Clark County faces uphill battle in effort to test all long-term care facilities

The state had set deadlines of June 12 and June 26 to complete the testing

CLARK COUNTY — The first known case of COVID-19 was found on Jan. 19 in a 35-year-old Everett, Washington man who had recently returned from Wuhan, China, epicenter of the outbreak.

Since then, neary 26,000 people in Washington state have tested positive for the SARS-CoV-2 virus which causes the disease, and more than 1,200 residents of the state have died.

More than 60 percent of those deaths are connected to long-term care facilities throughout the state.

Clark County Public Health Officer Dr. Alan Melnick during an interview in March. Photo by Chris Brown
Clark County Public Health Officer Dr. Alan Melnick during an interview in March. Photo by Chris Brown

In Clark County, where 28 deaths have been blamed on the virus, 16 of those have been linked to outbreaks at a long-term care facility.

In late May, the Centers for Disease Control issued guidance, advising states to begin full-scale testing at long-term care facilities. On May 28, Washington Secretary of Health John Wiesman issued an order, requiring all nursing homes to have universal testing available by June 12, or June 26 for all assisted living facilities with a memory care unit.

“These congregate settings are a priority for us,” Wiesman said in a news release announcing the order. “We are working with local health jurisdictions, facilities and health system partners to understand the challenges associated with expanded testing and mobilizing the resources to support scaled operations among these facilities.”

The goal was to provide shipments of testing kits, including personal protective equipment in waves, every three weeks. The first wave went out June 1, before problems cropped up.

“There was some issues with supplies,” said Dr. Alan Melnick, Clark County’s public health officer, at a Board of Public Health meeting on Wednesday. “There was a problem with one of the labs and now the specimens are all going to one lab at the University of Washington.”

So testing at long-term care facilities is already nearly a week behind the June 12 deadline, with the state still determining supply needs for memory care facilities.

Melnick added that he’s not aware of any facility that has been fined for failing to meet the deadline.

“I think folks are doing the best they can,” he said. 

In a presentation on Wednesday, Melnick said the county has eight skilled nursing facilities with 819 licensed beds, 15 assisted living facilities with 1,302 beds, and four memory care facilities with 262 beds. In addition, there are 341 adult family homes with 1,594 residents and 1,132 staff.

Even without problems with supplies and lab capacity, Melnick noted, “this is a big undertaking.”

Universal testing, or at least much more widespread use of tests, has been a recommendation made frequently by Clark County Councilor Gary Medvigy, who sees it as a necessary tool for allowing more industries to reopen, while keeping workers safe.

Melnick has pushed back, saying testing is cost prohibitive and potentially inaccurate.

“Testing is an adjunct to infection prevention,” he said Wednesday. “The key is infection prevention.”

Something that long-term care facilities have been doing a much better job of in recent months, Melnick added.

“We haven’t had any outbreaks at long-term care facilities for a while now,” he said. “And there’s a vast difference in infection control practices at these long term care facilities in our county (now) then there was a couple of months ago.”

Medvigy noted that he has heard anecdotal evidence that one point-of-care testing machine, which can provide results in as little as 15 minutes, has been used only 26 times.

“Why can’t we use the point-of-care testing to augment the PCR testing,” Medvigy asked, “to have this more widespread and to have it on time?”

Melnick’s response indicated that he believes widespread testing represents a poor use of resources, given the cost, and the fact you might have to test multiple times.

“If you do testing, how frequently do you have to do that,” he said, “because we’ve got a disease that has a long incubation period, up to 14 days.”

Melnick noted that the cost to test all residents and staff at the county’s long-term care facilities would be close to a million dollars, just for a single test.

“For me, the main part of the resources that we’re addressing ought to be around infection prevention,” he added, “with testing in addition to that.”

To make his point, Melnick noted that employees and close contacts for both Firestone Pacific Foods and Pacific Crest Building Supply had been tested only once. So far, there appear to be no cases of community spread beyond those employees and their close contacts.

“You can test people once, but that doesn’t mean that they’re not going to become positive a few days later,” Melnick said. “Testing is important, I completely support that. but it’s a part of the efforts to control these outbreaks.”

More important to Melnick is quarantining people who are known to be sick, and requesting their close contacts to self-isolate until they know they’re safe.

“Getting somebody tested within 24 hours is not necessarily a magic timeframe,” he said. “Just because you’re testing an employee or a contact at day two, or day five, or even day seven,  doesn’t mean that they’re not going to become symptomatic up to 14 days afterwards.”

Melnick said he’s hopeful other long-term care facilities that are conducting universal testing will provide enough data in the next week or two to provide a better understanding of whether it is useful in slowing the spread of the virus.

“What I’d like to do is see what the state gets out of that data,” Melnick concluded, “and then bring that back and have a longer discussion with all of you about the results of that.”