Many nursing homes in Maine say they lack the basic testing supplies needed to detect and contain COVID-19 outbreaks: nasal swabs.

Seventeen of 28 nursing homes – or nearly 61 percent – that responded to a survey by the Maine Medical Directors Association last week reported that they had seven or fewer nasal swabs, which are needed to collect specimens to test for COVID-19, the disease caused by the new coronavirus. Nine of them – 32 percent – had no swabs at all.

Puritan Medical in Guilford produces millions of swabs a week for coronavirus testing. The swabs are long enough to reach through the nasal cavity to the upper part of the throat. Photo courtesy of Scott Wellman

The survey underscores the impact of a nationwide shortage of testing supplies, including nasal swabs and testing chemicals.

The association, which represents physicians and staff at long-term care facilities, sent the survey to the nearly 100 nursing homes in Maine. Eleven of the 28 that responded had not tested any residents for COVID-19, and five had not tested any employees – even though 13 of the facilities, or nearly half, said they were aware of outbreaks within 20 miles.

Dr. Jabbar Fazeli, a spokesman for the association, hopes the survey becomes a rallying cry for the Maine Center for Disease Control and Prevention to become more proactive and aggressive with testing in congregate living settings, where the disease can spread rapidly with dire outcomes among their 10,000 medically vulnerable residents.

“It’s nice to have the state put the best face on things, but we’re not at a point where we can congratulate ourselves on a job well done,” said Fazeli, a geriatrics physician. “As the community at-large has more cases and the disease is more prevalent, it’s going to seep into every single nursing home we have.”

And people in assisted living communities are “even more vulnerable,” he said.

Nursing homes, assisted living facilities and other congregate living complexes have been hit especially hard by COVID-19, a respiratory disease that spreads easily among groups of people and is particularly dangerous to people with underlying health conditions.

Nursing home outbreaks have claimed thousands of lives across the United States. Nursing homes account for a quarter of the nation’s coronavirus deaths, with at least 16,000 nursing home residents and employees testing positive for COVID-19, according to a USA Today database published Friday.

The Maine CDC is monitoring outbreaks at six long-term care facilities, which as of Tuesday reported 249 cases (88 staff and 161 residents) and 35 deaths. Long-term care facilities account for 22 percent of Maine’s 1,150 confirmed cases and 57 percent of the 61 deaths.

State officials have frequently cited a lack supplies, including a shortage of swabs and chemicals, as the reason more widespread testing isn’t being done.

Officials announced last week that Puritan Medical Supply of Guilford was teaming up with Bath Iron Works and Cianbro construction to double its swab production to 40 million a month.

Dr. Nirav Shah, the director of the Maine CDC, said Maine expects to begin receiving 15,000 swabs a week starting this week.

Robert Long, a spokesperson for the Maine CDC, said the state received 4,000 swabs Monday from the Federal Emergency Management Agency. He said the swabs will be distributed to facilities that need them, while noting that each facility is required to maintain its own supplies.

“It’s important to note that medical directors of long-term care facilities can order testing whenever it’s warranted in their clinical judgment,” Long said.

Shah said Tuesday that he would like to do more widespread testing, especially in long-term care facilities. But the state needs enough supplies to test both residents and staff, as well maintaining testing for hospitalized patients and first responders.

“We are working very diligently on trying to expand our overall testing supply, which will be the real kingpin that’s necessary before we move to more expanded testing,” Shah said.

Fazeli acknowledged the supply shortages, but argued that more testing could be done in nursing homes if fewer tests were conducted of the community at-large. He said he’d like the Maine CDC to encourage nursing homes to test all residents and staff, including those without symptoms, before outbreaks occur.

“You would get more bang for your buck when you test in high-risk settings like nursing homes,” said Fazeli, who first raised testing concerns in March. “They can’t keep saying we’re short and we can’t do it.”

The survey comes as the U.S. Centers for Disease Control and Prevention is recommending increased testing of all nursing home residents because early experience has shown that many residents who have tested positive are asymptomatic. The U.S. CDC recommends testing every three days.

Maine was one of the first states to implement universal testing in nursing homes at the first sign of an outbreak, defined by three or more cases. But Fazeli would like universal testing to be done sooner.

“When they step in it’s already too late for that building,” Fazeli said of the Maine CDC. “They already have an outbreak.”

Shah, the Maine CDC director, said Monday that state officials are reviewing the new guidelines, which would result in 11,000 nursing home residents and staff being tested every three days. He said the state would first need a strategy for dealing with what he expects will be a high number of false positive tests.

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