Covid-19 Surveillance Testing and Resident Outcomes in Nursing Homes

Area of Science:

• Infectious Diseases
• Epidemiology
• Public Health

Background:

• Skilled nursing facilities (SNFs) have widely adopted COVID-19 surveillance testing for staff.
• Limited evidence exists on the relationship between staff testing and resident outcomes in SNFs.

Purpose of the Study:

• To investigate the association between staff surveillance testing volumes and COVID-19 cases and deaths among residents in SNFs.
• To analyze this association across different pandemic periods, including pre-vaccine, pre-Omicron, and during the Omicron wave.

Main Methods:

• Retrospective cohort study using data from 13,424 SNFs (2020-2022).
• Compared COVID-19 cases and deaths in residents of high-testing (90th percentile) vs. low-testing (10th percentile) facilities.
• Assessed outcomes during potential outbreaks, defined as new cases after two weeks of no cases.

Main Results:

• Higher staff testing was associated with a reduction in resident COVID-19 cases (-71.5 per 100 outbreaks) and deaths (-7.1 per 100 outbreaks) overall.
• The most significant reduction in cases (-300.3 per 100 outbreaks) and deaths (-41.6 per 100 outbreaks) occurred before vaccine availability.
• During the Omicron wave, high-testing facilities showed fewer resident cases but similar death rates compared to low-testing facilities.

Conclusions:

• Increased staff surveillance testing in SNFs is linked to meaningful reductions in resident COVID-19 cases and deaths.
• The protective effect was most pronounced before widespread vaccine availability.
• Sustained staff testing remains a critical strategy for mitigating COVID-19 impact in SNF residents.