IDPH Webinar

On February 14, IDPH hosted a LTC webinar discussing changes to test and outbreak reporting as well as covering revised guidance from the CDC. If you were unable to attend this webinar, here are notes summarizing the content. Dr. Hennenfent stated the recording of the webinar and slides will be available to those that registered, LeadingAge Iowa will include a link to the recording and slides when it is available.

Reporting:

Effective at midnight, February 16, 2022, anyone conducting testing under a CLIA waiver, will only be required to report positive COVID-19 testing results. Negative test results will no longer be required to be reported to IDPH (via RedCap or NHSN – POC Test Reporting Module). 

• Positive test results can still be reported to IDPH via RedCap or NHSN – POC Test Reporting Module.
• Nursing Homes will still be required to report cumulative numbers into the NHSN LTC Reporting Module, which includes PPE Supplies, Facility Impact (such as number of residents and staff that tested positive during the week, etc.).
• A written reporting order will be released on the IDPH website when available.

Nursing Homes will no longer be required to report outbreaks according to IDPH definition, via RedCap. IDPH will review the NHSN reporting data that is publicly released by CMS (located at CMS COVID-19 Nursing Home Data website) for nursing homes that meet outbreak criteria. 

• IDPH will communicate with local public health departments to determine who will reach out to the nursing home when outbreak criteria is met.  Communication will come from either IDPH or local public health (not both) to assist the nursing home with any needs related to the COVID-19 outbreak. 
• IDPH will no longer require spreadsheet reports upon an outbreak of all testing conducted with positive or negative results as nursing homes have experienced in the past.
• The RedCap survey for reporting outbreaks will be removed from the IDPH LTC website effective February 16.  It is important to note that positive test results can still be reported to RedCap, the removal is only for reporting outbreaks.

Calculating Community Transmission:

During the webinar, Dr. Hennenfent explained that the CDC COVID-19 Data Tracker that is currently utilized to determine testing frequencies and PPE requirements will continue to display community transmission even though negative tests are not reported.  The CDC will calculate the community transmission levels by calculating the number of new cases per 100,000 people in the county. (Note there are currently two figures that determine community transmission and CDC utilizes the higher of the two figures.  Moving forward it will only be based on the one figure.)

CDC Guidance Changes:

Note these changes are from the following documents that Dr. Hennenfent provided links to during the Webinar. 

• Stay Up to Date with Your Vaccines
• Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes
• Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic
• Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2

Quarantine for Residents:

• New admissions or residents leaving for more than 24 hours that are not up to date with vaccines must quarantine for at least 10 days (7 days with negative test within 48 hours prior to discontinuation of isolation).
• Residents that had close-contact to someone testing positive for COVID-19 that are not up to date on vaccines must quarantine for at least 10 days if the resident is asymptomatic. (7 days with negative test within 48 hours prior to discontinuation of isolation).
• Quarantine for new admissions, residents leaving for more than 24 hours, or those with close-contact is not required for residents that have recovered from COVID-19 within the last 90 days.

Testing for COVID-19:

• Residents that are new admissions or readmissions, regardless of vaccination status, should be tested immediately and if negative, again between days 5-7.
• Residents that had close-contact to an individual with SARS-CoV-2 should be tested immediately, but not sooner than 24 hours following the close-contact, and if negative, again between days 5-7.

Visitation:

• Despite the guidance for community discontinuation of isolation providing options to discontinue isolation after 5 days with improvement of symptoms, visitors should not enter healthcare centers unless they meet criteria for resident and HCP discontinuation of isolation.  This guidance states residents and HCP must isolate for 10 days according to the documents cited above.

Q&A:

How does this guidance affect licensed-only providers?

• The reporting guidance for test results includes all providers with a CLIA Waiver for conducting COVID-19 tests.  If licensed-only providers as well as Assisted Living (or other health care entities) are conducting testing according to their CLIA waiver they are no longer required to report negative tests.
• Providers that are not regulated by CMS such as licensed-only providers and Assisted Living were not required to report COVID-19 outbreaks in the building to IDPH, therefore that guidance has not changed.

If a resident is placed in quarantine and then accepts a booster dose, how long before the resident meets criteria for being “up to date”?

• According to the Stay Up to Date with Your Vaccines document from the CDC, once a person receives a booster dose, they are considered up to date immediately.

Are providers still required to input all test results into NHSN?

• Providers should document all testing results to remain in compliance with QSO-20-38-nh-revised (per DIA) and only report positive test results into NHSN.

Can we stop reporting negatives effective today?

• No, the reporting order ending negative test result reporting will be effective at the end of the Governor’s proclamation, which expires February 15 at 11:59 p.m. Therefore, discontinuation of reporting negative test results will be effective February 16, 2022.

Can HCW stop using eye protection when providing care to up to date with vaccine residents?

• Residents that require quarantine must be cared for utilizing transmission-based precautions including those that are not up to date with vaccines. Transmission-based precautions require an N95 or higher-level respirator, eye protection, gown and gloves.
• Eye protection for residents that are not in transmission-based precautions should still be utilized based on community transmission levels. (Utilized when community transmission is substantial or high.)

When a resident that is not up to date with their vaccines is newly admitted is the discontinuation of isolation based on the potential close-contact date or the date of admission?

• The quarantine period should be based on the date of admission for newly admitted or readmitted residents. 
• If a resident has close-contact with someone testing positive for COVID-19 the quarantine period would be based on the date of the close-contact.

Are nursing homes required to test staff for routine testing that are not up to date with their vaccines?

• DIA indicated that surveyors are reviewing routine testing frequencies for staff according to the QSO memo (20-38-nh-revised), which only includes staff that are not fully vaccinated for routine testing. The QSO requirements are the minimum standards that nursing homes should follow.
• The CDC guidance recommends that nursing homes test staff that are not up to date with their vaccines at the frequencies described in the QSO memo, however, CMS hasn’t revised the QSO memo to include this definition.

Where will the COVID-19 data be posted for the state?

• At the expiration of the Governor’s proclamation, the Iowa COVID-19 website will be taken down.  IDPH is in the process of developing a respiratory illness page (similar to Influenza data) that will include COVID-19 information.

Does the vaccine mandate include CDC’s definition of up to date for staff?

• DIA stated that the Interim Final Rule or QSO-22-09-all only includes that staff are required to be fully vaccinated, which includes the primary series.  It does not include a requirement for staff to receive the booster dose.