Quicker results helped ensure interventions could be introduced sooner
By Rebecca de Witte
December 18, 2023
Delays in receiving COVID-19 test results
In the Brucelea Haven long-term care facility in Bruce County, Ontario, clinical support staff have been reflecting on the time taken for residents to receive their COVID-19 test results, which depends on the type of test and the facility carrying out the test. Given the backlogs experienced by medical facilities during periodic rises in COVID-19 cases (Yetman, 2021), the turnaround time to obtain traditional laboratory service confirmation test results has varied from days to over a week. This has been especially difficult for the long-term care sector as a delay in delivering COVID-19 results has a markedly negative impact on residents’ overall health.
As clinical support, the full scope of our care depends on the timely management of COVID-19, which, amid the ongoing global situation for residents in long-term care, has been critical to achieving optimal health care within the sector. In addition to COVID-19, respiratory syncytial virus (RSV) and influenza A and B require timely management to help reduce complexities among the elderly.
Accurately testing for COVID-19, influenza and RSV requires effective laboratory procedures and processes using the latest and most effective technology. The ID Now lab technology from Abbott — a quantitative, rapid molecular test — is a point-of-care molecular diagnostic tool considered the most effective in detecting SARS-CoV-2 (COVD-19) as well as other infectious diseases.
Collecting nasal, throat and nasopharyngeal swabs
Implementing the ID Now technology begins with the collection of samples. Clinical support staff collect samples by swabbing residents’ nasal, throat or nasopharyngeal routes and analyzing the swabs. Testing an entire unit of residents is a time-consuming procedure. However, the ID Now swab is more comfortable than the previously administered polymerase chain reaction (PCR) tests. Moreover, if the test cannot be processed in the on-site lab immediately, the swab can be stored at 2⁰ to 8⁰C for 24 hours (Abbott, 2020).
When we were ordered by public health to run a test on a whole unit, the external lab was preferred as the internal lab takes approximately 15 minutes per test, so with 25 residents per unit, testing could take nurses a whole shift to complete. This has been a downside of the process, and sending the batch out for testing is a better use of our time. Using the ID Now test for a handful of residents is better when we need to identify the disease and isolate and treat our residents quickly to prevent a severe outbreak.
Health-care practitioner training
In favour of continuity of nursing care for residents during the COVID-19 crisis, the ID Now instrument, which was installed and operated within a biosafe environment, could only be administered by trained health-care practitioners. We were trained according to the instructions provided by the manufacturer, with the objective of ensuring consistent and precise testing. It was important for us to understand how ID Now works and continue within the framework of an individual benefit/risk analysis for the health unit (Kampf & Kulldorff, 2021). This is because when using ID Now technology, point-of-care testing in long-term care facilities requires strict controls. By ensuring thorough training in clinical support care, we continued to provide residents with the routine care needed while ensuring we met the high standards of ID Now.
At the same time, we always have to be vigilant that the necessary controls are applied and the instruments conform to the requirements of the Ministry of Health Canada (Deslandes, Clark, Thiruganasambandamoorthy, & Desjardins, 2022). Therefore, the added pressure was for the implementation process to be in tandem with government and institutional requirements on COVID-19 testing.
Adapting to changes in testing procedures in the long-term care sector
Although the results of the ID Now tests are returned within 15 minutes compared to days or weeks with PCR tests, this still consumed too much time. Therefore, doing a PCR sweep of the entire unit and subsequently sending the tests to the outside laboratory made more sense in some cases. At the same time, public health’s testing policy has also evolved as more information about the transmission of the virus between close contacts has been revealed. As such, now public health only requires testing of residents who present with symptoms or whose roommate presents with symptoms, following the protocol for persons who have been in close contact with someone symptomatic (Padula, 2020). The request to test all residents on the unit has diminished, gradually relieving the nursing staff of this responsibility.
While collecting and processing the point-of-care tests, we noted that residents have tolerated the test well and that there are no side effects or unwanted after-effects. Indeed, in the clinical support group, we have been discussing how point-of-care tests are better than PCR tests, which go further into the nasal cavity, causing more discomfort. When a resident experiences discomfort during such procedures, they may wince and pull back, thus not allowing for the full swab and rendering the test unreliable. At that point, we acknowledge that it is essential for nurses to establish a relationship of trust and care with the resident, to show them that their personal experience with regard to the necessary procedures is taken into account and that they are not being treated as just another test subject. This is why improving the test procedure to ensure that residents are subjected to little-to-no discomfort is important on a psychological and an interpersonal level.
Addressing specific therapeutic criteria
Keeping with the current guidelines for managing long-term care residents with COVID-19 (Ontario COVID-19 Science Advisory Table, 2022), we administer the recommended 100 mg of Paxlovid and 300 mg of nirmatrelvir twice per day for five days to those residents who are experiencing a mild case of COVID-19 and have risk factors such as obesity, diabetes, heart disease, hypertension, congestive heart failure, chronic respiratory disease, intellectual disability, sickle cell disease, and/or moderate to severe kidney disease and do not require oxygen. We are also responsible for clearly communicating to residents the known effects of these drugs and the potential side effects so that they can rest assured that their symptoms are being treated according to the latest public health recommendations. This puts their mind at ease that they are receiving the necessary care and improves their prospects of recovery.
As meeting these specific therapeutic criteria required the medications to be started within five days of symptom onset, we were responsible for keeping track of all the important dates and deadlines and ensuring proper time management. However, the ID Now technology alleviates the issue of delayed laboratory results for testing in the long-term care sector. If test results were available sooner, by promptly following the guidelines in “Therapeutic Management of Residents of Long-Term Care Homes with COVID-19” (Ontario COVID-19 Science Advisory Table, 2022), a higher percentage of residents would qualify for Paxlovid and other relevant treatments. This is exactly what happened. We categorized residents and their care needs based on acknowledging that those with an accurate and timely diagnosis would have a theoretically quicker recovery from COVID-19, lower hospitalization rates and a reduced duration of hospital stay in the event that hospitalization was required.
A review of Brucelea Haven’s two recent outbreaks revealed that only two residents qualified for Paxlovid administration in the previous August to September 2022 outbreak before the ID Now machine was available, with nine transfers out (medical leave) and seven deaths. However, during the most recent outbreak, from October to November 2022, with the ID Now machine, 22 residents qualified for Paxlovid as there was no delay in diagnosing COVID-19. Subsequently, there were only four transfers out (medical leave) and five deaths.
Therapeutic management of COVID-19 guidelines in long term care
By identifying the virus in a timely manner, the health-care team can implement the therapeutic management of COVID-19 guidelines, which have been issued to all health-care establishments. We had to observe numerous guidelines on the prevention of transmission, as well as on the treatment of symptoms among both residents and staff. These included Paxlovid and other recommendations from the Centers for Disease Control and Prevention influenza protocol (CDC, 2020) as the disease and information about it evolved throughout 2020 and 2021. In the field of long-term care, we are tasked with staying up to date with the latest guidelines. We also try to explain to residents or their immediate family and caregivers, in simple terms, the procedures we are administering so that they are informed and to ensure their trust and our acknowledgment of their best interests.
As clinical support, our responsibility is to ensure that residents in long-term care facilities benefit from early identification of diseases. In the face of the COVID-19 pandemic, caregivers have to be better organized in accordance with the recommendations and guidelines issued by the leading authorities in health. We have worked to contain outbreaks by making the ID Now instrument more readily available, which has contributed to ensuring more efficient implementation of the testing procedures. The approach has been especially useful as living in such facilities predisposes residents to viruses and infections, including COVID-19, as well as influenza A and B and RSV infection. Our experience demonstrates that the ID Now technology is an effective and accurate tool for testing for these diseases. The technology allows for prompt point-of-care testing for geriatric patients, improving the management of increasing complexities associated with COVID-19 and other communicable diseases in the elderly population.
Permission and approval have been obtained and confirmed by the facility’s director for the data in this paper to be published.
Abbott. (2020, May 4). Steps to use ID NOW effectively. Retrieved from https://www.abbott.com/corpnewsroom/diagnostics-testing/steps-to-use-id-now-effectively.html
Centers for Disease Control and Prevention (CDC). (2020, November 17). Interim guidance for influenza outbreak management in long-term care and post-acute care facilities. Retrieved from https://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm
Deslandes, V., Clark, E., Thiruganasambandamoorthy, V., & Desjardins, M. (2022). Implementation of the Abbott ID Now COVID-19 assay at a tertiary care center: A prospective pragmatic implementation study during the third wave of SARS-CoV-2 in Ontario. Diagnostic Microbiology and Infectious Disease, 102(3). doi:10.1016/j.diagmicrobio.2021.115609
Kampf, G., & Kulldorff, M. (2021). Calling for benefit–risk evaluations of COVID-19 control measures. The Lancet, 397(10274), 576–577. doi:10.1016/S0140-6736(21)00193-8
Ontario COVID-19 Science Advisory Table. (2022, April 22). Therapeutic management of residents of long-term care homes with COVID-19. Retrieved from https://covid19-sciencetable.ca/sciencebrief/therapeutic-management-of-residents-of-long-term-care-homes-with-covid-19-version-1-0/
Padula, W. V. (2020). Why only test symptomatic patients? Consider random screening for COVID-19. Applied Health Economics and Health Policy, 18(3), 333–334.
Yetman, D. (2021, March 9). How long does it take to receive COVID-19 test results? Retrieved from https://www.healthline.com/health/how-long-does-it-take-to-get-covid-results
Rebecca de Witte, RN, BScN, works as the best practice lead in the clinical support department of Brucelea Haven, which is operated by Bruce County Long Term Care, Ontario.