State Says Testing Delays Not A Factor In Nursing Home COVID Infections
When Connecticut officials approved more than $34 million in contracts with private vendors to test for coronavirus at nursing homes, the contracts shared a common clause: The Department of Public Health wanted quick results, ideally, within one day. But interviews with health officials, contracted vendors and state documents show that hasn’t always been the case.
At Three Rivers Nursing Home in Norwich, a staff member went to work in July while waiting for the results of a COVID-19 test, which came back positive three days later, according to state records.
An outbreak at that facility later infected at least 26 people and killed three residents.
How COVID-19 spread so rapidly at Three Rivers remains under investigation. But in a “statement of deficiencies” released last month, DPH highlighted how that staff member who later tested positive worked while feeling sick and did not properly wear a mask while awaiting test results.
But the three-day delay in getting those results was not specifically highlighted as a deficiency, even though DPH’s contract with the vendor, PhysicianOne Urgent Care, said it shall “report COVID-19 test results to the Department within twenty-four hours of collection of specimens.”
DPH declined requests for an interview, but in a written statement it said testing delays were not to blame for the outbreak at Three Rivers.
“The staff member was tested on a day they reported to work while ill,” DPH spokesperson Av Harris wrote in a statement. “This was not a case where an asymptomatic staff member spread the disease because the facility missed testing.”
“The statewide testing strategy is what allowed us to detect this outbreak and make quick decisions to tackle it head-on,” Harris wrote.
The state has contracts with eight vendors to run COVID-19 testing at about 200 Connecticut nursing homes and long-term care facilities. The vendors are called “care partners” and contracts are paid using federal taxpayer dollars from the CARES Act.
Included on that list is a $6 million contract between DPH and PhysicianOne, which is responsible for testing at about 30 long-term care facilities, including Three Rivers.
In a statement, PhysicianOne blamed an outside lab for testing delays.
“PhysicianOne has utilized a state-approved lab throughout this process and if disruptions to the supply chain occur as a direct result of the national pandemic, PhysicianOne Urgent Care remains in regular communication with the DPH and any affected facilities to address any concerns surrounding testing commitments,” a spokesperson said in a statement.
The company declined to name the lab, and DPH would not immediately comment.
It’s also unclear exactly how the state Department of Public Health tracks test turnaround times.
In a statement, Harris said, “typical turnaround times for test results have typically been within 24-48 hours,” but details broken out by care partners were not immediately provided.
“The 24-48-hour turnaround time includes collection of samples, delivery to labs, lab processing, then reporting,” Harris said. “Some of our care partners are reporting to us that lab processing time alone can be 24 to 25 hours.”
Meanwhile, some of the same vendors used by DPH perform testing under separate contracts with the state through the comptroller’s office, which monitors the turnaround time, breaks those times out by each individual vendor, and provided them to Connecticut Public.
All of the labs for those contracts reported turnaround times of less than 24 hours, according to numbers provided by a department spokesperson.
Harris said if a vendor is experiencing delays in reporting tests results to DPH, punishment is not the first option.
“If a care partner has challenges meeting a 24-hour turnaround time for test results, our goal is to work with that care partner to eliminate whatever obstacles they face that result in delays,” Harris wrote. “It does not benefit the state, the nursing home, the staff or the residents to find a reason to be punitive towards a care partner if they are doing good work and doing everything they possibly can to meet the 24-hour testing result turnaround timeline.”
Quick Results Slow COVID’s Spread, But Supply Chain Problems Can Slow Results
Fast turnaround times mean coronavirus spreads slower, said Tom Balcezak, chief clinical officer for Yale New Haven Health. And Balcezak said slowing the spread is the best tool available to fight COVID-19.
“We know that patients that are asymptomatic can spread the virus. In fact, patients that are pre-symptomatic can also spread the virus. So finding it early and then isolating those individuals is one great way of reducing the spread,” Balcezak said.
Balcezak said cohorting, contact tracing and testing combined to dramatically reduce COVID-19’s spread in Connecticut nursing homes, but he said testing remains a challenge.
In a $4 million contract with the state, Yale New Haven Health initially agreed to test at 31 nursing homes. But Balcezak said that was lowered to 20 because of a lack of test supplies.
“There’s choke points at virtually every level, from the swabs to some of the reagents to some of the test kits. Even the machines themselves are in backorder if you went to order them today,” Balcezak said.
Because Yale New Haven Health processes its tests in-house versus shipping to an outside lab, Balcezak said, Yale hit the 24-hour turnaround clause in its contract “between 90 and 95 percent of the time.”
State officials have afforded vendors some flexibility in turnaround times. Contracts reviewed by Connecticut Public Radio provide carve-outs for “market disruptions” such as demand surge, which has made it difficult in recent months for some vendors to get COVID-19 test kits.
“Other care partners have relied on laboratories to actually procure supplies for them,” said Patrick Charmel, CEO at Griffin Hospital, which holds a roughly $20 million contract with the state Department of Public Health and tests at more than 100 long-term care facilities.
“My understanding is some of those laboratories have had some interruptions or some difficulties supplying their care partner with the supplies they need to collect the samples, which has caused some problems,” Charmel said.
Charmel said Griffin bought all of the materials it needed to both collect and transport COVID-19 samples prior to embarking on its contract with the state.
“So we’ve had no -- zero -- supply disruptions,” Charmel said, noting Griffin drives its COVID-19 samples to the Jackson Laboratory in Farmington within “a matter of hours” after collection.
“And from the time they receive it in their hands to the time they produce a result that comes across our electronic interface, call it, on average, about 18 hours,” Charmel said. “It’s a relatively short turnaround.”
Other vendors said supply chain disruptions were causing results for some nursing homes tests to extend beyond 24 hours.
“Stamford Health has consistently returned test results to the Department of Public Health ... within 24-48 hours,” wrote Andie Jodko, a spokesperson for Stamford Hospital, which entered into a $2.1 million care partner agreement with the state.
“Delays in turnaround times are due to market disruptions such as surges in test volumes and timing of specimen collection,” Jodko said in an email.
Prospect Waterbury, which has a roughly $550,000 testing contract with the state, echoed that sentiment.
“We do rely on outside labs for processing COVID-19 outpatient test samples,” said Lauresha Xhihani, a spokesperson for Prospect Waterbury. “Turnaround times can be impacted by market disruptions that may delay processing times. We are currently in the process of identifying options for in-house testing.”
Hartford HealthCare, which holds a $1.3 million care partner testing contract with the state, also said flare-ups have put a strain on testing capacity.
But James Cardon, an executive vice president at HHC, said in an email: “Where timing is critical, we have prioritized testing. High priority tests can expect turnaround times of 24 [hours] or less.”
As fall approaches, students return to school, and health officials warn of more possible COVID-19 flare-ups, fast turnaround times will remain essential to contain COVID-19’s spread.
Harris, from the state Department of Public Health, said using established relationships with health care networks and in-state labs has worked so far to slow the spread in nursing homes, despite some vendors missing deadlines.
“Since June, new COVID-19 cases among staff and residents have gone down dramatically,” Harris wrote. “We do the best we can and adapt when needed.”