widely available, Parikh said. Nursing homes also were considered a Tier 2 facility for PPE (hospitals are Tier 1) and there was a nationwide shortage of masks, gowns, gloves and other equipment.

“Knowing how common asymptomatic infection is, that left a lot of cases unreported and unidentified,” Parikh said.

In the study of 33 nursing homes, “we looked for facilities that had at least one case identified with COVID within the prior week … and also looked for facilities where there was a large number of people who were at risk for COVID who hadn’t yet had COVID,” Parikh said.

They found 601 of 2,117 residents tested positive. “In approximately a month after the first case was detected in a facility, by the time the point-prevalence survey was conducted, over half of those nursing home residents had had COVID,” he said, calling the increase “just incredibly dramatic.”

The study also found, of 530 residents tested without symptoms, 11.7 percent developed symptoms within 14 days. Just three nursing homes tested had no positive cases.

Since the study was conducted, all 215 state nursing homes have had their residents tested, with similar results, Parikh said.

“The overwhelming majority of residents who turned out to be positive with COVID had no symptoms on the day of testing,” Parikh said. “What it shows you is if you’re trying to control an outbreak in a congregant setting, you need to test everyone and … test repeatedly until you get the outbreak under control.”