Residents in long-term-care facilities have been especially vulnerable to COVID-19 during the current pandemic, accounting for as many as half of all deaths in a number of European countries, over three quarters in Canada, and around 40% in the United States. There are many reasons.
Compared with same-aged community dwelling older adults, nursing home residents accumulate more clinical complexity, multi-morbidity and frailty over time. In a study of long-term-care residents in Ontario, Canada, the proportion of residents aged 85 years and older increased from 45.1% to 53.8% over 16 years. The proportions of individuals with seven or more chronic conditions (from 14.1% to 22.1%) and with nine or more prescription medications (from 44.9% to 64.2%) have also increased over time.
Yet nursing homes still operate on antiquated assumptions made decades ago about the complexity of care their residents require, according to Christopher E. Laxton, executive director of AMDA – The Society for Post-Acute and Long-Term Care Medicine. Previously, older adults populated nursing homes primarily for custodial care and needed little medical intervention. Scientific advances have introduced treatments for illnesses that previously were synonymous with death.
Compounding the problem are conditions shared by many nursing homes, which can exacerbate efforts to stop the spread of infectious diseases. They include infrastructure (e.g., shared rooms are common), low staff-to-resident ratios, low-paid staff, low skill-mix and high staff turnover.
The COVID-19 pandemic has shown that surveillance and rapid detection can avoid outbreaks. And in a study of a long-term-care facility in King County, Washington, researchers concluded, “In the context of rapidly escalating COVID-19 outbreaks, proactive steps by long-term-care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of COVID-19.”
Just as testing has proven its value during COVID-19, they are also valuable deterrents to outbreaks of other infectious diseases, including Influenza, Group A streptococcus and Respiratory Syncytial Virus (RSV).
The COVID-19 pandemic has shown that surveillance and rapid detection can avoid outbreaks.
Influenza, Strep and RSV
Influenza is a frequent cause of epidemic and endemic respiratory illness in long-term-care facilities (LTCFs), resulting in considerable morbidity and mortality, notes the Long-Term-Care Committee of the Society for Healthcare Epidemiology of America (SHEA). Detection of outbreaks in this setting can be difficult, because the clinical presentation in older adults is atypical and other pathogens also cause influenza-like illness (ILI) during the influenza season. The use of rapid tests for the detection of influenza in conjunction with more sensitive case definitions of ILI may lead to the earlier detection of influenza outbreaks in LTCFs, earlier initiation of infection control measures, and reduction in transmission. Even if it’s not influenza season, influenza testing should occur when any long-term-care resident has signs and symptoms of acute respiratory illness or influenza-like illness, advises the U.S. Centers for Disease Control and Prevention.
Group A Streptococcus (GAS) is a bacteria carried in the throat or skin, and is often present even when the person has no symptoms. It causes illnesses from relatively mild sore throats (strep throat) or skin infection (e.g. impetigo), to life-threatening invasive infections such as pneumonia, necrotizing fasciitis, bloodstream infection, or toxic shock syndrome. Long-term-care residents are at increased risk for serious GAS disease due to advanced age, frequent breaks in the skin, and immunocompromising conditions. Staff and residents can become ill with non-invasive infections such as strep throat or cellulitis and spread their infection on to susceptible individuals, who can then develop serious invasive infections.
Respiratory Syncytial Virus is detected throughout the year, however, it is more common in winter and early spring. It can cause upper respiratory infections and lower respiratory tract infections. RSV has a high attack rate and commonly affects daycares and schools, but can also cause severe illness and outbreaks in long-term care facilities. Since RSV symptoms are similar to other respiratory illnesses such as influenza, respiratory testing is recommended to confirm the etiology.
Solutions for a susceptible population
Persons residing in long-term-care facilities are very susceptible to the acquisition and spread of infectious diseases, and the consequences of infection may be serious. SEKISUI Diagnostics provides rapid tests to help clinicians identify Influenza, Group A streptococcus and RSV.
- OSOM® Ultra Plus Flu A & B test is a qualitative test that detects influenza type A and type B nucleoprotein antigens directly from nasal swab and nasopharyngeal swab specimens obtained from patients with signs and symptoms of respiratory infection. Results in 10 minutes
- OSOM® Strep A test is a color immunochromatographic assay intended for the qualitative detection of Group A Streptococcus antigen directly from throat swab specimens. Results in 5 minutes.
- OSOM® RSV/Adeno test is a rapid chromatographic immunoassay for the qualitative detection of RSV and/or Adenovirus antigens directly from nasal swabs or nasal suction fluid in patients suspected of having a viral respiratory infection. Throat swabs are also an acceptable sample type for the detection of Adenovirus antigens. Results in 10 minutes or less.