COVID-19 and Influenza Testing in Long-Term Care Settings

Testing Strategies

• The American College of Physicians and the Infectious Diseases Society of America recommend testing all residents and staff weekly for COVID-19 when there are no active outbreaks, and immediately testing any resident or staff member with respiratory symptoms, behavioral changes, or atypical presentations during influenza season or COVID-19 community transmission 1, 2
• The Centers for Disease Control and Prevention suggest increasing testing frequency to every 3 days once a single COVID-19 case is identified in the facility, and using nasopharyngeal swabs for SARS-CoV-2 testing via RT-PCR or rapid antigen tests 1
• The World Health Organization recommends testing residents presenting with atypical presentations that may precede respiratory symptoms, such as diarrhea, falls, or delirium, as well as classic respiratory symptoms like cough or shortness of breath 3, 4

Influenza Testing

• The Infectious Diseases Society of America recommends implementing active surveillance immediately when one laboratory-confirmed influenza case is identified in the facility, and initiating outbreak control measures when 2 cases of healthcare-associated laboratory-confirmed influenza are identified within 72 hours of each other on the same ward or unit 2, 5
• The Centers for Disease Control and Prevention suggest testing any resident with acute respiratory symptoms, temperature elevation or reduction, or behavioral changes without respiratory symptoms during an identified outbreak 2, 5
• The American College of Physicians recommends obtaining separate nasopharyngeal and throat swabs within 24-48 hours of symptom onset for optimal viral isolation, and using rapid antigen tests for faster isolation and prophylaxis decisions 6, 7

Dual Testing Approach

• The Infectious Diseases Society of America recommends testing for both COVID-19 and influenza simultaneously in any resident with respiratory symptoms or atypical presentations when community transmission of both pathogens is occurring 1, 2

Staff Testing

• The Centers for Disease Control and Prevention recommend testing all staff weekly during routine surveillance periods, and testing symptomatic staff immediately before allowing facility entry 1, 3, 4, 8

Laboratory Evaluation

• The American College of Physicians recommends obtaining CBC with manual differential within 12-24 hours of symptom onset for residents with suspected infection, and carefully assessing for bacterial superinfection if left shift or leukocytosis is present 9, 10