April 20

Every day blurs together. Some days I blog, other days I'm writing all day, but I don't blog.  I try to remember to write in my blog every day, but time has lost meaning for me during my battle with the government and the nursing home industry.  I know that I wrote a lot yesterday, and sometimes I'll just cut and paste it in. So, that's what I'll do.  Here was my email yesterday morning:

Your timing is perfect.  We are actually urging the Los Angeles County Department of Public Health to do just this.  A couple of weeks ago, a nursing home in Los Angeles had four residents test positive.  We had available testing and tested all staff, and ultimately all of the residents.  As it stands now, 90% of staff tested positive and 75% of residents have tested positive.  At this time, most of the staff and residents are still asymptomatic.  The advantage for the facility was that the knowledge allowed them to go into full PPE and isolation/containment.  There have been three deaths, all of whom were already end-of-life/hospice residents.

The bottom line is that we don’t know what we don’t know.  Many of us have found that once we test, we’re finding asymptomatic positives amongst both staff and residents.  The sooner we find this out, the sooner we can act on it and fully utilize PPE and put residents in isolation.  Thus far, in speaking to a number of clinicians on the front lines, this “might” impact outcomes  We all need data to know the answer to this.

In my opinion, how can we not be promoting full testing of nursing home staff in communities that have the virus?  At the very least, this will give us the opportunity to compare this approach with what has already been transpiring in nursing homes around the country.  This should be the highest priority for both CMS and the CDC. Not providing surveillance in the setting that has produced the highest mortality rates just doesn’t make sense. 

Here are some facts.  Asymptomatic staff can be contagious. Why wouldn’t we want to identify staff who will become the vector for transmission?  What is the downside to widespread testing of staff in nursing homes?

The Quadruple Aim put forth on CALTCMs website on Friday speaks to providing stellar infection prevention, sufficient PPE, readily available testing and that facilities be operating under their emergency preparedness plan.  Until we actually assure that all of these things are happening, how can anyone suggest not doing all of these things?

Mike