Some providers are dubious as the pre-COVID return to ‘normal’ becomes officially OK

Providers are still asking for answers about how best to comply with a slew of new rules and recommendations issued by federal agencies over the past two weeks, officials confirmed during a call from nursing home stakeholders on Thursday.

One of the most frequently asked questions is whether employees in buildings can really work maskless in areas without high transmission power. Others concern whether staff can skip daily COVID-19-specific screening measures and return to routine resident assessment, and whether dining and activities in areas with lower transmission rates can now function much like they did before COVID.

The answers to all of the above questions are yes, reiterated officials from the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and the White House COVID-19 Response Team.

However, it will be crucial to keep an eye on local transmission rates and remain vigilant to encourage vaccination of residents and staff to maintain new, pre-COVID-like freedoms. COVID death rates are rising in the over-75 age group, officials admitted Thursday.

“You’ve heard a lot today about the strength of the vaccines and I just want to reiterate that one of our concerns is that with these new, revised guidance we are detaching or separating some of the testing requirements from vaccination status. said Evan Shulman, director of the CMS nursing home division. “This might make some people wonder if vaccination still matters? The answer is unequivocally yes.”

During the call, CMS officials said the only remaining vaccine requirements are that providers have received their first batch. There are no boosters under the federal mandate.

However, White House expert Tom Tsai, MD, noted that deaths among those over 75 have increased over the past six months, even as the country recorded its lowest six-month average daily death rate since the pandemic began.

Even more alarmingly, the proportion of deaths in nursing homes has started to rise, while deaths in hospitals have been falling.

“We’re in a different place this year because we have access to treatments, but we need to use those treatments effectively and use our vaccines effectively,” Tsai said. Captioned that new efforts are being made to add telemedicine to the state’s test-to-treat initiative launched earlier this year.

Administration of Strategic Preparedness and Response chief medical officer Meg Sullivan, MD, noted that HHS has increased its test-to-treat reach to 44,000 physical locations and affiliated 2,000 long-term care pharmacies to the effort. However, she said of those enrolled only a small number are active, meaning they have not reported any stock ordering additional supplies recently.

Testing can remain part of infection control measures in care homes and should continue in areas that still have high transmission, which still included most of the country earlier this week.

This distinction, and when staff should be allowed to remove masks and other PPE, was critical that several speakers wanted to underscore.

A screening test is still recommended for new admissions in high-frequency areas. Testing should also be done in suspected cases or after known exposure, according to the CDC.

But it’s also important that providers heed new information provided by CMS last week that again restricts the off-label use of point-of-care antigen testing.

Still, Shulman noted that it’s largely okay for many facilities to return to pre-COVID “normal” conditions for both residents and their potentially exposed visitors when it comes to dining and communal activities.

“With the exception of some guidance from CDC, the answer is yes. We say we should encourage physical distancing and avoid large crowds, and we think that’s an important thing. But there’s nothing on the CDC website or in our guidance that prohibits sharing meals or activities, so they can go ahead as usual,” he said.

“Be careful. Of course, the safest practice is to keep physical distance and wear source control, but depending on where we are and the instructions, it’s permissible,” he stressed.

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