SEATTLE — Pairs of doctors and nurses in plastic gowns and purple gloves moved down the nursing home’s halls in a tandem ballet.
Test kit hand-off, nasal swab, specimen bag drop. Squeeze of hand-sanitizer, new gown. Another squeeze, new gloves. Next room.
Within 90 minutes, the team had tested all 115 residents of Queen Anne Healthcare, a Seattle nursing home considered a high priority for coronavirus testing for an odd-sounding reason: It had no reports of the virus.
“One of the greatest values is to catch it before it spreads,” said Dr. Thuan Ong, the University of Washington’s medical director of post-acute care. “It’s much easier to do contact tracing when you know there’s zero cases, or one or two cases. When you have a facility that has five, 10, 15 cases, it’s incredibly hard to know who came into contact with those people.”
Last week, Public Health-Seattle & King County officials sent Ong a list of 19 Seattle-area nursing homes. The facilities, which represent more than one-third of all skilled nursing facilities in the county, were considered a top priority because no residents had tested positive.
By Wednesday, teams had tested all residents and staff at four of the homes, with other sites planned in coming days. None of the residents was positive, but the tests identified two asymptomatic staff members at one of the facilities, enabling them to be isolated before spreading the virus further.
Nursing homes around the country have complained about a lack of adequate testing. But in the Seattle area, which suffered the first bad outbreak in the U.S., public health officials are no longer merely responding to hotspots at skilled-nursing facilities but trying to head them off.
Along with better capacity for tracing contacts of patients, widespread testing is an important prerequisite for reopening the economy. Gov. Jay Inslee this week announced he intends to increase the number of those devoted to contact tracing from 700 to 1,500, with help from the National Guard. Washington state is moving toward testing all residents at any long-term care facility that has had a positive COVID-19 test among staff or residents.
Sending “drop teams” to conduct universal testing at skilled nursing facilities in collaboration with public health officials is one aspect of the region’s approach to controlling COVID-19. UW Medicine has taken advantage of its existing network of skilled nursing facilities, sending experts to train staff on using personal protection equipment and demonstrating for administrators how they might isolate residents who test positive.
During outbreaks in rural areas, the university and Harborview Medical Center staff have helped direct patients to various hospitals so that local ones don’t get overwhelmed, as happened early on when dozens of patients from the Life Care Center of Kirkland were brought to a single nearby hospital, Evergreen Hospital.
At one nursing home where a university-led team tested all staff and residents this month amid an outbreak with dozens of cases, administrators grouped all positive residents into one wing, Ong said. The facility — CRISTA Rehab and Skilled Care in Shoreline — was then able to assign specific staff members to that wing, rather than having them also interact with negative residents. The result? The workers did not have to constantly replace their personal protection equipment, thus conserving precious masks, gloves and gowns.
Queen Anne Healthcare previously had eight residents with symptoms tested for COVID — none was positive. Last Friday, three days after Ong received the list, he pulled up in his white Volvo SUV and opened the hatchback to reveal stacked boxes of protective gear along with test vials, paperwork forms and labels, and red bio-hazard bags for collecting used protection equipment.
Close to 20 other medical professionals drawn from a roster of volunteers met with him in the parking lot, reviewing the procedures for testing. They broke into pairs, with one “hot” person entering the rooms and administering the tests while the other “clean” person stayed in the hall, observing for signs of broken protocol and doling out test kits and squirts of sanitizer.
Queen Anne Healthcare administrator Erin Doss said she woke up the following morning to an email from Ong saying all the tests were negative. Her staff cheered when she told them, she said.
“It’s really helpful to know all my residents are negative. It was stressful to not know,” Doss said.
