Clinician in protective gear collecting nasal sample for a senior woman with a sampling swab.

Health officials in at least one major US city are once again asking nursing home visitors to undertake COVID-19 testing before entering, as community transmission there has ticked dangerously high this month.

Los Angeles County reinstated a visitor testing program earlier this month, as a particularly virulent wave spiked case counts high enough to threaten a broad, new indoor mask mandate.  

Officials reported 2,911 daily COVID cases last week, a rate of 202 per 100,000 residents. That’s more than double the threshold of 100 to be considered high, according to Centers for Disease Control and Prevention guidance.

While officials said the wave appears to have plateaued for now, protections are remaining in place for residents of the county’s 340 nursing homes.

“We are expecting visitors to nursing homes to test within 24 hours prior to the visit, and if it doesn’t happen, which happens a lot, you can offer the self-test kits,” Karen Nie, lead physician at the Los Angeles County Department of Public Health explained during the LeadingAge national COVID call Wednesday.

Nie, a former geriatric medicine fellow, oversees the COVID-19 response in the county’s skilled nursing facilities. LA County officials have been sending antigen-based testing kits to facilities every two weeks to ensure they’re well stocked both for resident testing and visitors, Nie said. 

But unlike at the height of the pandemic, the goal is not to exclude those who refuse COVID-19 testing but rather to help residents and visitors make informed decisions when spending time together. The move to ramp up screening but stop short of mandates mirrors statements made by key federal regulatory officials in recent months that US nursing homes “will not go back” to early COVID shut-downs that excluded almost all visitors.

“We’re at a different place now compared to early in the pandemic,” Nie said. “We do feel like, based on evidence, that the risk is lower and there is a lot of consideration for the quality of life of residents. We don’t go as far as to say that visitors would be prevented from visiting if they don’t have a negative test or just really don’t want to test prior to the visit.”

Vaccine coverage remains high in Los Angeles, with a staff vaccine coverage rate of 98% in the 305 skilled nursing facilities that self-reported data to the county for the week ending Dec. 11. A full 91% of residents are fully vaccinated, which means that they received at least an initial vaccination series.

But cases among seniors are growing in LA, and elsewhere across the US.

For the week ending Dec. 11, more than 65,000 tests were administered among nursing home staff and residents, with 1,175 new cases reported.

While the use of masks is being encouraged to combat COVID, flu and RSV transmission, they are not universally required in nursing homes. Public health officials also have put on hold their plans to bring back a mask mandate for all indoor locations starting Jan. 6, if cases remain steady at lower numbers.