COVID-19 UPDATE #274

November 28, 2022

On Tuesday, November 22, 2022, the Biden Administration announced a six-week campaign to improve COVID-19 booster uptake rates. The campaign will focus on reaching seniors and other communities hardest hit by COVID-19, including a focus on nursing homes.  

As part of this campaign, the Center for Medicare and Medicaid Services (CMS) will focus on the requirement for nursing homes to educate and offer the COVID-19 vaccine, including subsequent boosters, outlined in QSO-21-19-NH. State survey agencies will be verifying that this requirement is being complied with, particularly in facilities with low publicly reported vaccination rates, including booster rates. Facilities out of compliance will be faced with enforcement actions.  

AHCA/NCAL recommends that facilities verify their vaccination rates, including booster rates, which can be found on the CMS COVID-19 data website. If the posted rates are low, facilities should prepare for outreach from the state survey agencies to ensure compliance with QSO-21-19-NH . If the posted rates are not accurate, facilities should verify the accuracy of their NHSN reporting and address where needed.  

While the overall up-to-date (including bivalent booster) rate in nursing homes is 43% (substantially higher than the general population), there is wide variation in booster rates, with over a quarter of nursing homes having up-to-date rates over 72.4% and a quarter of nursing homes with rates less than 7.3%.  

COVID-19 boosters are proven to be effective in protecting individuals from serious illness, hospitalization, and death from COVID-19 even when they have a breakthrough infection. Staying up to date on COVID-19 vaccines is particularly important for nursing home residents due to their underlying health conditions that make them more susceptible to serious illness and hospitalization from COVID-19 and other respiratory viruses.  Comagine Health, in partnership with Theresa Watts, has developed an immunization status tracker to assist nursing homes with collecting and organizing resident immunization status quickly and easily. 

CMS also issued QSO-23-03-ALL encouraging facilities to focus on the timely use of COVID-19 therapeutics. These treatments can prevent serious illness, hospitalizations, and save the lives of high-risk individuals who would otherwise be at risk of severe complications even when vaccinated.  

You can read the AHCA/NCAL and LeadingAge joint press statement on the announcement here and AHCA's all-hands-on-deck plan shared with the Administration to encourage a collaborative approach to increase vaccination rates. For questions, please contact AHCA/NCAL at covid19@ahca.org.

The Washington State Department of Health (DOH) will continue to provide free COVID-19 home test kits to residents at least through the end of 2022, despite the end of federal financial support for testing programs. With upper respiratory season at a high peak, at-home tests offer a way for individuals to check their COVID status without needing to access the healthcare system.

Washingtonians can order up to 10 free at-home test kits per month through the “Say Yes! COVID Test” program. To order, visit sayyescovidhometest.org. The kits are delivered to the requester’s home or work address, free of charge.

The antigen tests take 15 minutes to complete, offering users a convenient way to check whether they are infected with COVID-19. Users can follow up with a test from a medical provider or test site to verify results. Those testing positive can report their test result to Washington's COVID-19 hotline at 1–800–525–0127. More information and resources are available here.

Testing is one of the key ways to prevent the spread of COVID-19, along with staying current on vaccines, wearing a well-fitted mask in crowded or poorly ventilated indoor settings, frequent handwashing, and staying home when sick. DOH encourages everyone to get their flu shot and activate WA notify on their phones, which allows you to receive or send anonymous notification if you have come in contact with someone who tested positive.

These precautions are especially important now because hospitals and emergency rooms are operating at a higher than usual capacity due to a surge in respiratory viruses. Consider taking a COVID-19 test prior to a gathering, especially if you are getting together with people who are older, immunocompromised, or at risk for severe disease.

DOH first started the program in January 2022, in a partnership with the National Institutes of Health, the Centers for Disease Control and Prevention, Care Evolution, Amazon, and other community partners. Since then, DOH has received over 2.5 million orders, distributing 12.5 million test kits in Washington.

For more information on how to prevent the spread of COVID-19, click here.

The DOH website is your source for a healthy dose of information. Find the DOH on Facebook and follow them on Twitter. You may also sign up for the DOH blog, Public Health Connection, here. 

Washington State Department of Health (DOH) and the Department of Social and Health Services (DSHS) answers questions related to entertainers or singers coming into the long term care (LTC) setting.  

There are no restrictions on neighborhood schools or other groups coming to sing/carol or provide entertainment for residents.

• There are no exemptions in the Secretary of Health’s statewide face covering order for singing.  
• Carolers should follow mask guidance when indoors in a LTC Setting.
• Children under the age of 5 years old are exempt from requirements to wear face coverings.
• The Local Health Jurisdiction (LHJ) may restrict groups coming into the facility during an outbreak.

Visitation can be conducted through different means based on a facility’s structure and residents’ needs. 

• Visits can occur in resident rooms, dedicated visitation spaces, and outdoors. 
• Certain core principles and best practices reduce the risk of COVID-19 transmission and should be followed, such as hand hygiene and mask wearing
• The facility should follow CDC guidance to ensure a process to make visitors aware of IPC practices and actions to take to prevent transmission in the event of
• a positive viral test for SARS-CoV-2
• symptoms of COVID-19, or
• close contact with someone with SARS-CoV-2 infection (for patients and visitors) or a higher-risk exposure (for healthcare personnel (HCP)).

References:

• Order of the Secretary of Health Amending Order 20-03
• QSO-20-39-NH, Revised September 23, 2022

Also, with holidays coming up, DOH and DSHS have received inquiries from patients’ families regarding gatherings. The DOH provides guidance to facilities about visitation in Interim Recommendations for SARS-CoV-2 Infection Prevention and Control in Healthcare Settings. Below is a summary of the guidance: 

• All LTCFs should follow DOH screening and visitor exclusion guidance
• Ensure that everyone entering the facility is aware of infection prevention and control practices in the facility.
• Follow CDC recommendations to establish a process to make everyone entering the facility aware of recommended actions to prevent transmission, regardless of their vaccination status, if they meet any of the following three criteria so that they can be properly managed. (Note: options for establishing a process are included in the guidance.)
• A positive viral test for SARS-CoV-2, or
• Symptoms of COVID-19, or
• Close contact with someone with SARS-CoV-2 infection (for patients and visitors) or a higher-risk exposure (for HCP).

• Facility policies and procedures to manage visitors in their facility should include:
• Ensuring visitors wear appropriate source control (for example, well-fitting facemasks).
• Any additional expectations as determined by the facility to manage visitor flow to allow for distancing and other infection prevention practices (for example, specific entry or exit, routes through the facility, specified hours for visiting, etc.).
• Educating visitors and prospective visitors on expectations of infection prevention.
• Denying entry to any person who is unable or unwilling to adhere to infection prevention measures described in this document and the facility's policies and procedures.
• A process to respond to exposures involving visitors, healthcare workers, or patients.
• Post signage that strongly encourages staff, visitors, and patients to practice frequent hand hygiene with soap and water or hand sanitizer, avoid touching their face, and practice cough etiquette.

Additional guidance surrounding facility visitation can be found in the following:

• Dear Provider Letter NH#-2202-061 referencing QSO-20-39-NH Nursing Home Visitation - COVID-19 (REVISED)
• Communal Activities, Dining and Resident Outings. The safest approach is for everyone, particularly those at high risk for severe illness, to wear a face covering or mask while in communal areas of the facility