Leading doctor decries lack of testing at Maine's long-term care facilities - Press Herald

A leading geriatrics physician is raising the alarm about the lack of COVID-19 testing among residents and employees at Maine’s long-term care facilities.

Maine’s 93 nursing homes and more than 200 assisted-living facilities have been largely ignored when it comes to testing for the disease caused by the coronavirus, said Dr. Jabbar Fazeli, spokesman for the Maine Medical Directors Association, which represents physicians and staff members at long-term care facilities.

Dr. Jabbar Fazeli, a geriatrician who is a leader in Maine’s nursing home network, is sounding an alarm about the lack of testing for residents and workers at Maine’s long-term care facilities. Photo courtesy Jabbar Fazeli

The Maine Center for Disease Control and Prevention on Wednesday gave residents of nursing homes and assisted-living facilities second-tier priority because testing supplies are scarce and the capacity of the Maine State Lab is limited. Health care workers, first responders and hospital patients who have a high fever or respiratory symptoms are in the first tier.

When nursing homes or assisted-living facilities have tested for coronavirus infection, the results have been so slow in coming – sometimes taking a week or more – that they have provided little help to facilities that might have the disease in their midst, said Fazeli, a geriatrician who oversees medical care at three long-term care facilities in southern Maine.

That’s a problem because 80 percent of COVID-19 deaths are among people age 65 and older, Fazeli said, and some facilities are using up scarce masks, gloves and other personal protective gear because they must assume a patient has the disease until they receive test results.

At Durgin Pines, a nursing home and skilled rehabilitation facility in Kittery where Fazeli is medical director, they’ve tested four residents and four staff members in recent days. Results for the staff members and two residents came back negative.

However, results for two residents tested on March 17 were still pending Wednesday – eight days later.

“We need test results within hours, or at least within a day, so we can incorporate them into our care plans,” Fazeli said. “It’s no good if we have to wait. We’re trying to keep ourselves negative (for coronavirus infection) and functioning as long as possible so we can stay working.”

At Sentry Hill, an assisted-living facility in York that Fazeli also oversees, staffing is down 40 percent because employees have called in sick, Fazeli said. They’ve tested two residents and one staff member; one resident tested negative and the other two are pending, Fazeli said.

At Bella Point, an assisted-living facility in Freeport that Fazeli oversees, they’ve tested two residents; one came back negative and the other is pending, he said.

If testing at long-term care facilities isn’t prioritized and getting results continues to take days, Fazeli warned in a Twitter post Wednesday, Maine’s hospitals soon could be flooded with critically ill patients.

Wednesday night the Maine CDC informed the Press Herald that it would update its testing guidelines on Thursday to assign Tier 1 priority to long-term care facilities, along with residents of congregate housing, jails and shelters, and patients over age 60 and with underlying medical conditions.

However, Fazeli questioned whether the change would significantly accelerate testing or receiving test results given continuing concerns about the state’s testing capacity.

Dr. Nirav Shah, director of the Maine CDC, expressed frustration Wednesday at the state’s testing capacity, saying that it’s still too limited, despite receiving additional testing supplies and signing on more labs. He said the CDC plans to acquire a new testing “platform” that would increase capacity.

Fazeli’s colleagues share his concern. Rick Erb heads the Maine Health Care Association, which represents 200 nursing homes and assisted-living facilities across the state. Fazeli also is a member.

“He’s absolutely right. Long-term care facilities need to be a priority for testing,” Erb said. “We’re struggling now and there have been no positive tests at nursing homes in Maine. Unfortunately, there aren’t enough test kits for blanket testing and that a problem nationwide.”

Six residents of the OceanView at Falmouth retirement community have tested positive for COVID-19, including two who were being treated at Maine Medical Center in Portland.

Fazeli said he has been able to get results within four to 12 hours by sending some tests directly to NorDx, a commercial lab in Scarborough that’s part of the MaineHealth system that includes Maine Med. However, NorDx recently notified Fazeli that it would restrict testing to the most critical specimens as the federal government directs testing supplies to large cities in other states.

“The federal government must stop ignoring Maine because of it’s a low population center,” Fazeli said. “We’re the oldest state. They’re going by (total population) and it’s unconscionable.”

Maine has the oldest population in the nation, with the highest median age (44.7 years) and largest proportion of people 65 and older (20.6 percent). That’s about 276,000 people among 1.34 million Mainers.

Fazeli noted that the coronavirus threat appears to be more acute in southern Maine; most of the 142 cases reported statewide have been in Cumberland (87) and York (23) counties.

Jeff Ketchum, administrator of the South Portland Nursing Home, said having a faster turnaround on COVID-19 testing would help his employees keep the coronavirus out of their facility.

They’ve taken all recommended precautions, including a full ban on visitors, and they’re closely monitoring residents’ health, requiring physical distancing and increasing disinfection. They’ve also enforced tougher staff screening measures, taking each employee’s body temperature upon arrival and requiring them to wash their hands as they enter the building.

“We’re on high alert every day,” Ketchum said. “We’re basically isolating ourselves from the community around us.”

One employee was sent home several days ago after showing a slightly high temperature, but that person has shown no further signs of illness and is expected to return to work in a few days, Ketchum said.

He said no residents at South Portland Nursing Home have been tested for COVID-19 because none has shown signs of coronavirus or any other illness they watch out for, including the flu and norovirus, a food-borne illness that causes diarrhea, vomiting and fever.

If a resident did develop symptoms, Ketchum said, his staff would immediately assume that the person was contagious and could have contracted the coronavirus. The resident would be isolated and tested immediately and staff members would wear personal protective gear whenever they were in the room.

“It would be very beneficial if we had the test results right away,” Ketchum said. “Operationally now, we’re doing OK, but if we get a few symptomatic residents, that could change.”

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