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Key measures to track SC nursing home outbreaks aren't public, concerning advocates

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Transmission electron microscopic image of an isolate from the first U.S. case of COVID-19, formerly known as 2019-nCoV. The spherical viral particles, colorized blue, contain cross-section through the viral genome, seen as black dots.

A transmission electron microscopic image of an isolate from the first U.S. case of COVID-19. The spherical viral particles, colorized blue, contain cross-section through the viral genome, seen as black dots. CDC/Provided

COLUMBIA — The novel coronavirus remains a deadly threat to scores of South Carolina nursing homes, but gaps in the state’s public tracking of the virus keep families in the dark on how effectively the facilities where their loved ones live have controlled infections.

For some large nursing homes that hosted some of the state’s worst initial outbreaks, whether infections have continued to mount at those facilities in recent weeks is anybody’s guess.

That’s because the state Department of Health and Environmental Control, unlike other models, does not report the number of tests performed at nursing homes, or the percentage of tests that come back positive — both key measures for tracking the virus at large.

In fact, nursing homes aren’t required to do any testing at all. The state health agency tested all patients and staff at the state’s 194 nursing homes in May — roughly 40,000 tests.

But that effort only gathered a baseline. DHEC has not continued universal testing, though health authorities point to it as a key measure for infection control. Since June, while the state health agency has recommended regular testing, it has left the matter up to the nursing homes themselves.

It’s unclear if some homes have heeded the advice.

Consider Greer Rehabilitation and Healthcare Center in the Upstate.

According to DHEC’s latest update, the 133-bed facility has had one of the state’s worst outbreaks, with nearly 100 patients and staff infected and 11 dead.

But that information is two months old. DHEC has not recorded a single new infection at the facility since the beginning of June, and it’s unclear how often the facility has tested residents or staff.

A spokesman for the facility, reached by The Post and Courier, said that staff are screened daily for symptoms, but that the last time all patients and staff were tested was in May.

It’s possible that other tests have been performed sporadically, such as when someone shows a common symptom. But the spokesman, Adam Smith, said he didn’t have more details.

In Columbia, it’s also unclear how often staff and residents are being tested at Midlands Health and Rehabilitation Center. The 88-bed facility at one point had the highest rate of infection in the state — 100 cases among patients and staff, and 12 people dead.

But like with Greer, DHEC has not published any new information about the facility since June. DHEC spokeswoman Laura Renwick said she couldn’t immediately determine what test results the agency has recently received from the facility, if any.

Federal health officials stress that outbreaks should only be considered controlled after rigorous testing for at least a two-week period. Specifically, federal guidance calls for all residents and staff — even those not showing symptoms — to be tested at least once a week, until those results yield zero positive cases for 14 straight days.

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Some nursing homes may have cleared that hurdle, but it’s impossible for the public to know.

In DHEC’s bi-weekly tally of infections and deaths at nursing homes, the agency does not indicate when tests were performed, if there was any lag in results or what percent of tests — per facility — came back positive.

Other models tracking infections at nursing homes are more detailed.

North Carolina’s state health agency identifies facilities considered to have their outbreaks under control, based on test results. Even a private provider, Pruitt Health, on a tracker it maintains on its website reveals more information, such as the number of nursing home patients who have been tested.

At Pruitt Health’s nursing home in North Augusta, for instance, the company’s public tracker shows four suspected cases of COVID-19. Because DHEC has not received a positive test from that facility, the agency has not included it in its tally.

Renwick, the DHEC spokeswoman, stressed that the health agency has kept close watch over nursing homes, including sharing federal guidance on testing as it is updated. DHEC also performed spot infection control inspections at all 194 nursing homes in June and July, she said.

“During those inspections, we were able to assess that appropriate disease prevention protocols were in place at each facility and to perform follow-up surveys at facilities when warranted,” Renwick said.

For lawyers who practice nursing home litigation, the lack of information has only made matters worse for families who have been unable to visit loved ones since nursing homes locked down in mid-March.

Because watchful family members have long been key watchdogs against abuse and neglect at nursing homes, lawyers have called on Gov. Henry McMaster to roll back his restrictions on visitation at the homes.

McMaster seemed prepared in early July to release DHEC guidelines for how nursing homes may begin to allow limited visitation. But as infections mounted statewide, he put those plans on hold.

Brian Symmes, a spokesman for McMaster, said the governor shares the concerns about the lack of visitation, and expects to release the DHEC guidelines soon.

“Nobody wants to open up these facilities more than the governor does,” Symmes said.

Especially for those residents who may be unable to communicate their own conditions directly, lawyers contend it’s critical that families have access to as much information as possible.

“They need to know what the positivity rates are,” said Matt Christian, a Greenville lawyer. “They need to know what the testing procedures are at the facility. And they need to know this information right now.”

Follow Joseph Cranney on Twitter @joey_cranney.

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