Thousands of lives could have been saved at relatively little cost, if nursing home operators had made wider use of rapid COVID-19 tests during the pre-vaccine days of the pandemic, a study published Wednesday found.
“Cheap and fast, but slightly less accurate, on-site antigen tests performed about as well as highly accurate lab-based PCR tests for providing valuable information that helped prevent or slow outbreaks,” said lead author Brian McGarry, PT, PhD, (pictured above) an assistant professor in the Division of Geriatrics and Aging in the Department of Medicine at the University of Rochester.
“Facilities that had to wait particularly long for lab-based results did worse than those who got results back more quickly,” he added in a 1-on-1 interview with McKnight’s Long-Term Care News.
The study, published Wednesday in the New England Journal of Medicine, used data on more than 90 million nursing home staff COVID tests, partly to determine whether the screening of asymptomatic staff reduced the severity of outbreaks. The answer was an overwhelming yes.
High-testing facilities had about 30% fewer resident cases and 25% fewer deaths prior to the availability of vaccines.
On average, the nation’s 1.1 million nursing home staff were being tested about once per week. Doubling that by spending $5 for another test per week per employee would have prevented an estimated 3,079 resident COVID cases and 427 resident deaths per week, the researchers emphasized.
Financial costs mounted
Besides the vast improvement on the human mortality and suffering scale, the enhanced testing would have meant an economic bonanza to the system as well, investigators discovered.
“This translates into a cost of about $13,000 per life saved, an incredibly good value relative to the cost of other life-saving treatment — which could easily range into the millions of dollars per individual — that the Centers for Medicare & Medicaid Services typically covers,” McGarry explained.
While the administration could be lauded for pushing rapid COVID testing, it also holds responsibility for not pressing further with it, he noted: “Surveillance testing was very effective and we likely underinvested in this.”
The retrospective cohort study, “Covid-19 Surveillance Testing and Resident Outcomes in Nursing Homes,” was co-authored by Ashvin Gandhi, PhD, of UCLA, and Michael L. Barnett, MD, of the TH Chan School of Public Health and the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital. They considered data from more than 13,000 nursing homes.
“To me, this paper is a very tangible ‘here’s something we could have done differently’ and in the presence of a future infectious disease outbreak or future pandemic, rapid, frequent surveillance testing should be a priority,” McGarry said.
Although it required a comparatively lengthy study period, the investigators said the relatively controlled settings of locked-down nursing homes during the pandemic’s early days was especially useful for coming to conclusions. They used data from the Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN).
“Looking forward, this has huge implications for future infectious diseases. Maybe the part where there are some nuances is, what does it mean for facility testing protocols today,” McGarry explained. “That’s where it gets a little more fuzzy.”
Providers in the 90th percentile of testing performed 1.6 tests per staff member per week, while those in the 10th percentile did an average of only about 0.6 per week per employee.
“5.5 million dollars for an extra test per employee per week may sound like a lot, but to the federal government, that’s a drop in the bucket,” McGarry noted.
Testing education lax
He added that stronger educational efforts also were needed because POC tests often “just showed up without a lot of explanation.” He cited many cases of providers leaving rapid tests on the shelf because employees were either resistant to testing or facilities were uncertain how to use them or conflicted over using the rapid tests, which would produce more false positives than PCR tests. PCR tests were ultimately often “worthless” because conditions could have changed so much by the time results were known days later.
By a post-vaccine period, most facilities were using point-of-care tests, partly because they were free.
“Eventually, the economics won out, but there was that critical period starting in the summer of 2020, where rapid point-of-care testing was available, the vaccines were not yet available and we really had a window there to make a big difference in terms of preventing outbreaks and preventing resident deaths and I think some of the misinformation and the misunderstanding about the value of the point-of-care testing inhibited our ability to maximize their benefit.,” McGarry said.
He believes the responsibility lies with federal policy makers, who sent these kits out “without a lot of instruction, without a lot of education about how to use them and what they’re good for.”
He said responsibility also can be assigned to a “disconnect” between physicians who make clinical decisions for individual patients and decisions that need to be made strictly from an infection control, public health standpoint that are about the well-being of the full population of the nursing home, not just individual patients.