Many nursing homes still face long turnaround times for COVID-19 tests

Coronavirus

RALEIGH, N.C. (WNCN) — More than one-quarter of the nursing homes in North Carolina responding to a government survey waited an average of three or more days for COVID-19 test results for their residents, a CBS17.com data analysis found.

The Centers for Medicare and Medicaid Services has surveyed nursing homes across the country each week during the coronavirus pandemic in an effort to create an accurate picture of how the public health crisis is affecting one of the most vulnerable populations and the facilities where they live.

A total of 374 of the 428 nursing homes in the state responded to questions about testing residents for COVID-19 according to the most recent data from the week ending Oct. 25.

Of those, 95 — or slightly more than 25 percent — reported an average wait time of three or more days for test results. Meanwhile, 38 said their average wait time was less than a day while the vast majority — 64 percent — said their results were back on average between 1-2 days.

The state Department of Health and Human Services lists the overall statewide average turnaround time of PCR tests as 2.3 days.

The data also show 79 of the 95 with the longest wait times have an in-house point-of-care test machine. 

But since the previous report a week earlier, 56 of those facilities said they didn’t perform any point-of-care tests, and another 19 performed seven or fewer of them. The other four facilities performed an average of 57.

Many nursing homes still send their samples to labs for PCR testing, which detects the genetic material of the virus. That test is widely considered more accurate but results may not be available for days.

Rapid antigen tests, which detect a specific protein, can produce results in minutes but are less effective when a person being tested has low levels of viral load. Those tests have been used with increasing frequency across the state in recent months.

Because COVID-19 is highly infectious, and a single infection can lead to an outbreak, nursing homes must balance the need for speedy results with a similar need for the most accurate ones.

“The challenge is the sensitivity of the test and the reliability of that test finding,” said Sandi Lane, a professor of health care management at Appalachian State and an expert on nursing homes.

“We can do the rapid test, but the reliability of that positive or negative is not as sensitive or reliable as the PCR tests…There are ways we can shorten that time frame, but we also know the sensitivity of the rapid test is not as strong as the PCR test. So we’ve got to balance that when we think about testing and those results coming back.”

Of the 95 with the longest average wait times, nearly half — 44 of them — are among the 221 nursing homes across the state experiencing active outbreaks, according to the latest DHHS list Tuesday.

But Lane says the driver of those outbreaks isn’t the lack of testing — it’s a reflection of community spread.

DHHS has recorded 303,454 lab-confirmed cases of COVID-19, with 15,839 of them coming at nursing homes — an increase of 54 percent over the past two months.

The state set a single-day record Wednesday with 3,119 reported cases, with another 2,893 cases reported Thursday — the third-highest single-day total so far.

“It is that community spread that is going to drive cases in the nursing home so we’ve got to get a handle on community spread,” Lane said. “That’s where we really have to focus. The testing is there to help us manage the cases in the nursing home, but we really have to work to get the community cases lower because we know from the research that when there’s a high prevalence in the community, that’s what’s going to drive the cases in the nursing homes.”

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