Iowa Abandons Routine Testing At Nursing Homes As Outbreaks, Deaths Mount

At a time when there are 39 current long-term care facility COVID-19 outbreaks in Iowa, Gov. Kim Reynolds’ administration has announced the state won’t be implementing a new federal rule to strengthen surveillance testing efforts there. In a letter sent to nursing home facilities yesterday that Iowa House Democrats released this morning, the Iowa Department of Public Health said that they will not provide routine surveillance testing intended to prevent outbreaks to meet new national guidelines.

“The volume and frequency that will be generated by the new requirement for routine staff testing, in addition to the testing already occurring across the state, will exceed the current capacity of SHL (State Hygienic Lab),” the letter read. “Therefore, SHL will be unable to provide and process routine tests for Iowa’s long-term care facility staff members for the purpose of complying with the CMS rule.”

What IDPH is referring to is a new rule from the Centers for Medicare and Medicaid Services outlining more stringent testing protocols for staff and residents.

“This rule directs long-term care facilities to test residents and staff for COVID-19 based on parameters set by the Department of Health and Human Services (HHS),” IDPH noted. “This includes testing of staff and residents with symptoms of COVID-19; testing staff and residents in response to an outbreak; and conducting routine testing of staff, including consultants, contractors, volunteers and others.”

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Because IDPH feels they cannot implement all that surveillance testing, they are not going to try. They will, however, continue testing “in facilities when staff or residents become symptomatic, or when cases are identified.”

“This letter is intended to serve as documentation that neither SHL, IDPH or county public health departments in Iowa can provide testing services for surveillance purposes as outlined in CMS-3402-IFC and QSO-20-38-NH,” the IDPH letter concludes.

Deaths from nursing home residents have accounted for roughly half of the state’s overall fatalities in the pandemic throughout the year. As of today at noon, 658 long-term care facility residents have died, or about 53% of the total 1,250 deaths in Iowa from COVID-19.

Democratic legislative leaders were furious upon learning the news.

“More Iowans will die as a result of this terrible decision,” said Waterloo State Rep. Timi Brown-Powers in a statement. “Instead of expanding testing to prevent outbreaks and keep Iowans safe, Gov. Reynolds is moving us backwards and starting to ration COVID tests used to protect our most vulnerable in nursing homes and those on the front-lines.”

Gov. Reynolds’ office, however, pushed back on that framing, saying there will be no decrease in testing.

“The state of Iowa has and will continue to be a leader of testing at our long-term care facilities,” said communications director Pat Garrett. “IDPH and SHL continue to test in facilities when staff or residents become symptomatic, and when positive cases are identified. New federal guidelines requiring routine testing of staff could generate more than 130,000 tests per week in addition to the significant testing that’s already underway. The increase will exceed SHL’s capacity and is why the state will need to rely on incoming federal support. As the letter noted, the U.S. Department of Health and Human Services intends to supply rapid point-of-care (POC) diagnostic testing supplies and equipment to long-term care facilities in Iowa.”

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As the Des Moines Register reported yesterday, there is a new plan from the federal government to ship rapid-testing machines to long-term care facilities, and hundreds (though not all) or Iowa nursing homes should receive them soon.

IDPH mentioned this in their letter, but did not lay out a plan for how that might compensate for their retreat from the testing effort.

“IDPH and DIA are aware that HHS intends to supply rapid point-of-care (POC) diagnostic testing supplies and equipment to long-term care facilities in Iowa,” they said. “Information on the availability and use of POC testing will be provided as soon as it is available.”

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The White House task force on the pandemic has repeatedly singled out Iowa for its uncontrolled COVID-19 spread, encouraging the state in particular to implement a mask mandate to help protect the most vulnerable elderly residents at nursing homes. They pointed to success in Arkansas with a similar approach. Reynolds has repeatedly refused to implement a mandate and has actively blocked local ordinances instead.

You can read the full letter from IDPH here.

by Pat Rynard
Posted 9/17/20

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