Advocates for North Carolina nursing home residents are calling for proactive testing for COVID-19 in nursing homes, starting with facilities with poor federal quality ratings and low staffing.

“My recommendation out of what we’ve seen so far is that they should be just going into every one- and two-star nursing home and testing everybody,” Bob Konrad, a retired professor from UNC-Chapel Hill’s Gillings School of Public Health, said in an interview with The News & Observer.

In analyzing the publicly available data on North Carolina’s nursing home outbreaks, Konrad and other members of the board of Friends of Residents in Long Term Care found that low-quality ratings appear to be correlated with higher rates of infection.

In other words, the virus seems to have spread more widely in facilities with low-quality ratings.

Seniors with underlying health conditions are at high risk of dying from COVID-19, the disease caused by the virus. In North Carolina, 122 nursing home residents diagnosed with the disease have died, according to the state’s data dashboard Monday morning. That’s more than 40% of the statewide death toll.

Advocates are particularly worried about the virus spreading in facilities that are short-staffed. Due to fear and sickness among staff and the additional time required for them to put on and take off protective equipment, a viral outbreak is likely to make staffing challenges worse.

And without enough staff, the health of all residents, those infected and those not, is likely to suffer, said Lauren Zingraff, the executive director of Friends of Residents.

The group’s analysis is limited by the N.C. Department of Health and Human Services’ position that naming congregate care facilities with outbreaks and providing information about their number of positive test results and deaths violates patient privacy laws.

But county officials have provided some of that information to the public. Twenty-one facilities that had been identified in news reports with case counts were included in the study. More than twice as many had reported an outbreak as of Monday morning, according to the state’s data dashboard.

Asymptomatic spread

On March 29, North Carolina’s nursing home residents and staff were put in a priority testing category; however, it’s unclear how that designation has affected testing patterns. A DHHS spokeswoman said Monday morning that more information about testing in nursing homes would be available soon.

It’s increasingly evident that many nursing home residents could be asymptomatic and that could contribute to the virus’ spread. The CDC found in studying an outbreak in Washington state that roughly half the facility’s residents were asymptomatic at the time of testing, but many developed symptoms later.

As recently as Friday, the North Carolina nursing home industry was pushing for more testing.

“Testing is critical,” Adam Sholar, CEO of the North Carolina Health Care Facilities Association, told Gov. Roy Cooper’s coronavirus task force, according to a recording. “We need to be testing hospital discharges for COVID-19, and we need help getting access to more testing, especially as we’re continuing to see more and more asymptomatic individuals testing positive for COVID-19.”

Sholar also called on state officials to help nursing homes get more personal protective equipment, or PPE. He said that about 4 in 10 nursing homes in the state have a week or less supply of masks and that there was an even greater need for gowns.

In an interview with Fox News on Friday, the CEO of the national nursing home trade group called for testing every staff member and every resident.

“We’ve been at the bottom of the list of priorities both for testing and equipment,” Mark Parkinson said. “The results are obvious and tragic.”

“If we don’t have testing, we don’t know who has it, and so staff members are going out into the community and unwittingly and certainly unintentionally bringing it back into the facilities,” he said.

Governments around the country are beginning to move toward ordering widespread testing.

The Los Angeles County health director recently called the recommendation to test only symptomatic people in nursing homes “a mistake,” the Los Angeles Times reported.

The governor of West Virginia recently issued an executive order directing universal testing of all nursing home residents and staff in the state with the help of the National Guard.

Several other states, including Florida, have deployed the National Guard to help with testing too, The Hill reported.

Friends of Residents would like to see something similar here: a supplementary workforce, outfitted with the necessary protective gear, to provide not just testing, but patient care.

This story was originally published April 27, 2020 at 10:46 AM.