Residents of Maine nursing homes and assisted-living facilities who show symptoms of possible coronavirus infection now have top testing priority under guidelines issued Thursday by the Maine Center for Disease Control and Prevention.

However, a leading geriatrics physician who is calling for more frequent testing and faster lab results for long-term care facilities questioned whether the change in guidelines “on paper” will have a significant effect.

Also on Thursday, Gov. Janet Mills announced a MaineCare funding measure to help nursing facilities meet the financial challenges of dealing with the coronavirus crisis.

Dr. Nirav Shah, director of the Maine CDC, said at a news conference Thursday that he decided to move long-term care residents from Tier 2 to Tier 1 priority for testing after reading a recent report about coronavirus transmission on cruise ships. He said cruise ships and congregate care facilities have similar risk factors for disease transmission.

The report, published Monday by the U.S. Centers for Disease Control and Prevention, found that cruise ships are often settings for infectious disease outbreaks because of their closed environments, as well as contact between travelers from many countries.

Transmission occurred across multiple voyages from ship to ship by crew members and among passengers, according to a study of more than 800 cruise-related, lab-confirmed COVID-19 cases across the United States, including 10 deaths.

The report concluded that outbreaks of COVID-19 on cruise ships pose a risk for rapid spread of disease beyond each voyage and call for aggressive efforts to contain transmission, including postponement of all cruise travel worldwide during the pandemic.

Dr. Nirav Shah, director of Maine’s CDC, said congregate care facilities share risk factors with cruise ships when it comes to the spread of coronavirus. Joe Phelan/Kennebec Journal Buy this Photo

Shah said he recognized a transmission correlation between cruise ships and living situations where many people share close quarters, including long-term care facilities and other congregate housing.

“We follow the data,” Shah said at the news conference.

As a result, Shah said, residents of nursing homes and assisted-living facilities are now in the Tier 1 testing category for high-risk individuals, along with health care workers, first responders and hospital patients who have a high fever or respiratory symptoms.

Also in the top tier now are residents of group homes, jails and shelters. Symptomatic patients who are over age 60 or have underlying medical conditions remain in the Tier 2 category of testing guidelines for the Maine State Lab.

Shah said the change differs from U.S. CDC guidelines, which place symptomatic long-term care and other congregate housing residents in Tier 2. Further, he said, the state guidelines do not require universal testing of individuals in these settings who don’t appear to be ill.

Ultimately, Shah said, the decision to test remains with the physician, though he continued to express frustration with the slow turn-around for test results through the Maine State Lab.

The lag time in getting test results also has been a source of frustration in the nursing home community.

Dr. Jabbar Fazeli

Dr. Jabbar Fazeli, geriatrician and spokesman for the Maine Medical Directors Association, which represents doctors and other staff members at long-term care facilities. Photo courtesy of Dr. Jabbar Fazeli

“This tier change will be action on paper,” said Dr. Jabbar Fazeli, spokesman for the Maine Medical Directors Association, which represents physicians and other staff members at long-term care facilities.

Fazeli, who oversees medical care at three long-term care facilities in southern Maine, said he respects Shah and the hard work being done by the Maine CDC.

However, Fazeli said, he doubts the tier change will result in more frequent testing or faster lab results, which he believes long-term care facilities need to keep operating as the coronavirus outbreak wears on.

Fazeli said he’s been able to get some test results within four to 12 hours by pressing commercial labs to prioritize his requests, but in some cases results have taken several days because commercial labs are conserving limited testing supplies.

“We need test results within hours,” Fazeli said. “Test results two weeks later are not useful.”

Fazeli said he’s not calling for universal testing, but long-term care facilities must be able to test residents and staff members who show symptoms or have been exposed, and then get quick results.

Fazeli said the state should pressure the federal government to release Maine’s share of testing supplies and give them to commercial labs that are set up for mass testing and rapid results.

Also on Thursday, Gov. Mills and Health and Human Services Commissioner Jeanne Lambrew announced that the state will provide additional payments through MaineCare, the state’s form of Medicaid, to help nursing facilities meet demand for additional staffing, infection control and visitor screening.

Nursing facilities may request supplemental reimbursements as an “extraordinary circumstance allowance,” which are available for costs associated with unforeseen events outside of their control.

Starting March 1, Lambrew said, facilities should track and submit costs beyond their normal operating expenses, such as hiring additional staff to maintain proper coverage and buying additional sanitizing supplies and personal protective gear.

Rick Erb, head of the Maine Health Care Association that represents 200 nursing homes and assisted-living facilities, said the special funding will provide much needed flexibility in facility staffing and operations.

“The extraordinary circumstances provision maximizes Medicaid funding during this time of emergency and will help pay for unanticipated costs related to COVID-19,” Erb said. “We appreciate the governor’s commitment to working with Maine’s long-term care providers to ensure the health and well being of our residents.”

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