In the early phase of the pandemic, health officials prioritized nursing home residents for safety measures, including frequent staff testing, given that the facilities care for vulnerable people with underlying health conditions who live in close quarters.
Researchers who examined the impact of frequent testing today reported that the strategy paid off with lower rates of COVID-19 infections and deaths. They detailed their findings in the latest issue of the New England Journal of Medicine.
Nursing home residents make up 2% of the US population but represented 20% of COVID-19 deaths through the end of 2021. Federal health officials had recommended that nursing homes in areas experiencing high transmission test asymptomatic staff up to twice a week, though staff shortages and a lack of rapid tests in the early pandemic months posed challenges.
Biggest impact during prevaccine months
For the study, the team used the Centers for Medicare and Medicaid Services (CMS) COVID-19 Nursing Home Database to track more than 90 million COVID test results from nursing home staff from 2020 to 2022. They looked at three time frames: before vaccines were available, after vaccines were available but before the Omicron wave it, and during the Omicron period. They measured the frequency of testing by facility, comparing it to neighboring facilities and examining infections and deaths during potential outbreaks in the facilities.
During outbreaks, high testing frequency (1.7 COVID tests per week per staff member) was linked to fewer cases and deaths in residents compared to low testing frequency (0.6 per week). The difference was more pronounced during the prevaccine period, when high-testing facilities registered 25% fewer deaths.
The team estimated that performing an additional test per staff member each week during the prevaccine months could have averted 30% of cases and 26% of deaths.
Once vaccines became available, the association wasn't as strong during the pre-Omicron period. And when the group looked at the Omicron period, frequent testing reduced cases but not deaths, which they said tracks with a drop in the vaccine's efficacy in preventing infections, though it did protect against hospitalization and death.
A powerful tool in a vulnerable population
In a press release on the study from the University of Rochester Medical Center, Brian McGarry, PhD, the study's lead author and assistant professor of medicine and public health sciences at the facility, said, "This research demonstrates that frequent COVID surveillance testing protected nursing home residents and undoubtedly saved lives by detecting more infected staff, potentially earlier in the disease course, and disrupting potential viral transmission chains."