“Our findings highlight the potential benefits of low-cost, flexible mitigation measures to protect nursing home residents from COVID-19 during periods of high incidence,” said Alyssa Bilinski, Peterson Family Assistant Professor of Health Policy and assistant professor of health services, policy and practice and of biostatistics. “We have tools to protect this uniquely vulnerable population – including vaccines, antivirals, masks and tests. The key is to support nursing home staff and residents in accessing them.”
Testing asymptomatic staff and residents, whether they have been exposed to the virus or not, identifies carriers and prevents outbreaks within long-term care settings. This straightforward intervention belongs to a list of low-risk safety measures nursing homes have at their disposal, which also includes social distancing, air purification, masking, vaccination and antiviral treatments.
Previous research has shown that screening effectively reduces the rate of COVID-19 infection among nursing home residents; it can also be scaled up or down based on the needs of individual facilities, the researchers note in their report. But at the moment there is a lack of clarity over whether to screen residents and when to increase or reduce the use of screening as a safety measure.
Guidelines from the Centers for Disease Control and Prevention require testing only when a resident is symptomatic or has been exposed to the virus, leaving routine screening to the discretion of individual nursing home administrators.
But Bilinski and her team write that nursing home residents remain vulnerable to the disease, suffering “disproportionate levels of mortality even when overall case rates are low.” They stress that screening is not just effective but also flexible in preventing severe outcomes and for mitigating the spread of the virus. Along with interventions like vaccination and antivirals, screening is less restrictive than social distancing, and can be easily substituted for other measures—so if a nursing home has higher levels of booster and antiviral uptake, administrators may reduce or even phase out their screening strategies.
The researchers emphasize that this study provides a “flexible framework” for caring for residents as vaccine immunity wanes, COVID-19 variants continue to evolve and co-circulating diseases such as influenza and respiratory syncytial virus pose simultaneous risks for nursing home residents and staff. They ultimately urge nursing home administrators to consider these findings when planning for outbreaks and varying levels of transmission across the U.S.
“We hope this work supports nursing homes,” Bilinksi said, “in employing flexible, adaptive, evidence-based strategies to control respiratory illness while minimizing disruption to staff and residents.”
