Missouri’s new plan to attack rising COVID in nursing homes: test everyone, test often
After her Clay County nursing home conducted a second round of COVID-19 testing last week, Administrator LaDonna Vaughan said she would drive the tests to Jefferson City herself.
She wanted to make sure the tests were processed as soon as possible so she would know if any additional residents or staff at Pleasant Valley Manor Care Center had the virus. And this week, she plans to do it all again.
Here’s why: Late last month, an employee told Vaughan that she had a headache. Better go get tested, Vaughan told her.
On May 28, that employee’s positive test was the first for the nursing home located outside Liberty. And the first for any long-term care facility in Clay County.
Just two weeks later, the facility has 57 confirmed cases and two deaths.
For months, Pleasant Valley had avoided what long-term care facilities throughout the Kansas City area and across the country had been dealing with. Now, as health care officials worry about a new spike in cases in the U.S. following Memorial Day, nursing homes think they have at least one advantage compared to the first wave: Testing.
“I’m going to do it weekly until I have no positives,” Vaughan said of testing her entire facility after this first outbreak. “Unless the state comes back and says no you don’t have to do that, that’s what I’m going to do.”
In fact, health officials in Missouri say she’s doing exactly what they want her and other nursing home administrators to do in order to stop the virus from overwhelming more long-term care facilities. Even after just one confirmed case of a resident or staff member, state health officials now recommend that facilities implement facility-wide testing.
“It can be like a ball rolling down the hill,” said Dr. Randall Williams, director of the Missouri Department of Health and Senior Services. “Once it picks up momentum, it keeps getting worse. You need to intervene as early as you can.”
Two months ago, long-term care facilities across the nation typically only tested symptomatic residents. States didn’t have the resources to conduct massive testing in every facility with an outbreak. That frustrated facilities and families who felt more should be done to detect outbreaks earlier.
It’s only recently, now that more testing is available, that states are expanding their testing.
In a news release Friday, Kansas detailed how its Department of Health and Environment now will assist long-term care facilities with early detection of the virus. Once a case is detected, that facility can request testing help through the state laboratory.
KDHE also will support the testing of all asymptomatic and symptomatic residents and staff, according to information released Friday by the Kansas Department for Aging and Disability Services.
In Missouri, officials have gone further and faster.
Testing guidelines changed on May 18 with an executive order — and the launch of a “boxed-in strategy” for long-term care facilities. That order required facilities to notify the state within 24 hours of a confirmed case.
The state also recommended that there be building-wide testing for any long-term care facility with at least one resident or one staff member with confirmed coronavirus.
“We’re going to have to get better every day at testing,” Gov. Mike Parson said then.
Asymptomatic with the virus
Since May 18, residents and staff at dozens of Missouri nursing homes and assisted living complexes have been tested.
As of Wednesday, 94 facilities reported a “new positive” in the past 14 days. Of those, 81 have completed facility-wide testing; the others are in the process of scheduling, according to DHSS.
Ann Bickel, board member of the Missouri Coalition for Quality Care, didn’t know the state had adopted a new strategy for nursing facilities with COVID-19 cases. The move, she said, is a “step in the right direction.”
“I think that we’ve wanted more testing all along to know where the virus is,” Bickel said. “Then they can isolate that person and keep it from spreading like wildfires through the whole facility. ... This is great news.”
The state of Missouri now works with 20 labs that can do up to 20,000 tests a day. The capacity wasn’t available at the beginning of April when long-term care facilities began to see outbreaks.
A major concern for facilities with vulnerable seniors has been a growing number of people testing positive for the virus with no symptoms, or without showing any when they were initially diagnosed.
That was the case at Pleasant Valley Manor in Clay County. Vaughan said only a few residents and staff were symptomatic when they were tested.
Another facility in the Kansas City area experienced something similar.
An employee at Olathe’s Villa St. Francis tested positive for the virus. The person hadn’t been around any residents, but 14 fellow employees were tested. All were negative.
The director, Rodney Whittington, thought the virus may be inside the nursing facility, but because of asymptomatic cases, he couldn’t see it. When the Johnson County health department didn’t have resources to test asymptomatic people, Whittington contacted a laboratory that could and facility-wide testing revealed a cluster of coronavirus.
As of Friday morning, Villa St. Francis has had 64 cases and four deaths.
The two facilities — one in Kansas and one in Missouri — show why conducting facility-wide testing has been crucial. Both processes exposed large clusters that may not have been detected until more people were infected.
“That’s when you see the real power of the testing,” said Kelsey Neth, director of communications for the Clay County Public Health Center. “How it can reveal things that aren’t obvious to everyone.”
‘Help us save lives’
The idea for the “boxed-in strategy,” according to Williams, initially came from Deborah Birx, the White House coronavirus response coordinator. In a phone call earlier this year with state health directors, she explained what could happen after coronavirus cases peaked.
Williams recalled hearing her advise health officials that COVID-19 wasn’t going to just go away once states “get on the other side of the curve.”
Birx cautioned that states would have nursing homes and prisons report clusters of cases and “you’re going to have to go in and box it in,” Williams said.
“It was her idea,” he said. “I just took it and ran with it as fast as I possibly could.”
Early last month, Williams worked with Jefferson County health director Kelley Vollmar after an outbreak at a facility in a suburb of St. Louis. After several confirmed cases, everyone was tested. Soon, the facility was able to contain the virus.
That served as a pilot project for the strategy that was announced last month.
At that time, 163 long-term care facilities had reported at least one case of the coronavirus. And 91 had a case within the past 14 days. Of those, only 41 had done facility-wide testing.
So the state first worked with the remaining 50 to set up and conduct testing. Now with each new outbreak, facilities across the state are learning what to do.
Last week, a facility in Independence reported an outbreak. As of Thursday, 34 residents and staff members had tested positive at The Groves.
The facility has 400 staff members and approximately 300 residents. The City of Independence is working with the Jackson County Health Department to make sure the facility has enough PPE and testing resources.
“Testing is currently being done in batches,” said Kayla Parker, communications specialist with the Jackson County health department. “And everyone will be tested.”
During the summer months, Williams said, the goal is for counties and all long-term care facilities to come up with a contingency plan.
“If they have one case — one resident or one staff member — report that to us within 24 hours,” he said. That will then trigger a discussion of comprehensive testing.
“We want to be very, very purposeful of boxing it in. Testing, doing repeat testing and staying on top of it.”
So far, the results of the strategy are “promising,” Williams said.
“We truly believe by catching it early and isolating, and getting staff out of there,” he said, “that going forward, this will help us save lives.”
