Frequently Asked Questions: COVID-19 Testing at Skilled Nursing Facilities/ Nursing Homes includes 27 FAQs:

1. Who will receive the testing platforms and U.S. Food and Drug Administration (FDA)- authorized antigen diagnostic tests?

2. How is distribution of the testing platforms and FDA-authorized antigen diagnostic tests being determined? Will these devices be sent directly to the nursing homes or to states for distribution? 

3. When will the testing platforms and authorized point-of-care tests be distributed?

4. How many COVID-19 test kits will nursing homes receive?

5. Who will provide training to nursing home staff? In what format will the training be provided in?

6. How were nursing homes prioritized to receive a testing platform and FDA-authorized antigen diagnostic tests?

7. Will HHS be providing more tests after the initial shipment?

8. What safety precautions are required when performing these tests?

9. Will every nursing home receive a point-of-care instrument and associated tests? 

10. Which nursing homes will receive instruments and tests in the first wave of shipments?

11. When will my nursing home receive the shipment of testing platforms and FDAauthorized antigen diagnostic tests?

12. How will states be made aware that nursing homes within their states will receive instruments and supplies?

13. What are antigen tests? Is it required to retest negative results with a PCR test?

14. How many tests can be conducted with the Quidel Sofia 2 Instrument and the BD Veritor™ Plus System testing platforms?

15. Why is the federal government sending antigen testing supplies to nursing homes if they cannot be used to rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment?

16. Are nursing homes required to report results of any COVID-19 tests?

17. Can nursing homes keep the testing platforms? 

18. How should facilities handle indeterminate results?

19. Do facilities need a provider order to conduct the test?

20. How should the materials be stored when they arrive?

21. Does a Skilled Nursing Facility/ Nursing Facilities need a CLIA (Clinical Laboratory Improvement Amendments of 1988) Certificate of Waiver in order to perform testing of specimens for COVID-19?

22. I understand that HHS will be distributing tests and test systems to Skilled Nursing Facilities/ Nursing Facilities. What type of CLIA certificate would my facility need in order to perform this testing?

23. How do I apply for a CLIA Certificate of Waiver so that my Skilled Nursing Facility/ Nursing Facility can perform COVID-19 testing?

24. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, can we begin performing COVID-19 testing?

25. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, am I required to update my test menu with CMS?

26. How does my Skilled Nursing Facility/ Nursing Facility obtain the instrument, test kits and disposables?

27. My Skilled Nursing Facility/ Nursing Facility is located in a CLIA Exempt State (Washington or New York). Will we be able to get one of the new test systems? 

Coronavirus Disease 2019 (COVID-19) and Diabetes: The Importance of Prevention, Management, and Support

You may participate in this COCA Call via Zoom

During this COCA Call, presenters will focus on current information about the impact and increased risk for COVID-19 complications in people with diabetes and the importance of diabetes prevention, management, and support.

Below are changes to the guidance as of July 15, 2020:

• Added language that protective eyewear (e.g., safety glasses, trauma glasses) with gaps between glass

Testing Guidelines for Nursing Homes FRIDAY, JULY 17, 2020

Revisions were made on July 17, 2020, to reflect the following:

• Updated “Testing to determine resolution of infection” to add information about people who are severely immunocompromised.

The Centers for Disease Control and Prevention (CDC) offers strategies for optimizing the supply of:

N95 respirators

Face masks

Isolation gowns

Eye Protection

Gloves

Powered Air-Purifying Respirators (PAPRs)

Elastomeric respirators

Ventilators

The Centers for Medicare & Medicaid Services (CMS) announced the agency’s targeted approach to provide additional resources to nursing homes in coronavirus disease 2019 (COVID-19) hotspot areas.  Specifically, CMS plans to deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in the hotspot areas as identified by the White House Coronavirus Task Force. QIOs are CMS contractors who work with healthcare providers to help them improve the quality of healthcare they provide to Medicare Beneficiaries. In addition, the agency is implementing an enhanced survey process tailored to meet the specific concerns of hotspot areas and will coordinate federal, state and local efforts to leverage all available resources to these facilities. The purpose of these efforts is to target facilities with known infection control issues by providing resources and support that will help them improve quality and safety and protect vulnerable Americans.

Nursing homes are especially vulnerable to the prevalence and spread of COVID-19.  Additional resources are needed to ensure nursing homes take proactive steps to enhance infection control policies and practices to limit potential transmission and prevent widespread outbreaks within these facilities.

Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities — Detroit, Michigan, March–May 2020

Early Release / July 1, 2020 / 69

Guillermo V. Sanchez, MSHS, MPH1; Caitlin Biedron, MD1; Lauren R. Fink, MPH2; Kelly M. Hatfield, MSPH1; Jordan Micah F. Polistico, MD3,4; Monica P. Meyer, MS, MPH3,4; Rebecca S. Noe, MN, MPH1; Casey E. Copen, PhD1; Amanda K. Lyons, MS1; Gonzalo Gonzalez, DNP2; Keith Kiama2; Mark Lebednick2; Bonnie K. Czander2; Amen Agbonze2; Aimee R. Surma, MS2; Avnish Sandhu, DO3,4; Valerie H. Mika, MS4; Tyler Prentiss, MA5; John Zervos, JD5; Donia A. Dalal2; Amber M. Vasquez, MD1; Sujan C. Reddy, MD1; John Jernigan, MD1; Paul E. Kilgore, MD4; Marcus J. Zervos, MD4,5; Teena Chopra, MD3,4; Carla P. Bezold, ScD2; Najibah K. Rehman, MD2 (View author affiliations)

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Summary

What is already known about this topic?

Symptom-based screening in skilled nursing facilities (SNFs) is inadequate to detect SARS-CoV-2 transmission. Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) can identify asymptomatic cases during outbreaks.

What is added by this report?

Repeated point prevalence surveys at 26 Detroit SNFs identified an attack rate of 44%; within 21 days of diagnosis, 37% of infected patients were hospitalized and 24% died. Among 12 facilities participating in a second survey and receiving on-site infection prevention and control (IPC) support, the percentage of newly identified cases decreased from 35% to 18%.

What are the implications for public health practice?

Repeated point prevalence surveys in SNFs can identify asymptomatic COVID-19 cases, inform cohorting and IPC practices, and guide prioritization of health department resources.

CMS has issued seven Frequently Asked Questions to supplement existing guidance about the rules for nursing home visitations during the COVID-19 pandemic, starting with No. 1:

1. What steps should nursing homes take before reopening to visitors? 

Nursing homes should continue to follow CMS and CDC guidance for preventing the transmission of COVID-19, and follow state and local direction. Because nursing home residents are especially vulnerable, CMS does not recommend reopening facilities to visitors (except for compassionate care situations) until phase three when: 

• There have been no new, nursing home onset COVID-19 cases in the nursing home for 28 days (through phases one and two) 

• The nursing home is not experiencing staff shortages 

• The nursing home has adequate supplies of personal protective equipment and essential cleaning and disinfection supplies to care for residents 

• The nursing home has adequate access to testing for COVID-19 

• Referral hospital(s) have bed capacity on wards and intensive care units