Regularly screening nursing home residents for COVID is a cost-effective way to reduce infections and protect lives, especially when many residents are not up-to-date on vaccinations, according to a study published Friday in JAMA Network Open.
The authors said that the study can provide context for long-term care providers as they adapt to COVID as an endemic virus and to relaxed requirements from the Centers for Disease Control and Prevention.
“This study provides a flexible framework for reducing COVID-19 mortality in the Omicron era in the context of unexpected waves of COVID-19 cases, rapidly mutating variants and the recurrence of diminishing vaccine immunity,” they wrote. “These findings can be used by nursing home administrators to guide planning in the context of widely varying levels of SARS-CoV-2 transmission and intervention measures across the US.”
The researchers found that weekly testing of residents — including those with no symptoms — can reduce infections by 60% in situations with low COVID incidence and by 70% with high incidence. Testing twice weekly can reduce that total by another 55% to 65%.
Low incidence was defined as 5 cases per 100,000 residents, and high incidence as 100 cases per 100,000.
Twice-weekly screenings were also effective at reducing resident deaths — by around two-thirds in low-incidence settings and by more than half in high-incidence settings.
The study estimated the cost of weekly testing for a month of weekly screening at $4,000 for a nursing home averaging 90 residents and 83 staff members.
The authors found that screenings were less cost-effective at protecting residents when combined with other methods, such as consistent antiviral use, high vaccination rates or isolation. They also noted that screenings are a less harmful and intrusive intervention than isolations, in particular.
“Interventions, such as screening, vaccination and antiviral use are less restrictive ways to reduce resident deaths,” the authors concluded. “Additionally, these strategies can substitute for one another; for example, at high levels of booster and antiviral uptake, screening may be scaled down or phased out.”
However, since vaccination rates are lagging and antiviral use is inconsistent, the authors recommended screening as an effective and relatively cheap alternative even in low-incidence settings.
While no longer a national health emergency, the threat of COVID still looms large over nursing homes. Residents accounted for 9% of the nation’s COVID deaths in 2023 despite only making up 0.4% of the population, the researchers noted. Only around 30% of residents are up-to-date on boosters, according to CDC data.
