Long-term care facilities and daycares among those targeted for coronavirus tests.

COURTESY PHOTO - Andrew Flood, Brok Frost and Chelsie Beaver of Jefferson County Emergency Medical Services help Jefferson County Public Health with COVID-19 testing at long-term care facilities.Three years ago, Public Health staff from Crook, Deschutes, and Jefferson County developed a plan to protect our most vulnerable populations. Health data had repeatedly demonstrated that older adults in long-term care facilities and children in daycares throughout Central Oregon were being disproportionally impacted by outbreaks related to seasonal influenza, norovirus, and other communicable diseases. Additionally, the spread of these illnesses was not limited to each of the individual counties. Instead, trends could be identified that showed the interaction of the three county's populations and the true connectedness of Central Oregon as a whole. "Communicable disease does not know county lines and working together as a tri-county area improves the response to protect the public's health. The team really strengthens the response," said Muriel DeLaVergne-Brown, Public Health Administrator in Crook County. As the three organizations operated at different levels in with different capacities, a formal agreement was established. This agreement created the Central Oregon Public Health Partnership.

The Central Oregon Public Health Partnership was formed with the very specific goal in mind of limiting the potential for outbreaks with our most vulnerable population. Originally developed to assist both long-term care facilities and daycares with personalized training and education around infection control and outbreak prevention, the program has shifted in the last two years to focus exclusively on long-term care facilities. "We looked at the data and our need in Central Oregon to better prevent and respond to communicable disease outbreaks. Long-term care facilities are a fragile population, and that's who's seen the majority of flu outbreaks and norovirus outbreaks in our region. So our three public health departments came together and created an infection prevention program that provides training and consultation to long-term care facilities to help them prevent and quickly respond to outbreaks," adds Heather Kaisner, Advancement and Protections Section Manager with Deschutes County Health Services. The shift in focus could not have been timelier, as the impacts of COVID-19 on long-term care facilities has made local and national headlines.

In June, Governor Brown announced a new Comprehensive Coronavirus Testing Plan for all long-term care facilities. These best practice guidelines included:

Conducting active daily screenings for fever and COVID-like symptoms for all residents and staff,

Providing monthly testing for any residents or staff with even mild symptoms.

Providing testing for all residents and staff if there is a single new confirmed or suspected resident case or a confirmed staff case and retesting weekly until at least 14 days pass without a new positive result.

Testing all new residents prior to admission or readmission.

With support from Jefferson County Public Health, Jefferson County Emergency Medical Services (JCEMS), Oregon Office of Emergency Management, and the US Department of Veterans Affairs, all long-term care facilities in Jefferson County have completed the first round of COVID-19 testing of all residents and staff. Why is this so important? Resident surveillance testing is very important because there are many COVID-19 positive cases who have no symptoms that are considered infectious and able to spread to others. Staff surveillance testing is very important because they are the ones that leave the facilities after their shift and have the potential of becoming infected and bringing that back into the long-term care facility community. Because of the seriousness of this illness for this vulnerable population, Oregon Health Authority and Department of Human Services licensing agency have implemented testing requirements for all types of long-term care facilities: Skilled Nursing, LTC, Assisted Living, and Memory Care. Visitor restrictions have been in place at long-term care facilities, since June, to help prevent additional sources of exposure for the vulnerable residents. Residents only leave the facility for necessary medical appointments, or other very specific reasons. "A COVID-19 outbreak in these settings represents a significantly higher risk of serious illness and fatality to residents, due to their congregate setting and vulnerable population", states Kari Coe, the Public Health Infection Control Nurse.

All long-term care facilities in the state of Oregon must complete one round of all residents and staff testing by September 30, 2020. After testing, facilities need to start 25% of all mandatory staff testing weekly, within 30 days of the comprehensive testing completion. The facilities are required to operationalize this work themselves. The goal is to complete 100% of the staff each month, then start the rotation again each month while we are in this global pandemic.

In July, Jefferson County Board of County Commissioners established a small grant program to support local long-term care facilities in purchasing personal protective equipment (PPE), cleaning supplies, and testing materials. Coe will continue to be in close communication with them regarding testing and results.

The Central Oregon Public Health Partnership's work with long-term care facilities has been shown to be very successful. In fact, similar versions are now being attempted throughout the state with several counties and a position similar to the infection control nurse has been created with the Oregon Health Authority to support this work.

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