This review was posted on behalf of Spencer Hofschulte-Beck, medical student at Marian University, and approved by Dr. Kathleen Unroe, IU School of Medicine Associate Professor, geriatrician, and IU Center for Aging Research Scientist.

COVID-19 Testing of healthcare workers

This policy statement was released on May 18, 2020, by AMDA – The Society for Post-Acute and Long-Term Care Medicine – who is a medical specialty society representing a community of health practitioners working in various post-acute and long-term care settings.

Universal testing and its challenges

• One of the hurdles with universal testing is that it only provides a prevalence estimate i.e., it only tells you how many HCP and/or patients are infected with COVID-19 at one particular time.
• Repeat testing should be performed to estimate again the prevalence, but the frequency at which testing should be done is still in debate. Current data suggests the average incubation period is every 5 days – the recommendation is to test every 5 days.
• For facilities with lower rates of infection, the process of universal screening may not be appropriate, but rather random screening and strict guidelines may be more applicable.
• Facilities should consider the emotional impact of testing certain patients with dementia or psychological health conditions, and the nasopharyngeal test is uncomfortable.
• Some HCP or residents may refuse testing, and facilities should have a plan in place to decide what to do in these situations.

Types of Tests, Receiving Results, and Things to Consider

• The most common method of testing for COVID-19 is Reverse transcriptase polymerase chain reaction on a nasopharyngeal swab. Other tests include serology blood tests, which look at antibodies in the blood. Results may take up to one week to return.
• It is recommended to have a plan in place if ever there are low supplies of PPE, residents need to be put in cohorts, or if staff members need to be furloughed.

Financial Aspect of Testing

• The average cost of a test is currently $50-110 or more.
• Residents on Part A coverage paying for the test – the cost is borne entirely by the facility.
• HCP testing costs may not or only partially covered by healthcare insurance. This can put a large burden on HCP who are uninsured or cannot afford insurance.
• If a point-of-care test is inconclusive, the individual would need a follow up PCR test. In these situations, insurances usually only cover the first test, leaving the facility or individual to cover the rest of the expenses.