It’s time to expand rapid testing in B.C.’s long-term care and assisted living residences
Last year as the COVID-19 pandemic continued to rage across the seniors care and living sector – particularly with new long term care outbreaks – BC Care Providers Association (BCCPA) advocated for the expanded use of rapid testing across the province. In late November 2020, as part of a major report BCCPA released to better prepare seniors care and living for subsequent COVID-19 waves, it recommended that the Provincial Health Officer establish rapid testing alongside screening protocols for residents and staff in long-term care, assisted living, and independent living.[i]
Following that, BCCPA’s membership at their December AGM also approved a motion recommending the B.C. Government develop and fully fund a provincial COVID-19 testing strategy for seniors’ care and living, which includes specific targets around the frequency of testing and test result turnaround times for those working in long-term care, assisted living, home health and independent living. The tests are understood to help prevent or mitigate the spread of COVID-19.
The motion also noted that along with providing priority access to testing and quick turn-around of results, the B.C. Government should prioritize the seniors care sector for point of care and less invasive tests as they become available.[ii]
Use of rapid testing to deal with increased outbreaks
As outlined in December 2020 BCCPA op-ed, while lab-based polymerase chain reaction (PCR) testing may be more accurate, the use of rapid testing in long-term care is still be a valuable tool to assist in quickly isolating positive cases. While the rapid tests are not 100 percent reliable and have some limitations, the deployment of these tests will likely detect many asymptomatic cases, prevent transmission to staff and residents, reduce the frequency of catastrophic outbreaks and perhaps alleviate the detrimental physical and mental health impacts of social isolation.[iii] As well, jurisdictions within Canada like Ontario and countries such as the United States and Germany have been using such tests to a much greater degree in seniors care.
Late last year, the BC government began using rapid testing in a very limited way. A pilot of the Abbott Panbio rapid antigen tests was begun by Providence Health in early December. As of the first week of January, a positive COVID-19 case in an asymptomatic care home employee was detected during the pilot.
In addition to providing an extra layer of safety for those living and working among vulnerable populations, the rapid tests are generally inexpensive to use and easy to https://bccare.ca/wp-content/uploads/2022/08/medcare-img22.jpgister. There is also strong support among a sampling of care home operators, who indicated to BCCPA they are willing to participate in any rapid testing program as it becomes available. The use of rapid testing has also been used quite effectively in other environments including schools and the Vancouver Airport, where a pilot project has tested over 300 passengers quite rapidly and inexpensively with reliable results.[iv]
An increasing number of COVID-19 outbreaks in senior care and living highlights the importance of expanding the use of rapid testing. In the B.C. Ministry of Health’s first publicly released report on outbreaks in early January 2021 it found that 602 residents of long-term care, assisted-living or independent-living homes had died of COVID-19 or about 63 per cent of B.C.’s fatalities. 336 of the deaths were also at sites where an outbreak was active.[v]
According to most recent outbreak data released in mid-January, 50 long-term care, assisted and independent-living facilities across the province were managing outbreaks. [vi] More than half are in the Fraser Health region and five had more than 100 confirmed cases among staff and residents.[vii] One of these five care homes is Little Mountain Place care home in Vancouver, which has had the highest numbers of fatalities (over 40) and where 99 of 114 residents and over seventy staff have tested positive for COVID-19. Newspaper commentators have gone so far as to say that more rapid testing may have lessened the outbreak that occurred at Little Mountain Place.[viii]
Latest Evidence
The most recent research and related guidelines seems to support the need for increased testing including rapid tests in response to outbreaks in long-term care and assisted living residences. The latest evidence from the United States Centres for Disease Control (CDC) shows that more than half or close to 60 percent of COVID-19 transmissions come from people who do not know they have it.[ix] In particular, the analysis found that 59% of all disease transmission came from asymptomatic individuals — with 35% of those being pre-symptomatic people and 24% people who never developed symptoms.[x] Recognizing the value of such tests, the United States earlier this year even allocated an additional $300 million to support its point-of-care testing program, noting that it may have already saved tens of thousands of lives.[xi]
In mid-January 2021, the first Health Canada report released by the Testing and Screening Expert Advisory Panel identified four priority areas, one of which was the deployment of rapid tests for screening. In particular, it notes the use screening with rapid tests to limit outbreaks in congregate and high-risk settings, such as long-term care. While the report notes various operational considerations to consider, it also highlights that screening programs with rapid tests that are used as part of standard practice in these settings could help identify COVID-19 infections before they spread and also help prevent an outbreak.[xii]
Recently revised guidance on COVID-19 in long term care by the World Health Organization (WHO) also supports the use of increased staff testing. The latest WHO guidance notes evidence which shows that the consistent and rigorous implementation of infection prevention and control policies and measures can significantly reduce the risk of SARS-Co-V-2 infection in residents and staff. According to the guidance, one of most effective interventions to prevent the control and spread of the virus in long-term care communities is the screening and testing of residents, staff members and visitors.[xiii] In particular, some of the key highlights related to testing from the latest WHO guidance includes:
- Recommending testing for all new admissions into long-term care where there is evidence of community spread;
- Studies of outbreaks showed that 7% to 75% of residents and 50% to 100% of staff who tested positive were pre-symptomatic or asymptomatic;
- In areas of community transmission of SARS-CoV-2, regular testing of all residents and staff allows early detection and isolation of positive patients and staff (including asymptomatic and pre-symptomatic infected individuals) and their appropriate management, as well as prevention of an outbreak in the facility;
- A separate study found that testing of all residents and staff after a case is identified in the facility can identify 10–100 additional cases for each initial case diagnosed; and
- Irrespective of the SARS-CoV-2 transmission scenario, staff working in long-term care should be considered for routine testing.[xiv]
Concerning local developments – such as the outbreak at Little Mountain Place – has led the B.C. government to indicate that it is looking at several options to reduce the spread of COVID-19 in care homes, including the mass testing of workers. B.C. Seniors Advocate Isobel Mackenzie is also calling on the provincial government to consider wider testing for staff at care homes.[xv] Ms. Mackenzie argues that the need for more testing is needed to keep the coronavirus from spreading in long-term care homes where people are most at risk, while noting that the tests are being used for hockey players in the NHL and for film crews, but not in places where they are perhaps needed most.[xvi]
Call for Action
While BCCPA supports the B.C. government’s shift in stance to look further at rapid testing, it also believes now is the time for expanding this effort. British Columbia must follow the lead of other jurisdictions like in Ontario, the United States and in Germany to increase the use of rapid testing in long-term care.
Rapid testing should be used more broadly alongside other recommended measures, including physical distancing, wearing appropriate personal protective equipment (PPE), and employing infection prevention and control (IPC) practices as the vaccination of residents and vulnerable seniors continues to ramp up. Enhanced contract tracing – being piloted now by a private care home in Abbotsford[xvii] – is a further measure to consider.
While significant progress has been made already in vaccinating long-term care residents and staff in Vancouver Coastal and Fraser Health regions,[xviii] [xix] other health authorities such as Interior are hoping to complete by end of next month.[xx] Although vaccinations will be a key element in reducing the overall death rate particularly among seniors in long term care, it is less clear how much it will reduce overall transmission and cases.
The need for rapid testing is also necessitated by the short-term slowdown in vaccine distribution as seen by recent delays in the Pfizer vaccine[xxi], as well as the hesitancy of some care staff to take the vaccine. A recent SafeCare BC survey, for example, found that 57% of continuing care workers indicated they intended to get the vaccine, while 28% were unsure and 15% said they did not intend to.[xxii] This is why continuing to maintain appropriate PPE and IPC measures as well as adopting further testing and contact tracing will continue to be necessary for the foreseeable future.
Reconnecting Families
Increased testing will also be critical as we attempt to loosen visitation restrictions in long-term care and assisted living. As noted in the earlier BCCPA op-ed, it is the hope that new measures like rapid tests to reduce COVID-19 will result in fewer long-term care home outbreaks particularly as we urgently find ways to reconnect families to their loved ones in care.[xxiii]
BCCPA is also exploring how to reunite family members with loved ones in care as part of its broader advocacy. This will topic will be discussed our February 11, 2021 Care to Chat that will look at how restrictions on family visits in long-term care and assisted living have taken a major physical and emotional toll on the health and well-being of seniors and their caregivers. At this event it will also discuss how the potential use of rapid testing may help open up care homes for families and seniors.
Now is the time for action from the Ministry of Health and Public Health to support greater use of rapid testing to reduce COVID-19 outbreaks in long-term care and assisted living, and to help increase social connections between care home residents and their loved ones.[xxiv]
END NOTES
[i] BCCPA. Pandemic Next Wave Report. November 2020. Accessed at: https://bccare.ca/pandemic-next-wave-report/
[ii] BCCPA. 2020 AGM Update: Year in Review, policy motions, and new board directors. December 2020. Accessed at: https://bccare.ca/2020/12/agm-update-year-in-review-policy-motions-and-new-board-directors/
[iii] Times Colonist. Comment: To improve residents’ lives, we need COVID-19 rapid testing at care homes. Ted Rosenberg. December 4, 2020. Accessed at: https://www.timescolonist.com/opinion/op-ed/comment-to-improve-residents-lives-we-need-covid-19-rapid-testing-at-care-homes-1.24250206
[iv] CBC News. Rapid-testing project at YVR shows promise for future use in long-term care homes. January 13, 2021. Accessed at: https://www.cbc.ca/news/canada/british-columbia/rapid-testing-ltc-yvr-1.5870744
[v] CBC News. Residents in care facilities make up nearly two-thirds of COVID-19 deaths in B.C.. January 7, 2021. https://www.cbc.ca/news/canada/british-columbia/long-term-care-data-covid19-bc-1.5865755.
[vi] BC Ministry of Health. Weekly COVID-19 Long Term Care, Assisted Living & Independent Living Outbreak Report. January 13, 2021. Accessed at: http://www.bccdc.ca/Health-Info-Site/Documents/COVID_sitrep/LTC_AL_COVID-19_Outbreak_Report_0113_2021.pdf
[vii] CTV News. Active COVID-19 outbreaks: These 5 health-care facilities in B.C. have more than 100 cases. January 15, 2021. Accessed at: https://bc.ctvnews.ca/active-covid-19-outbreaks-these-5-health-care-facilities-in-b-c-have-more-than-100-cases-1.5268881
[viii] Vancouver Sun. Vaughn Palmer: Could rapid testing have helped curb COVID-19 outbreak at Little Mountain? January 12, 2021. Accessed at: https://vancouversun.com/opinion/vaughn-palmer-could-rapid-testing-have-helped-curb-covid-19-outbreak-at-little-mountain/wcm/f5cb208b-26d8-4c38-b54b-100184c1ebdb/
[ix] JAMA. SARS-CoV-2 Transmission From People Without COVID-19 Symptoms. January 2021. Accessed at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774707
[x] McKnight’s LTC News. CDC study confirms: Coronavirus most often spread by asymptomatic carriers. January 11, 2021. Accessed at: https://www.mcknights.com/news/cdc-study-confirms-coronavirus-most-often-spread-by-asymptomatic-carriers/
[xi] McKnight’s LTC News. $300M more given for point-of-care tests, which have ‘saved thousands’: HHS official. January 8, 2021. Accessed at: https://www.mcknights.com/news/300m-more-given-for-point-of-care-tests-which-have-saved-thousands-hhs-official/
[xii] Government of Canada. Priority strategies to optimize testing and screening for COVID-19 in Canada: Report. January 2021. Accessed at: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/medical-devices/testing-screening-advisory-panel/reports-summaries/priority-strategies.html. In the report one of the operational considerations for rapid testing is around equity. Particularly as noted in the report COVID-19 has highlighted and amplified existing health inequities in Canada. Research has shown that COVID-19 has disproportionately affected some populations, in particular: racialized communities, economically disadvantaged individuals, people with disabilities, and older adults, especially those living in communal facilities such as long-term care.
[xiii] McKnight’s Senior Living News. WHO issues new infection prevention, control guidance for assisted living operators facing SARS-CoV-2. January 11, 2021. Accessed at: https://www.mcknightsseniorliving.com/home/news/who-issues-new-infection-prevention-control-guidance-for-assisted-living-operators-facing-sars-cov-2/. Other measures listed included: Adequate personal protective equipment; Cohorting of employees and residents; Paid, mandatory sick leave; Physical distancing, masks and hand hygiene; Isolation of people who test positive; Routine disinfection of surfaces; Adequate ventilation; and Adequate staffing.
[xiv] World Health Organization. Infection prevention and control guidance for long-term care facilities in the context of COVID-19. Interim Guidance. January 8, 2021. Accessed at: https://apps.who.int/iris/bitstream/handle/10665/338481/WHO-2019-nCoV-IPC_long_term_care-2021.1-eng.pdf?sequence=1&isAllowed=y
[xv] Global News. B.C. health officials open door to mass COVID-19 testing for long-term care staff. January 12, 2021. Accessed at: https://globalnews.ca/news/7571821/b-c-health-officials-open-door-to-mass-covid-19-testing-for-long-term-care-staff/
[xvi] City News. Pressure mounting for B.C. to start rapid testing health care workers for COVID-19. January 13, 2021. Accessed at: https://www.citynews1130.com/2021/01/13/request-rapid-test-health-care-workers-covid/
[xvii] Abbotsford News. Abbotsford care home participates in COVID-19 contact-tracing pilot project. January 15, 2021. Accessed at: https://www.abbynews.com/community/abbotsford-care-home-participates-in-covid-19-contact-tracing-pilot-project/
[xviii] City News. Almost all long-term care home residents, staff in Vancouver Coastal vaccinated against COVID-19. January 14, 2021. Accessed at: https://www.citynews1130.com/2021/01/14/vancouver-coastal-lct-covid-19-vaccine/
[xix] CTV News. Fraser Health says all 151 care homes in its region have held COVID-19 vaccine clinics. January 15, 2021. Accessed at: shttps://bc.ctvnews.ca/fraser-health-says-all-151-care-homes-in-its-region-have-held-covid-19-vaccine-clinics-1.5268879
[xx] Castanet. Vaccine rollout in BC Interior is moving slower than on the coast. January 15, 2021. Accessed at: https://www.castanet.net/news/Kelowna/321914/Vaccine-rollout-in-BC-Interior-is-moving-slower-than-on-the-coast
[xxi] CBC News. Pfizer to temporarily reduce vaccine deliveries to Canada, minister says. January 15, 2021. Accessed at: https://www.cbc.ca/news/politics/pfizer-temporarily-reducing-vaccine-deliveries-1.5874645
[xxii] SafeCare BC. Briefing Note: Results – COVID-19 Vaccine Survey. Jan 5 2021. Accessed at: https://www.safecarebc.ca/wp-content/uploads/2021/01/Updated-vaccine-survey-analysis-briefing-note-Jan-2021.pdf. At closing, the survey has had over 1,500 responses from continuing care workers across British Columbia.
[xxiii] Medicine Matters. Seniors care homes need rapid COVID-19 tests now: BC Care Providers Association. Terry Lake. November 30, 2020. Accessed at: https://medicinematters.ca/seniors-care-homes-need-rapid-covid-19-tests-now-bc-care-providers-association/
[xxiv] BCCPA. The Best Visit Possible: A guide for supporting family visits during COVID-19. September 2020. Accessed at: https://bccare.ca/wp-content/uploads/2020/09/The-Best-Visit-Possible-Sept-21.pdf
