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What is COVID-19 surveillance testing and how will it help protect nursing homes from outbreaks?

Targeted testing helps identify ‘blips or trends’ in coronavirus cases, governor says

Details on testing nursing home residents and staff for coronavirus still being ironed out
Details on testing nursing home residents and staff for coronavirus still being ironed out

Gov. Ron DeSantis held a news briefing Wednesday to discuss ways the state plans to keep residents of nursing homes and long-term care facilities safe from the coronavirus, as the disease tends to disproportionately and more severely affect the elderly.

“We have over 4,400 long term care facilities in the state of Florida, over 150,000 residents and almost 200,000 staff who work at these various facilities which is a very important vector to worry about in the transmission of the disease,” he said.

DeSantis shared a graphic during his news conference that he said showed the breakdown of COVID-19 cases in Florida by age to emphasize the negative impact coronavirus has on senior citizens, however News 6 could not independently verify the statistics he shared:

Image courtesy Gov. Ron DeSantis
Image courtesy Gov. Ron DeSantis (Copyright 2020 by WKMG ClickOrlando - All rights reserved.)

As cases of COVID-19 were first detected in Florida at the beginning of March, it was already apparent that those over 65 tended to suffer more from the virus than younger and healthier populations. For this reason, the governor issued an emergency order on March 15 that would prohibit visitors in nursing homes and long-term care facilities and would not allow hospitals to send patients who tested positive for COVID-19 back to their respective living facility.

[TIMELINE: The spread of coronavirus in Florida]

The governor’s emergency order also required all vendors and staff to be screened for the virus prior to entering any facility.

In his news conference Wednesday, DeSantis said Florida had one of the lowest fatality rates from COVID-19 in nursing homes and credited the precautions put into place on March 15.

DeSantis provided the following graphic to show the rate of coronavirus fatalities at nursing homes in Florida and across the nation for comparison, however, News 6 could not independently verify these statistics:

Image courtesy Gov. Ron DeSantis
Image courtesy Gov. Ron DeSantis (Copyright 2020 by WKMG ClickOrlando - All rights reserved.)

The governor went on to say that in order to continue to protect the elderly in nursing homes and long-term care facilities as the state continues to ease into reopening, surveillance testing would be done to monitor new infections in these populations.

“There is surveillance testing that is going on that is a way to identify a trend or a blip, you’re not testing everyone when you’re doing surveillance, you’re trying to test representative samples and figure out if we see any flair ups in any of these facilities,” DeSantis said. “We think that’s the only way that we can get to a sustainable point where we’re minimizing risk to the vulnerable population.”

According to the Centers for Disease Control and Prevention, COVID-19 surveillance testing is being done on a national level as well, and “draws from a combination of data sources from existing influenza and viral respiratory disease surveillance, syndromic surveillance, case reporting, commercial lab reporting, the healthcare safety system, ongoing research platforms, and other new systems designed to answer specific questions.”

The CDC said this type of testing is used to help achieve the following goals:

  • To monitor spread and intensity of COVID-19 disease in the U.S.
  • To understand disease severity and the spectrum of illness
  • To understand risk factors for severe disease and transmission
  • To monitor for changes in the virus that causes COVID-19
  • To estimate disease burden
  • To produce data for forecasting COVID-19 spread and impact
  • To understand how COVID-19 impacts the capacity of the U.S. healthcare system (e.g., availability and shortages of key resources)

DeSantis said that Emergency Medical Service providers had been tasked recently with providing some surveillance testing work.

[INTERACTIVE MAP: Here’s where to get your drive-thru coronavirus test]

“EMS performed sentinel surveillance in five long term care facilities, they’ve tested about 300 staff... but this going to an ongoing project, that’s going to be done local, state federal ... this is likely to be the most impactful type of surveillance because you are focusing on where the introduction of the disease is likely to be the most consequential.”

The University of Michigan School of Public Health spoke with Emily Martin, an associate professor of epidemiology, who explained that understanding what surveillance testing doesn’t mean is equally important as the test results themselves.

“[Surveillance testing] doesn’t mean that everybody gets tested,” Martin said. “Instead, surveillance means that we test the right samples of the population in a way that allows us to make inferences as efficiently as possible. It doesn’t mean that we test everybody because it’s important that we strike this balance between getting the information we need and saving enough tests for clinical care.”

Martin went on to say that surveillance testing comes as a second priority to clinical care.

“In the initial days of an outbreak, as a virus moves into an area, the testing for that virus will often be centralized at the health department, and the goal is to define when the virus is here,” Martin said. “Once that’s established, then testing focuses on supporting clinical care and making sure the patients who are most severe are getting taken care of. And once that is under control, then we move onto this surveillance phase where we try to both continue taking care of people who need clinical care while also defining the epidemic as it rises and falls to be able to inform public health. That surveillance system is one that will come into play as the acute situation gets under control.”

In addition to surveillance testing, DeSantis said that a new mobile testing lab, unveiled earlier this month, had made massive improvements to testing at nursing homes across Florida.

[READ MORE: Florida to unveil mobile lab, antibody testing as coronavirus positivity rate reaches new low]

“We are now using this mobile testing lab, which is rapid testing (in) 45 minutes,” DeSantis said. “You go in, you can get the results in the same day. 3,500 tests per week, we introduced it last week and we are focusing these rapid tests exclusively on senior citizens and exclusively at long term care facilitates. We think [the mobile lab] is the first of its kind.”

Mobile testing teams, staffed by different state-run teams, have also been making rounds to nursing homes and long-term care facilities across the state to help control cases of COVID-19.

“This has been going on for weeks now, 50 mobile testing teams - this is the Florida National Guard, the Florida Department of Health --they go in and test residents and staff at facilities across Florida,” DeSantis said. “They’ve already tested more than 32,000 residents and staff, they’ve probably been doing it for three or four weeks now. This has been helpful at identifying clusters and being able to minimize further spread.”

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