As COVID-19 deaths rise in Monroe County nursing homes, doctors test some residents with no symptoms

Apr 16, 2020

As laboratories in Monroe County slowly increased the number of coronavirus tests they can run, a nursing home in Rochester began submitting more samples.

St. John’s Home said Thursday that it had received results for almost 90 tests. Of those, 23 came back positive.

Some tests were submitted for residents who had no symptoms of COVID-19.

“Expanded access to testing for those individuals who are asymptomatic has provided St. John’s with the opportunity to implement even more aggressive measures to stop organization-wide spread,” said Charlie Runyon, St. John’s president and CEO.

Dr. Dwight Hardy holds a vial of the type used to collect samples for coronavirus testing in this photo from a March news conference at the University of Rochester Medical Center's pathology laboratory.
Credit Max Schulte / WXXI News

Now that the home has a better idea of the prevalence of the virus, Runyon said, St. John’s will isolate all of its coronavirus-positive residents in two housing units.

“These isolated neighborhoods are fully staffed with round-the-clock, dedicated teams implementing the highest level of personal protective equipment including gloves, gowns, masks, and face shields,” Runyon said.

The nursing home described its efforts as “current best practices” to mitigate the spread of the disease. Some agree: County public health commissioner Dr. Michael Mendoza is giving local doctors discretion in whom to test, and the pathology lab at the University of Rochester Medical Center has begun processing samples from people without COVID-19 symptoms.

But testing those people is a procedure that's not recommended by either state or federal guidance.

The federal Centers for Disease Control’s guidelines describe testing for “individuals without symptoms” as a “non-priority.”

The state health department’s advice does not directly address testing people without symptoms, but it does lay out a series of criteria focused on testing people who do have symptoms.

A spokesperson for St. John's did not immediately respond to questions about how staff determined which residents who had no symptoms got tested for the virus.

Calls and emails to the other four largest nursing homes in the county asking whether any of their residents were tested for the virus despite not having symptoms either went unanswered or, in one case, received an uncertain reply. Those facilities house a combined 1,400 people, according to census figures from the state health department.

Mendoza acknowledged at a virtual news conference Thursday that testing asymptomatic people “is not part of the guidelines,” but he said the decision makes sense.

Neither state nor federal guidance has been updated since March 24, when Monroe County had a total of three COVID-19 deaths. Nursing home residents now represent more than a quarter of Monroe County’s 62 deaths from the disease.

“Now that the possibility of presymptomatic transmission has been described in the literature, it’s reasonable to begin screening asymptomatic individuals, especially if in high-risk settings,” the commissioner said in an email to WXXI News.

In the Thursday news conference, Mendoza said he wants individual doctors to have latitude in deciding whom to test.

“I’ve been very clear that individual clinical judgment is what supersedes population-level guidance,” he said.

Automated machinery has increased the testing capacity at the University of Rochester Medical Center's pathology laboratory.

A spokesperson for the URMC pathology lab stressed on Wednesday that doctors still need to be judicious. If all 5,000 nursing home residents in Monroe County were tested, the spokesperson said, the lab would be overwhelmed.

Nonetheless, the lab’s growing testing capacity has helped to focus local officials on the spread of COVID-19 in nursing homes.

Mendoza and other local leaders have established a task force that they say will protect residents and staff at those homes.

County Executive Adam Bello said the group secured hundreds of thousands of masks and other protective supplies to distribute to nursing homes in the county.

Still, Mendoza said the task force could not make accurate, timely reports on deaths in local nursing homes because that data does not come to the county first.

“I don’t have that information,” he said. “The nursing home deaths will occur basically unbeknownst to us.”

Mendoza said the county learns of those deaths, sometimes days later, through records from the state health department.

So does the public. As of Thursday evening, the state had not updated its tally of COVID-19 deaths at nursing homes since Tuesday.