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House Aging committee assesses virus

Doctor says widespread testing needed to slow spread

HARRISBURG — As the handling of the coronavirus pandemic in Pennsylvania’s long-term care facilities comes under more scrutiny — with over 4,000 of those facilities’ residents dead from the virus — the House Aging and Older Adult Services Committee assessed the situation this week.

The meeting came just days after Gov. Tom Wolf ordered all long-term care facilities to test all staff and residents by July 24.

Nina O’Connor, an associate professor of clinical medicine at the University of Pennsylvania and the chief medical officer for Penn Medicine at Home, spoke at the meeting and said testing has to be the most important part of the strategy to slow the spread.

“There are significant benefits to widespread testing,” O’Connor said. “As a physician, I believe it’s our single most impactful intervention to stop nursing home spread and to reduce the impact of this virus on our elders.”

She said long-term care facilities are grappling with other key challenges, too, including acquiring sufficient personal protective equipment for infection control, the sheer costs of testing residents and staff and having the manpower to both conduct tests and meet staffing requirements should employees fall ill.

“As we start to transition to yellow and to green, I think we are going to continue to have concerns and issues in our long-term care and personal care facilities with COVID-19, and I think we still have a few challenges with testing that are going to be important to overcome,” O’Connor said. “The biggest challenge remains testing capacity. Despite all the progress we’ve made with our public health laboratories and our commercial laboratories, we still lack sufficient testing capacity.”

The committee heard from Regina Lamendella, a co-owner of Contamination Source Identification, who proposed her laboratory’s idea of pooled testing as one potential solution to reduce the burden and minimize costs of mass testing.

Pooled testing is when multiple samples are tested at once, and individual samples are only tested if the group test is positive.

Lamendella said more rapid testing and reporting helps all areas of the fight to contain COVID-19, including contact tracing efforts and quarantining for individuals exposed to the virus or those who have tested positive.

Lamendella said CSI met with the state’s Department of Health recently, which she said appeared interested but noncommittal regarding her lab’s proposal. Lamendella said CSI, which is self-funded, is not currently able to scale to test statewide and isn’t necessarily trying to do so — but hopes to advance pooled testing through state funding for its own lab and sharing its methodologies with other labs.

Right now, Lamendella said CSI is conducting over 300 tests per day with a reporting time of less than 24 hours, but will be able to increase capacity to 1,000 tests per day.

She said her lab’s results indicate pooled testing will not impact the test’s accuracy.

“This paves the way for large-scale population screening for high-risk populations, such as nursing homes,” Lamendella said. “This pooled testing approach will allow for sound and scientifically-founded policy decisions by government bodies to ease restrictions in areas with low incidence of infection while at the same time cost effectively increasing surveillance where it has entered the environment.”

Both Lamendella and O’Connor said universal testing is important, but the frequency at which it is done is the big question. O’Connor said on the “up side” of the curve, weekly universal testing makes sense, but may not be necessary at a time at which there is no outbreak and no resident is exhibiting symptoms.

And Lamendella admitted that the cost savings of pooled testing is practically nullified during a major outbreak. The benefits in terms of cost savings, rather, come in during a time of lower amounts of infection.

State Rep. Gary Day, R-Lehigh, implored the committee to consider the benefits such a proposal can have for the state — and the state’s finances.

“I think they’re in an incredible position to be an incredible resource,” Day said. “My back of the envelope guess on the cost of the administration announcing to do universal testing in nursing homes across Pennsylvania, I think it’s $400-450 million, and if this offers an opportunity to be $200 (million), or $250 or even $300 … that means we have more assets, more of our scarce resources, to allocate to a PPE solution as well and other things.”

Still, there were no signs the legislature is jumping at the chance to fund this proposal right away. State Rep. Steven McCarter, D-Montgomery, questioned the proposal’s ability to scale.

“It sounds very remarkable and sounds very good, but is it available at this point in time or is this something that we’re looking at for possibly in the fall or some other time?” McCarter questioned. “I share your hope and I think it’s something surely that we need to do quickly and to look at. If I have a concern, it’s not with the company but it’s what’s their capability at the present moment. I think we have to look at the reality that even 1,000 tests per day is a very small number overall given the scope of the nursing home problem, much less the rest of the population of Pennsylvania at the present moment. We lack terribly — we are behind in testing, there’s no doubt about that.”

The committee also heard an update from Lt. Col. John Peacock of the Pennsylvania National Guard on how his team’s mission is going in providing temporary assistance at testing centers and long-term care facilities across the state.

Peacock said the National Guard has aided long-term care facilities in infection control, PPE training and fit testing, on-site coronavirus testing and providing direct care for “several thousand patients” — work that he said has saved lives.

“Many facilities were not prepared for a pandemic when it comes to highly transmissible diseases,” Peacock said.

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