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Community Coronavirus Disease 2019 Activity Level and Nursing Home Staff Testing for Active Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Indiana.

Authors
  • Blackburn, Justin1
  • Weaver, Lindsay2
  • Cohen, Liza3
  • Menachemi, Nir4
  • Rusyniak, Daniel E5
  • Unroe, Kathleen T6
  • 1 Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health at Indianapolis, Indianapolis, IN, USA. Electronic address: [email protected] , (India)
  • 2 Indiana Department of Health, Indianapolis, IN, USA. , (India)
  • 3 Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA. , (India)
  • 4 Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health at Indianapolis, Indianapolis, IN, USA. , (India)
  • 5 Indiana Family and Social Services Administration, Indianapolis, IN, USA. , (India)
  • 6 Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA; Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA. , (India)
Type
Published Article
Journal
Journal of the American Medical Directors Association
Publication Date
Jan 01, 2021
Volume
22
Issue
1
Identifiers
DOI: 10.1016/j.jamda.2020.10.038
PMID: 33248030
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To assess whether using coronavirus disease 2019 (COVID-19) community activity level can accurately inform strategies for routine testing of facility staff for active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cross-sectional study. In total, 59,930 nursing home staff tested for active SARS-CoV-2 infection in Indiana. Receiver operator characteristic curves and the area under the curve to compare the sensitivity and specificity of identifying positive cases of staff within facilities based on community COVID-19 activity level including county positivity rate and county cases per 10,000. The detection of any infected staff within a facility using county cases per 10,000 population or county positivity rate resulted in an area under the curve of 0.648 (95% confidence interval 0.601‒0.696) and 0.649 (95% confidence interval 0.601‒0.696), respectively. Of staff tested, 28.0% were certified nursing assistants, yet accounted for 36.9% of all staff testing positive. Similarly, licensed practical nurses were 1.4% of staff, but 4.7% of positive cases. We failed to observe a meaningful threshold of community COVID-19 activity for the purpose of predicting nursing homes with any positive staff. Guidance issued by the Centers for Medicare and Medicaid Services in August 2020 sets the minimum frequency of routine testing for nursing home staff based on county positivity rates. Using the recommended 5% county positivity rate to require weekly testing may miss asymptomatic infections among nursing home staff. Further data on results of all-staff testing efforts, particularly with the implementation of new widespread strategies such as point-of-care testing, is needed to guide policy to protect high-risk nursing home residents and staff. If the goal is to identify all asymptomatic SARS-Cov-2 infected nursing home staff, comprehensive repeat testing may be needed regardless of community level activity. Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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