We must rethink COVID-19 testing in LTC homes

COVID-19 has affected us all, but particularly older adults living in long-term care. Eight in 10 deaths from COVID-19 in the first wave of the pandemic in Canada came from long-term care. The spread of COVID-19 in these settings has proven challenging to control. Vaccines offer hope for the future and are beginning to roll out, but they are not a panacea.

It will be weeks before vaccination in long-term care is complete in every community. Not everyone is able or willing to get the vaccine. There are reports that up to 20 per cent of staff in some homes say that they do not intend to be vaccinated. Turnover of staff, residents, essential care partners and others coming into and out of the home create gaps in coverage.

We owe it to those living and working in long-term care to use every tool available to prevent, prepare for and manage outbreaks, including refreshed approaches to testing.

A recent report from the federal COVID-19 Testing and Screening Expert Advisory Panel states that new testing options should be part of our evolving approach to the pandemic. Their recommendations address optimizing diagnostic capacity, deployment of rapid tests for screening, equity and communications and offer guidance to build on as more evidence becomes available.

A range of tests is now available. Lab-based PCR (polymerase chain reaction) tests are the “gold standard” for diagnosing if someone currently has COVID-19, while rapid antigen tests detect the presence of a protein that is part of the SARS-CoV-2 virus.

These tests differ in turnaround times, the types of health professionals needed to administer and process the tests, their accuracy, portability and cost. There are also variations in how tests are administered, and some are less tolerable for repeated testing.

There is also growing recognition of the potential for mass screening of people without symptoms in targeted, high-risk situations like long-term care and other congregate living settings. Models suggest that quicker, more frequent testing can be more effective for screening than more accurate but less frequent tests with longer lag times to get results.

Balancing these factors is challenging and optimal testing solutions may vary in different scenarios. We may choose to use different tests for diagnosing infections than for when we need to rapidly identify people who are currently likely to transmit the virus to others. Optimal test choice may depend on locally available resources, test frequency and whether rates are high or low in a community.

The time is now. We need to use every option available.

Jennifer Zelmer is president and CEO of the Canadian Foundation for Healthcare Improvement and the Canadian Patient Safety Institute and is a member of the COVID-19 Testing and Screening Expert Advisory Panel. Dr. David Mowat is a public health physician and consultant who has worked as chief medical officer of