What to Do When You Have a COVID-19 Outbreak

In the last several weeks, the number of COVID-19 outbreaks in nursing homes and assisted living settings have increased. Because there was an extended time when outbreaks were low, we have received many questions about handling them, specifically visitation and testing.

Visitation
When there is a new onset positive COVID-19 case, visitation should be immediately suspended for the entire building until one round of whole-house testing is complete. Once the first round of testing is finished, there are decisions to make about the resumption of visitation.

• If there are no new positive cases detected during the first round of outbreak testing, visitation may open for all units/areas except the unit/area where a COVID positive resident lives.
• The units/areas where COVID positive resident(s) live must have no visitation until outbreak testing is complete. Outbreak testing is testing until there are no new positive cases in 14-days.
• Regardless of whether areas or units may open, outbreak testing needs to continue until there are no new cases for 14 days.
• Compassionate care visits and essential care visits may continue even on units where visitation is suspended.

Testing
Testing with an RT-PCR test or an antigen test during outbreak testing is acceptable. Antigen tests should only be used when there is serial testing, and, in the case of outbreak testing, there is serial testing.  If using antigen tests, there are a few requirements to follow.

For asymptomatic individuals:

• If a resident or staff member has a positive antigen test, it should be confirmed with a PCR test.
• If a resident or staff member has a negative antigen test, it can be considered a presumptive negative, and no further testing needs to be done.
• All positive and negative antigen test results need to be reported if the testing is done by the nursing home or assisted living.

For more information on antigen testing, please see the MDH guidance Using Antigen-based Point-of-Care (POC) Testing for COVID-19 in Long-term Care Facilities. This is still the current document and was last updated on April 21. There is a flow chart of how to handle antigen test results in symptomatic and asymptomatic individuals on page nine.For more information or questions, please get in touch with Kari Everson.

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