The federal government has started sending new COVID-19 testing systems to nursing homes around the country in hopes that the rapid results provided by antigen tests will slow the spread of the virus. Long-term care facilities certainly welcome that assistance, but some have major concerns about those tests.
"Antigen testing is useful for positive rapid results. But at the same time, the accuracy is concerning. So there's going to be retesting," said Dana Parsons, vice president and legislative counsel for LeadingAge Virginia, which represents more than 100 long-term care communities throughout the state.
While positive results from antigen tests are considered to be highly accurate, the tests can have a 20% rate of false negatives. The News4 I-Team obtained a copy of written guidance from Virginia's Department of Health, which says "negative results do not rule out infection" and "should be followed up with a confirmatory molecular test."
"We want to make testing efficient and cost effective, but we need to make sure that it's accurate to make sure that it's in the best interests of the residents, the staff," Parsons said.
The most common method used to detect COVID-19 is a PCR test, a molecular test that detects the virus' genetic material. But those have been plagued with short supply and long turnaround times for lab results.
Antigen tests can also diagnose active infections by looking for specific proteins on the surface of the virus. The results can come back in 15 minutes.
Parsons says some nursing homes have already received a one-time supply of antigen tests for residents and staff and a machine to run the results onsite. The U.S. Department of Health and Human Services is distributing them in COVID-19 hotspots around the country, including 23 priority homes in Virginia.
Leading Age sent a letter to HHS citing "major concerns" including the ongoing costs of testing and retesting, estimated to be in the tens of thousands of dollars per home per week.
"The cost associated with antigen testing is of great concern, especially taking into consideration how much time it takes for each person to undergo the test," Parsons said.
Coronavirus Cases in DC, Maryland and Virginia
COVID-19 cases by population in D.C. and by county in Maryland and Virginia
Plus, some state and local health departments don't accept antigen tests to satisfy their mandatory testing requirements for residents and staff. Homes are also questioning whether the antigen tests must be included in their weekly reports to the CDC.
"Just what are all the logistics for the rollout? It just seemed to happen very quickly without these questions being answered," Parsons said.
Long-term care facilities do have the option whether to use the antigen tests or not. Parsons says many are figuring that out on a case-by-case basis, depending on their supply of molecular tests and how long the labs are taking.
Virginia's Department of Health issued an algorithm for healthcare providers to help decide who to test and patient recommendations based on traditional COVID test results. It's currently working on similar guidance for antigen testing.