Dartmouth-Hitchcock Medical Center

A state-mandated program aimed at preventing future COVID-19 outbreaks in New Hampshire nursing homes by regularly testing staff and residents will now rely on a laboratory at Dartmouth-Hitchcock Medical Center instead of a distant for-profit lab.

That promises to shorten the lines of communication in a program which, since June, has required local nursing home operators to send thousands of samples for COVID-19 tests more than 700 miles to North Carolina laboratories run by a small company named Mako Medical.

“We were able to stand up Mako fairly simply, and it was OK, and now we have to pivot and move in a different direction that’s going to give us even better results,” N.H. Health and Human Services Commissioner Lori Shibinette said in a Zoom conference on Wednesday.

Nursing homes have been ground zero for the COVID pandemic in the Granite State. Of 405 deaths attributed to COVID, 332 occurred in nursing homes and other long-term care facilities including 304 in 32 multi-case outbreaks, according to data compiled through Thursday by state authorities.

In June, as the death toll mounted, New Hampshire officials launched a “surveillance and sentinel” program that during each 10-day cycle aims to test all employees and one in 10 residents in the state’s 75 nursing homes. That program reflected a change in prevention strategy that incorporated new scientific data that showed that COVID transmission often could be traced to infected people who had not yet developed high temperatures or other symptoms of illness.

Now state officials have adjusted that testing strategy. “We’re really working hard on trying to keep and bring some of our testing capacity up in state,” Shibinette said. “The more we can keep it local the better turnaround times we have, the better control over quality we have.”

Since early June, Mako processed nearly 20,000 samples collected from New Hampshire nursing home employees and residents and sent to the company’s North Carolina laboratories for analysis, according to data compiled by HHS. In the week that ended July 21, Mako conducted 786 tests a day for its New Hampshire customers, according to HHS.

Shibinette said the move to localize testing was prompted in part by lengthening times between sample collection and test results reporting in the program: “We’re seeing longer turnaround times from some of our commercial labs, because of not what’s happening in New Hampshire but because of what’s happening elsewhere in the country.”

Strains on testing providers have increased as the rate of infection has risen nationwide and surged in large Sunbelt states. On Wednesday, the U.S. Centers for Medicare and Medicaid Services announced that it would require weekly testing of employees in nursing homes in all states where more than 5% of individuals tested have the virus. During July, New Hampshire’s positive rate has remained well below 5 percent, according to the Johns Hopkins Coronavirus Resource Center.

Quality concerns also surfaced in New Hampshire’s nursing home testing effort, according to Brendan Williams, president of the N.H. Health Care Association, an organization of private and nonprofit nursing home operators. Williams said that at a July 17 board meeting several attendees complained about false positives in Mako tests. Such results, in which the test incorrectly signals the presence of the virus in a subject, were very alarming, adding to staffing and protective equipment expenses and triggered isolation of tested subjects and their roommates, he said.

A false positive episode also occurred in late June at the Mountain View Community, a county-run nursing home in Ossipee. Mountain View Administrator Howie Chandler reported that two residents whom Mako identified as COVID positive were found to be virus free in follow-up testing. After first denying that a so-called false positive test was possible, Mako acknowledged that a “pipetting error” and an inconclusive test had led to mistaken outcome, Chandler said.

Chandler said that while he understood that testing volumes at Mako were up as a result of the surge in disease in the Sunbelt that shouldn’t have affected quality. “You have to have 100% confidence in these tests,” he said. A false positive, and the isolation measures required, “put families through hell,” he added.

After a company public relations aide relayed questions about turnaround and quality issues in Mako’s New Hampshire testing program, Chief Operating Officer Josh Arant sent this brief response by email: “We are appreciative of the partnership with the New Hampshire Department of Health and Human Services during this pandemic and we are glad we were able to assist in fighting the spread of COVID-19.”

Not everyone was dissatisfied with Mako’s performance. Gary Sobelson, medical director of the Genesis Pleasant View nursing home in Concord, said the company’s testing “went pretty well.”

But Mako’s role as sentinel surveillance tester in New Hampshire ended this week. So far, HHS’ contract with Mako has not been made public nor its terms disclosed.

Dartmouth-Hitchcock spokesman Rick Adams said that the hospital was looking forward to its new role as a sentinel surveillance tester. Its agreement with the state “calls for us to process up to 600 tests per day – well within our testing capacity of up to 2,000 tests per day – with the remainder being processed by the N.H. Public Health Laboratories,” he said.

Terms and language of that deal have not been disclosed.

According to data compiled by New Hampshire officials, Dartmouth-Hitchcock’s testing for COVID recently peaked at 354 on June 13, while Mako processed 1,591 New Hampshire tests on July 18, its busiest day.

Shibinette said that shifting the testing from Mako to Dartmouth-Hitchcock would involve some “ramp-up time.”

But Adams said the sentinel testing wasn’t expected to affect other testing programs being done by the hospital’s Department of Pathology and Laboratory Medicine.

Shibinette said the state was preparing to soon expand surveillance testing to the state’s assisted living communities, beginning with those in Hillsborough and Rockingham counties, where most of the state’s COVID infections and deaths have occurred.

Shibinette also said the state was considering further easing of visitor restrictions at New Hampshire nursing homes, which banned all visitors starting March 15. In early July, limited outdoor visits by residents’ families began at facilities without active COVID outbreaks.

But that provides limited relief. Sobelson noted that Pleasant View, which is licensed for 176 beds, only has the capacity for 12 outside visits in a week.

In Wednesday’s conference call, Shibinette said that HHS officials and epidemiologists were considering ways to safely allow each nursing home resident to receive visits from a relative or someone else designated to act as that resident’s advocate.

This article is being shared by The Granite State News Collaborative. For more information visit collaborativenh.org.