News that free rapid at-home COVID-19 tests will be sent by the federal government (you can order them by mail as of Tuesday) couldn’t come fast enough for Cherry Marcelo, an administrator of Elmwood Nursing and Rehabilitation Center in South Berkeley, a facility that was hit hard by the early pandemic.
Like many nursing home staff, Marcelo has had to make difficult choices with Elmwood’s limited allotment of rapid tests since the state tightened visitor testing requirements at the end of last year.
As of Dec. 31, anyone wanting to visit someone in skilled nursing care must show proof of a very recent negative COVID-19 test, in addition to proof of vaccination. This also applies to people in intermediate care, or in a senior or adult residential facility licensed by the state.
Marcelo, like most nursing care managers, supports the new regulations. But she now faces families asking for testing from Elmwood, with her supplies needed for staff and patients. “We can’t offer them an antigen test because there is a shortage,” Marcelo said.
Marcelo recently made a heart-tugging exception.
A daughter showed up to see her dying mother, unaware of the new testing requirement. “We actually let her come in and we did the rapid test on her. We made it possible for her to see her mom,” Marcelo said. “It’s end of life.”
Marcelo said she also provided an on-site test recently to a visitor who had traveled far and wasn’t aware of the new requirements.
Precious resource forces tough decisions
For much of the pandemic, nursing homes were closed to visitors, but regulations loosened last year when when infection rates dropped and most older adults had been vaccinated.
Omicron forced the state’s re-think. It’s also forcing the stressful frenzy for the hard-to-come-by rapid tests, including in Berkeley. It boils down to survival of the luckiest, wealthiest, and most able.
People with loved ones in nursing care are in company with many others on the rapid test hunt since since omicron swooped in. Local social media and other reports are filled with stories of people desperate for tests before going to gatherings or events, or because they don’t feel well, or learned they’ve been exposed.
And this is aside from rapid school testing for students, teachers, and staff. Schools receive tests directly, through different programs and methods than medical settings.
Marcelo tested another visitor recently who had travelled far, and hadn’t learned of the new requirement.
Like at many nursing homes, visits are by appointment, and online video visiting is encouraged, she said.
Under the state’s new visiting requirement for nursing and acute care settings, visitors must show proof of a negative rapid or antigen test taken within one day, or a negative PCR test within two days (daily visitors can test every three days). Antigen results take about 15 minutes. PCR results usually take a few days.
This is in addition to proof of vaccination; proof of a booster shot is required for indoor but not outdoor visiting. Masking and social distancing are also required.
Nursing care staff must be vaccinated and test regularly, more often if they aren’t yet boosted or have a known exposure.
“Based on the emergence of Omicron, additional statewide facility-directed measures are necessary to ensure we protect the particularly vulnerable populations in long-term care settings,” said a California Department of Public Health statement on the updated regulations.
“This [new regulations] is great BUT … as you are likely aware, test supplies are scarce,” said KJ Page, administrator of Chaparral House, a skilled nursing facility in central Berkeley.
“We are carefully rationing our current supplies to assure we can do the also required twice weekly testing for all our staff (100% of whom are vaccinated and close to 80% are boosted),” Page said.
Chaparral requires visitors to test on site by appointment with a staff person observing, as recommended but not required by the state.
Visitors face back-ordered home tests and long waits for PCR testing appointments. Chaparral faces limited tests for staff and patients, also back-ordered, Page said.
“How is this going to work?” she asked.
“I have a line of upset visitors … and disappointed residents. Visitors are essential to our resident’s well-being,” she said. “We want to be in compliance with the rules, keep everyone safe and allow visitors, ” Page said.
Another nursing home, Berkeley Pines, isn’t allowing any visiting right now because a staff person tested positive for COVID-19, said administrator Al Macasieb. That person is quarantining at home. The facility is required to close to visitors until two rounds of negative staff tests, he said. Families have been notified and “are very understanding,” he said.
Balancing safety and care
Larry Yabroff, whose wife is at Chaparral House with late-stage Alzheimer’s, said he’s learned in recent weeks to be aggressive and expect the unexpected.
“It’s like being a stranger in a strange land. Nobody seems to know when tests are coming in. Not even store managers. Normal rules don’t apply,” said Yabroff, a Berkeley resident, who tries to visit his wife every other day.
His new visiting schedule — his wife has been at Chaparral for two years — is an exercise in calling and rushing to drug stores and pharmacies, sometimes waiting in long lines only to be disappointed.
He is visiting her less now.
“What I’m also experiencing is this kind of general fatigue,” Yabroff said, describing navigating omicron as a kind of Sisyphean task, referring to the Greek myth where Zeus punished Sisyphus by forcing him to roll a heavy boulder up a hill over and over again.
“We kind of got the boulder to the top of the hill and things were relaxing and boom … omicron and we’re pushing it up again,” Yabroff said.
Kat McGowan and her partner, Parker Barnum, have been lucky with Chaparral visits to her sister-in-law — so far. Chaparral is providing testing on site.
Her sister-in-law has an advanced neurodegenerative disease and the Berkeley couple try to visit daily.
“I don’t know what we would do if they said I’m sorry we can’t do this anymore,” McGowan said, “We’ll have to cross that bridge when we come to it.”
Her sister-in-law, she said, “needs a lot of help and support. We provide another level of attention that they just can’t.”
Phone calls, video visits and even window visits don’t work well for her, McGowan said.
McGowan knows what the rapid-test chaos feels like, needing them to visit her elderly parents in San Diego, who both have dementia. “I’ve seen firsthand how incredibly difficult it is for ordinary people to get and pay for these tests,” she said. “It makes me angry. This is not a realistic situation.”
She adds: “If we could buy our own tests and bring them [to Chaparral House] I’d be happy to do that. But we can’t; there aren’t enough tests.”
Free rapid tests from the feds
To order, go to special.usps.com/testkits. Tests will ship within 7 to 12 days, the administration said. A toll-free phone number for ordering is supposed to launch soon.
Additionally, the administration said, private health insurers will be required to cover at-home COVID-19 tests for their patients starting Jan. 15. Check with your health plan or provider for details.
Yabroff, for one, however, is skeptical of the government’s sweeping mailed-test plan. “I’m pessimistic,” he said, remembering how vaccination scheduling websites crashed early in the pandemic. “Everyone and their mother will be on the phone Wednesday morning trying to get a test. I think it will be chaotic.”
McGowan said it all sounds good, but it will take several weeks for these tests to arrive. “I’m glad the Biden administration is going to buy everyone tests, but what about right now. We can’t wait three weeks.”
City says it’s helping priority groups
The Berkeley Health Department is expanding its testing to help meet omicron demands, with new state funding, said Lisa Warhuus, city director of health, housing, and community services.
This includes at least some rapid tests.
As of last week, the city had received 3,000 rapid antigen tests from the state, which it will distribute on a priority system based on test access and risk, Warhuus said. She hasn’t specified a timeframe to start distributing the tests.
Priority groups include congregate care settings such as rehabilitation centers.
Other rapid test priorities are shelters, essential workers, day laborers, domestic workers “and those who would not otherwise have access to over the counter at-home testing,” Warhuus said.
On Monday, after being asked specifically about nursing homes, Warhuus said the state health department will send rapid antigen tests to skilled nursing facilities for visitors.
“As supply of these tests increases, we will consider broadening distribution,” she said.
Getting the hang of rapid test taking
Using the tests correctly is vital to their success in preventing Covid-19 spread, experts stress.
Rapid tests (antigen) aren’t as reliable as PCR tests, which means there can be false negatives and positives. They are most accurate when the viral load is high or the virus strong.
But they play an important role in screening, in addition to being portable and relatively easy to use, experts say.
Magdalen Edmunds, a physician at the nonprofit Lifelong Medical Care, which has five clinics in Berkeley, offered advice on home testing, based on state guidance.
If you test positive with an at-home test — with or without symptoms — treat it as a true positive and begin isolation or staying away from others.
If you don’t have symptoms but test positive at home, try to get a PCR test to confirm the rapid test result, avoiding close contact with others. If this isn’t possible, repeat the home test 3-5 days after the initial positive result. If this result is negative and you feel better, come out of isolation but mask around others for another five days.
If you test positive on a home test, but can’t access a PCR test or another home test, quarantine for 10 days.
If at any point you have trouble breathing and/or a high fever or life-threatening symptoms, go to the emergency room.
During times of high community COVID-19 spread, avoid gathering indoors with people outside of your household and wear a mask (surgical, N95, KN95) if you must gather.
The Centers for Disease Control (CDC) offers these tips for rapid tests.
- You can use self-tests, regardless of vaccination status, or whether or not you have symptoms.
- Follow all of the manufacturer’s instructions for performing the test.
- If you test positive, you should isolate and inform your healthcare provider, as well as any close contacts.
- Consider using a self-test before joining indoor gatherings with others who are not in your household.
- A positive self-test result means that the test detected the virus, and you are very likely to have an infection and should stay home or isolate for 10 days, wear a mask if you could have contact with others, and avoid indoor gatherings to reduce the risk of spreading disease to someone else.
- A negative self-test result means that the test did not detect the virus and you may not have an infection, but it does not rule out infection. Repeating the test within a few days, with at least 24 hours between tests, will increase the confidence that you are not infected.