Written Statement: Enhancing COVID-19 Testing in Care Homes

The protection of the most vulnerable people in our communities has been a priority during the COVID-19 virus outbreak.  As part of a package of measures for preventing transmission of COVID-19 in care homes and protecting residents and staff, a programme of asymptomatic testing of staff has been in operation in Wales since June 2020. At this current time, in response to high community infection rates, staff in care homes in Wales are undertaking weekly testing in line with the social care alert levels document published on 23 December 2020: Coronavirus control plan: Alert levels in Wales for social care services for adults and children.

Care home staff, local authorities and health protection teams continue to work tirelessly to prevent the introduction and onward transmission of COVID-19 in our care homes.  However despite best efforts we continue to see positive test results in care homes amongst both staff and residents with an increasing number of care homes currently managing active incidents and outbreaks. Whilst we are making good progress with the rollout of our vaccination programme, we are still in the early stages. This situation is compounded by the even more rapid transmission of recently identified variants which are a key factor in driving local outbreaks. Testing therefore remains a pivotal component in our response to the pandemic and it is clear that further intervention is needed to help identify infectious individuals within care homes sooner and manage outbreaks more effectively.

Following scientific validation of testing using Lateral Flow Devices (LFDs) we introduced LFD testing for visitors to all care homes in Wales in December 2020 in order to facilitate family and friend visits to people living in care homes. Due to changes to the level 4 restrictions introduced on 19 December only very limited visiting and associated testing activity has taken place. However, in line with the social care control plan alert level 4 guidance, testing for visiting professionals to care homes has also been introduced with visiting professionals who are not yet subject to regular asymptomatic testing being expected to undertake a LFD test at the care home they are visiting. Tests for visiting professionals will only be needed twice a week so following the first test of the week the professionals will not require a further test for the next three days.

Having considered the latest scientific advice we are also introducing a programme of regular, twice weekly, asymptomatic testing of care home staff in Wales, using lateral flow test devices in addition to the weekly PCR test that is currently undertaken. 

Additionally we are providing local health protection teams with the flexibility to consider the introduction of enhanced staff testing with daily testing for a period of 10 days in care homes where there is an outbreak. This enhanced testing is in line with the ‘test to safeguard’ priority described in the refreshed Welsh Government COVID-19 Testing Strategy.

COVID-19 community testing framework.

It is important that this enhanced testing is not used as a ‘test to maintain’ approach to allow staff who should be isolating to return to work early. Any member of staff who is a contact of a positive case will still need to isolate as normal.  Enhanced testing will not automatically be introduced into every care home with a positive case but will be considered as part of the outbreak risk assessment and management plan and should be considered in conjunction with care home managers.

Lateral flow tests detect the presence of the COVID-19 viral antigen from a swab sample and can produce results within 20 to 30 minutes allowing for positive individuals to be identified and isolated much more quickly than through the current PCR testing process.

A report by the London School of Hygiene and Tropical Medicine on repeated testing using antigen tests found ‘that the use of frequent lateral flow testing detects a comparable number of infections to frequent PCR, and can avert more transmission than PCR if they can be used more frequently.

The report also found that, ‘results indicate that frequent testing, i.e. every 1 or 3 days, is likely to detect a substantial proportion of asymptomatic and pre-symptomatic infections and avert the majority of onwards transmission, whether using LFA[D] or PCR testing. As LFA[D] tests results can be returned in a fraction of the time required to return PCR test results, infected individuals may be identified and isolated much more quickly, counteracting the loss in sensitivity of LFA[D] tests and averting a similar amount of transmission.

Therefore by combining PCR testing and LFD testing in care homes an increased number of asymptomatic infectious individuals will be identified and can be isolated more quickly to avoid further transmission. Whilst we recognise that this places an additional burden on the sector at a time of huge challenge, it is consistent with the importance placed on trying to identify asymptomatic positive individuals and recognises the longer term benefits of helping to bring outbreaks under control more quickly and preventing further transmission. 

Officials will be writing to care homes to give more detailed guidance on the introduction of additional LFD testing for care home staff.  However as part of the LFD testing programme for care homes;

• Staff will complete one ‘on site’ LFD test at the care homes on the same day as their weekly PCR test.

• Staff will also complete one LFD test midweek between PCR tests.  This can be completed at home before coming to work.

• Ideally staff undertake an LFD test at the beginning of their shift.

• If any staff test positive, they will need to book a confirmatory PCR and then self-isolate at home immediately until they receive their result

• In level four areas, care homes that have a positive case could consider and/or be advised by health protection professionals to undertake daily LFD testing for staff on duty for 10 days as part of an outbreak management process. (Any further extension of daily testing beyond 10 days will require clear justification that is formally recorded and careful consideration of a care homes ability to maintain and comply with the testing.

• Staff who are identified as contacts will still be required to isolate as normal.

To enable this additional programme of testing, funding of £3,045,000 is being made available to the end of the financial year to support the additional burdens associated with increased testing for staff and visiting including the additional cost and time burden of creating appropriate and safe testing spaces, training staff, supervising visitor tests and facilitating safe visits. This additional funding will be made available through the Local Government Hardship Fund in line with existing support to the social care sector and further detailed advice will follow.