Washington plans to test all nursing home residents and staff, says state doctor

May 12, 2020

Washington Gov. Jay Inslee has instructed the state Department of Health (DOH) to prepare to test all nursing home residents and staff for COVID-19 in the coming weeks, according to the physician leading the state’s testing strategy.

“Last week, Governor Inslee gave us the directive to test everyone, both resident[s] and staff in the nursing homes in the state,” said Dr. Charissa Fotinos in an interview on TVW’s “Inside Olympia” program.

Previously, the state's goal was to test all residents and staff in facilities where someone had tested positive -- something that has not yet been achieved, according to a Department of Social and Health Services (DSHS) spokesperson. 

DOH and the governor’s office have not yet formally announced the nursing home testing plan. And representatives of the state’s two largest long-term care associations said they had not been notified of the governor’s strategy.

In an email Tuesday, Inslee's office confirmed the governor had previously given this direction and also said DOH and DSHS are drafting guidance for all long-term care facilities. 

"Accomplishing this timeframe depends on timely delivery of the federal testing supplies we have been promised by HHS," said Inslee spokesperson Mike Faulk, referring to the U.S. Department of Health and Human Services. "We are also working to ensure our labs can handle the volume and our nursing homes can collect the samples."

A DOH spokesperson said details are still being worked out, but that the plan would be shared "broadly" when the time comes.

On Monday, the White House recommended that all states test nursing home residents and staff within the next two weeks. 

In the TVW interview, Fotinos said the plan would be to test an estimated 40,000 staff and residents over a two week period at the state's roughly 200 skilled nursing facilities. This would likely represent the first widespread testing of asymptomatic people in the state, which Fotinos said could be revealing.

“It will give us an idea of sort of the prevalence of, hopefully, asymptomatic infection,” Fotinos said. “That will continue to inform our understanding of how COVID spreads and impacts people.”

Long-term care facilities have been especially hard hit by COVID-19. In Washington, 279 facilities have reported positive cases, including 58 adult family homes. Early on in the COVID-19 crisis, the Life Care Center of Kirkland became the nation’s epicenter of the pandemic with nearly 40 deaths linked to that one facility. Subsequently, other nursing homes in the state have experienced outbreaks.

Last week, DOH reported that 19 percent of the state’s confirmed COVID-19 cases and 61 percent of the deaths have been associated with long-term care facilities. Nationally, The New York Times has calculated that nursing home residents and staff account for a third of the COVID-19 deaths in the U.S.

Separately, Washington Senate Republicans recently published an analysis that concluded the death rate among residents of these facilities in Washington is nearly 300 times higher than among the general population.

With visitors to long-term care facilities temporarily banned, it’s likely that staff, who come and go, are the vectors for COVID-19 entering the facilities. In New York, Gov. Andrew Cuomo has ordered that nursing home staff must be tested for the virus twice-a-week. 

Dr. Fotinos said a similar mandate for regular testing of nursing home staff and also residents is likely in Washington too.

“I don't have that interval right now, but that is the intent," Fotinos said. 

The plan to do widespread testing in nursing homes comes as the state of Washington ramps up its testing capacity. Currently, about 6,000 tests are done each day in the state. Inslee has set a goal of increasing that to 20,000 to 30,000 in the coming weeks. Washington has ample lab capacity, but test kits and personal protective equipment (PPE) have been in perpetual short supply.

Recently, though, the federal government said it would start sending the state swabs and transport vials, with the first of several large shipments expected to arrive this week.

Fotinos said the nursing home testing regime would be a “good test” of the state’s expanded testing capabilities.

But Deb Murphy, the president and CEO of LeadingAge Washington, which represents mostly nonprofit nursing homes, expressed skepticism that the state will be equipped to accomplish such an ambitious testing program in nursing homes so soon.

“The reality is there simply aren’t enough tests available today to comply even if mandated,” Murphy said.

In recent weeks, Washington’s long-term care industry has expressed frustration at the continued lack of PPE and testing which has hampered efforts to detect and control COVID-19 in nursing homes and other congregate care settings.

Much of that frustration has been aimed at the Trump administration. In response to the White House’s recommendation that all states test 100 percent of nursing home residents and staff, Murphy said: “It’s a little like closing the barn door after the horse has left the stable.”