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Critics say state needs to repeatedly test all nursing home staff and residents

The National Guard was deployed to Quincy to assist with COVID-19 testing at a nursing home on April 9.
The National Guard was deployed to Quincy to assist with COVID-19 testing at a nursing home on April 9.Stan Grossfeld/ Globe Staff

With nearly half of coronavirus deaths in Massachusetts occurring at long-term-care facilities, state officials are now offering to provide testing for residents and staff at any nursing home, assisted living facility or rest home, seeking to curb a contagion that preys upon the frail and elderly.

Because the illness can be transmitted by people who are not showing symptoms, the state said this type of universal testing is crucial so the facilities can isolate the infectious and identify the full scope of the outbreak.

But infectious disease specialists and advocates say the mobile testing program, which is being offered to all senior living facilities, is too limited to effectively fight the pandemic because it only calls for a single round of testing.

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What is needed, they said, is a surveillance program that frequently tests residents and staff and monitors them over time to identify new cases.

A single round of testing is a “recipe for disaster,” said Simon Johnson, a professor at the MIT Sloan School of Management who cofounded the COVID-19 Policy Alliance, which is helping nursing homes acquire testing, personal protective equipment, and additional workers. “They need to wake up and understand people are going to die horrible and unnecessary deaths because of a stupid policy that needs to be changed."

Johnson said the state needs to move “as quickly as possible to help implement a regular comprehensive surveillance testing program for all residents and staff, so we know who is infected and who is not."

Not only do some people carry the virus without displaying symptoms, some may test negative even though they have already been infected.

The state’s own testing guidelines recognize this prospect.

“Negative results, especially in asymptomatic individuals, should be interpreted with caution, as they merely represent a point in time and individuals who test negative could still be within the incubation period of disease," the guidelines read. "Further, individuals potentially exposed but testing negative should still be closely monitored and quarantined as appropriate, if still within 14 days of exposure.”

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Tom Lyons, a spokesman for the state’s COVID-19 command center, said the state will provide additional test kits for residents who test negative but later show symptoms of the virus. The state “is working to implement surveillance testing” at nursing homes, assisted living facilities, and rest homes, he said.

As of Thursday, there were 610 deaths linked to the coronavirus in the state’s long-term care facilities, 49 percent of all COVID-19 deaths in the state. There were 4,798 positive cases among residents and staff at those facilities, which do not include assisted living facilities.

As of Thursday, more than 5,883 tests had been administered at 279 facilities and nearly 11,000 test kits had been sent to 103 facilities, said Marylou Sudders, the state’s secretary of health and human services. The National Guard planned to visit 11 sites Thursday and conduct 1,349 tests, she said.

Facilities can request the tests by calling the state’s mobile testing hot line. The state will either provide kits, produced by the Broad Institute of MIT and Harvard, or dispatch the National Guard or Fallon Emergency Medical Service to conduct the tests.

The Broad Institute has the capacity to process approximately 4,000 diagnostic tests per day and is currently returning results within 24 hours, with most under 12 hours, according to David Cameron, a spokesman

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Harvard Medical School professor David Grabowski, who specializes in long-term care, said surveillance testing may be the only way to guard against false negatives registered when the disease is incubating in asymptomatic people.

“It’s a much better approach,” Grabowski said, cautioning that it would require significant resources. “You really need to test everyone, and test them several times. I think we should be doing this nationally, but we haven’t invested in the testing capacity and the staff to make it happen.”

The American Health Care Association and National Center for Assisted Living, organizations that represent operators of long-term-care facilities, said the industry is “struggling to gain access to reliable, rapid response tests to determine who has COVID-19 in their centers.”

“Long-term-care providers need to be able to test all staff and residents and obtain timely results. This is the only way we can manage and contain this virus," the groups said in a statement in response to questions from the Globe. “Our residents and staff have struggled to get testing or proper turnaround time on tests. This has been one of the most significant factors related to the spread.”

On average, labs are taking five to eight days to process tests from long-term care facilities, the groups said. Some facilities are looking for private labs to conduct testing, prompting the two groups to establish a team to review options. So far, only a third of the testing services they’ve reviewed have been deemed “viable” options, the groups said.

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Tara Gregorio, president of Massachusetts Senior Care, a trade association that represents long-term-care facilities, has urged Baker and state lawmakers to routinely test symptomatic and asymptomatic residents and staff at all nursing homes.

“Nursing facilities are working to secure testing for our front-line staff and residents but the process established by the state, while well-intentioned, has been inadequate to the scope of the problem,” she said.

Gregorio helped launch a pilot surveillance testing program this week at the Boston Home in Dorchester and the Leonard Florence Center for Living in Chelsea, with a grant that the MIT group, COVID-19 Policy Alliance, received from the Schmidt Family Foundation.

Nursing home operator Tom Lavallee said he is taking advantage of the state testing program but is also hoping to conduct a surveillance testing program at one of his homes with no coronavirus cases.

Lavallee, chief operating officer of Alliance Health & Human Services in Southborough, which runs eight skilled nursing facilities and a rest home in Massachusetts, said it’s unclear when the program will start or how often residents and staff will be tested.

But repeated testing may be the best approach to keep the virus at bay, he said.

“Given the incubation period of the disease,” Lavallee said, “this will really help us know who has it and where it is.”

In Cambridge, officials last week said they directed the city’s seven assisted living and skilled nursing facilities to join a surveillance testing program.

The first round of testing was completed last week, and all residents and employees will be tested again as soon as Friday, said Susan Feinberg, a spokeswoman for the Cambridge Public Health Department.

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“This approach will provide a more accurate picture of the true infection rate in skilled nursing facilities and assisted living facilities at a given point in time,” Feinberg said.

Frank Petras, executive director of Cadbury Commons, an assisted living and memory care facility in Cambridge, said recent tests showed that a number of residents and employees without symptoms had the virus. Infected residents are now being isolated and sick workers are staying away, he said.

“We had a lot of asymptomatic people,” said Petras. “If it was earlier, I think it would have helped us have fewer cases.”


Shelley Murphy can be reached at shelley.murphy@globe.com. Follow her on Twitter @shelleymurph. Laura Crimaldi can be reached at laura.crimaldi@globe.com. Follow her on Twitter @lauracrimaldi. Robert Weisman can be reached at robert.weisman@globe.com. Follow him on Twitter @GlobeRobW.