All Washington state nursing homes, assisted living facilities to test residents and staff for Covid-19

All nursing homes in Washington will be required to offer Covid-19 diagnostic tests to consenting residents and all staff by June 12. Institutions with memory care units must complete testing by June 26.

The new state proclamation is aimed, in part, at assessing the potential for asymptomatic carriers to spread the coronavirus at long-term care facilities.

"Very early on in the epidemic here in Washington state, we learned that nursing homes indeed were a high risk place where there were a number of outbreaks and infection," said state health secretary John Wiesman during a press conference on Thursday.

"Thankfully, over the last month, month and a half ... we have really seen a decrease in the number of outbreaks in our long-term care facilities."

Wiesman attributed the suppression of those outbreaks to facilities having access to personal protective equipment and the implementation of infection control strategies. He said those protocols, which included training on identifying symptoms, were in the works prior to the Covid-19 outbreak at the Life Care Center of Kirkland that started in February.

Moreover, Gov. Jay Inslee in March mandated restrictions on visits to nursing and assisted living facilities, to help mitigate the spread of the coronavirus.

Testing residents and staff, however, remains a priority, as new research suggests that asymptomatic carriers of the coronavirus are more common than previously thought. Officials say they are prioritizing facilities that haven't had known outbreaks.

"Maybe 25 to 40% of cases could actually be asymptomatic," Wiesman said. "We didn't know that at the beginning of this outbreak — this was a new virus. And previous coronaviruses didn't act that way."

The Department of Health is working with assisted living facilities to be able to separate asymptomatic Covid-positive residents from those who aren't infected, Wiesman said.

Health officials are particularly concerned about Covid-19 outbreaks within memory care units at long-term living facilities, where residents are considered especially vulnerable.

"In part, that's because folks with memory care issues ... tend to wander," Wiesman said. "And need to be able to move around as part of their daily living. And we know that that increases the risk of infection."

The rate of transmission in the community at-large is also a significant factor in controlling infections at long-term care institutions. Social distancing measures are believed to have slowed the spread of the virus in Washington thus far.

However, no decisions have been made regarding whether to lift the constraints on outside visits to long-term care facilities. But Wiesman said officials will use insight gathered from the testing efforts to determine how to best proceed.

"It's a tough balancing act here that we're very sensitive to," he said.

The state proclamation guiding the testing expansion exempts facilities that completed the Department of Health's Covid-19 point prevalence survey on or past April 1.

Deb Murphy is the president and CEO of LeadingAge Washington, an association that represents nonprofit senior care facilities. She sees the initiative as "a very positive and long overdue step forward" that is feasible.

But Murphy expressed concern that facilities may lose employees who refuse Covid-19 testing, which is mandatory for staff under the new proclamation.

"While our members will do what they can to inform staff of the importance of testing, emphasize that they will not bear any costs related to this initial testing, and may offer incentives for those who do submit to testing, there are some who will nonetheless refuse to test," Murphy said in an email statement.