nursing homes Benches sit empty Saturday outside the assisted living section of Universal Health Care of Lillington. The Harnett County nursing home has experienced one of the state's largest outbreaks of coronavirus cases, with 75 confirmed cases in staff and residents, and seven resident deaths from related illness, according to data the N.C. Department of Health and Human Services released Friday. Melissa Sue Gerrits / Carolina Public Press
Benches sit empty in June 2020 outside the assisted living section of Universal Health Care of Lillington. At the time the Harnett County nursing home had experienced one of the state's largest outbreaks of coronavirus cases. Melissa Sue Gerrits / Carolina Public Press

by Anne Blythe, North Carolina Health News

Health and Human Services Secretary Mandy Cohen laid out why it’s important for the entire state to work from the same playbook as it battles COVID-19 in response to a reporter’s emotional question about testing for the virus in long-term care facilities.

Kate Martin, a reporter for Carolina Public Press, choked with emotion as she explained that she was interested in knowing more about testing requirements and guidelines for long-term care and rehabilitation facilities because of how her father died in a Kansas facility last month.

“They won’t tell me whether they were testing anybody,” Martin said, echoing a universal frustration of people trying to get answers from such facilities in the middle of a pandemic when visitors have been barred.

If facilities have no one in them who has tested positive for COVID-19, there are no regulations to force proactive testing.

Testing is important, Cohen said, but more important is having a comprehensive strategy for long-term care facilities, congregate-living facilities, as well as the entire state.

“Testing itself is not the only thing we need to do,” Cohen said. “I think it’s really important to connect the dots of what’s going on in restaurants and what’s happening in our long-term care settings. We often can’t see those dots … because the virus is so tiny.”

What happens is the people who work in long-term care facilities, such as those in food delivery, nurses, personal care attendants, go out to restaurants, grocery stores and other places where the virus can spread.

“When there is more virus spreading, that means those folks who work in our long-term care are getting exposed to virus more often in their community,” Cohen said. “Then they bring that virus to those long-term care facilities.”

Testing is only one prong of the strategy to detect the virus in someone who is either pre-symptomatic or asymptomatic, health officials caution, because a test only reflects a moment in time.

“It’s more than testing,” Cohen said. “We had to make sure of a couple of things. … Are folks wearing the protective equipment and the face coverings that they need when they’re doing that work? Are we making sure to do other things, like unfortunately restrict visitors because we know that’s when more virus comes into those settings?”

If there is one case, Cohen said, everyone gets tested, including staff and the residents.

“The question has been are we going to be doing proactive testing when we don’t even see the virus there,” Cohen said.

North Carolina has committed to doing that at nursing homes.

“It’s not an easy lift to do, so it’s not going to get done overnight,”Cohen said “But we’ve already done this in our state-operated nursing facilities.”

Now, the state is working with private nursing homes to figure out how to marshal supplies and people for major testing projects, which also poses financial challenges to pull together and execute.

“I want to make that important connection that it’s not testing alone that’s going to help here.”

Over the weekend, scenes of restaurant-goers crowding the streets of Raleigh’s Glenwood South, a business district with many restaurants, bars and nightclubs, circulated on social media. Many people were not wearing face coverings.

Cohen described restaurants as risky places because diners take off face coverings to eat, allowing for virus spread.

North Carolina is one of the states now being watched nationally as the number of lab-confirmed cases rises quickly and people being hospitalized for COVID-related illness begin to raise capacity questions.

Last week, Cohen and Gov. Roy Cooper implored North Carolinians who are now more mobile not to drop their guard against the virus. They also have admonished open defiance of social distancing restrictions.

“That kind of behavior in crowds really worries the health experts and the epidemiologists and why we continue to tell people to avoid being in crowds if you can and even if you are, whether it’s inside or outside, perform the three Ws,” Cooper said.

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