As our understanding of the coronavirus develops, it has become clear that asymptomatic carriers could be the biggest threat when it comes to containing the virus, most notably in senior living communities due to the high susceptibility of the elderly to the virus. Given the asymptomatic nature of many carriers, testing for COVID-19 is becoming a critical weapon vital for protecting the elderly in senior living communities.
Barry Kaganson, CEO of Auria Senior Living – a company that develops, owns and operates senior living communities in South Africa – says: “It is becoming clear that the biggest battle the medical community is facing when it comes to containing this coronavirus is in identifying carriers. Previous thinking was that symptom identification was sufficient, however, recent case studies are showing that there is actually far more that can be done.”
A case study released by the U.S. Centers for Disease Control and Prevention (CDC) in early April, which focused on a sub-acute nursing facility in King County, Washington, showed that of the 23 residents who tested positive for COVID-19, 13 reported no symptoms initially. A mid-April study showed that up to one-third of residents in Chelsea, a hot spot in Massachusetts, may have been infected, and only half of them could recall having a single symptom over the previous four weeks. Another small study, of pregnant women in New York City, found that 15% tested positive for the virus, and 80% of them had no symptoms.
Pre-symptomatic transmission of Covid19 has been well documented – that is, people passing on the virus before they show any symptoms. The incubation period for COVID-19, which is the time between exposure to the virus (becoming infected) and symptom onset, is on average 5-6 days, however it can be up to 14 daysiii. During this period, also known as the “pre-symptomatic” period, some infected persons can be contagious. Therefore, transmission from a pre-symptomatic case can occur before symptom onset.
Senior living communities at risk
Kaganson says that senior housing and care providers in South Africa have to act quickly before they start discovering high rates of asymptomatic or pre-symptomatic cases amongst both residents and staff in their communities. An article published in the New England Journal of Medicine on 24 April 2020 suggests that “A new approach that expands COVID-19 testing to include asymptomatic persons residing or working in skilled nursing facilities needs to be implemented now.”
Containment and testing are critical
While most of us have thought that a combination of obvious symptoms and COVID-19 testing are sufficient to identify those who are infected, it is now clear that there is a major risk associated with symptomatic assessment alone. If the disease is contagious even in the absence of obvious symptoms, as it now appears, it means that there is a far higher likelihood of it being spread by unknowing carriers. Kaganson says that to protect the residents in senior living communities, actual testing combined with stringent containment measures is vital to protecting the health of the elderly. “Until now, most risk mitigation strategies have been focused around identifying symptomatic people – those with raised body temperatures, coughs, etc. However, this doesn’t deal with the real risk of asymptomatic transmission,” says Kaganson.
Kaganson also points out that staff who make use of public transport to come to work run the daily risk of becoming infected. Despite the nationwide five-week lockdown, Auria has been taking steps to mitigate this risk by housing all such staff on site to protect the virtual ‘bubble of safety’ around its senior living communities. However, as we enter ‘Lockdown Level 4’ more industries will have staff returning to work. Despite the nation’s best efforts to be prepared, we need to accept that the infection levels in South Africa will rise in the coming weeks. In fact, Professor Abdool Karrim, an infectious diseases specialist, has warned that South Africa’s COVID-19 infection rate will likely only peak in September. While residents of senior living communities remain in effective lockdown, even minimal exposure to commuting staff could pose a threat. The fact that infected staff could be asymptomatic poses a “silent threat” which requires serious consideration.
Rigorous process needed to protect those at risk
“Given that infection rates are due to escalate, we have stepped up our vigilance and will now be doing comprehensive testing among staff before they enter Auria’s senior living communities to begin their work shifts,” says Kaganson. “We also owe it to our highly committed staff to ensure their health and safety as far as possible.”
In order to facilitate quick identification and mitigation, Auria has devised a joint containment and testing strategy which entails all commuting staff being “quarantined” for 7 days prior to commencing their 14 day shift. During this quarantine period, they undergo nasal swab testing by a private pathology lab, and results are received within 24-48 hours. This ensures that once staff commence their 14 day shift, particularly in the high-risk care environment, it is reasonably certain, both medically and symptomatically, that they are not Covid19 positive.
“We believe that this maintains a ‘safety bubble’ around our communities which greatly reduces the chances of transmission by asymptomatic or pre-symptomatic staff,” says Kaganson. The fact that staff reside on site during their 14 day shift, and are also not commuting during their seven day quarantine, reduces their own risk of infection. This is important because a test is done at a single point in time, which would not be helpful in the case of staff who commute daily and are therefore at daily risk of infection. “This quarantine provides us the opportunity to get clear test results and prevent any infected persons from entering our communities,” says Kaganson. “It gives us a reasonable period since the last possible exposure to reduce the probability of a ‘false negative’ and a reasonable time after the test before a work shift starts to receive the test results.”
“The wellbeing of our residents is of paramount importance to us. They chose an Auria community in which to live their lives safely and in an environment of care. We owe them our extreme vigilance and diligence when it comes to their health and safety,” says Kaganson. In implementing this staff testing protocol, Auria maintains that it is operating in line with the most recent international best practice.
“With proper identification and quick mitigation, the spread and impact of this disease can be limited,” concludes Kaganson.
[i] https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e1.htm
[ii] https://www.nytimes.com/2020/04/26/opinion/coronavirus-test-asymptomatic.html
[iii] https://www.nejm.org/doi/full/10.1056/NEJMe2009758
About Auria Senior Living
Auria Senior Living (Auria) develops, owns and manages a portfolio of senior living communities throughout South Africa.
Auria is setting a new benchmark in continuing-care community living for the over 70s, providing for the intellectual, emotional, social and physical needs of its residents, in attractive and well-located environments.
The company’s flagship is San Sereno in Bryanston, and it is currently upgrading and renovating Melrose Manor in Melrose, due to be completed by mid-2020. Its latest project, Royal View, is a 122 apartment senior living development on the Royal Johannesburg & Kensington golf course, due to open at the end of 2021, with sales commencing in mid-2020.
For more information on Auria Senior Living visit: www.auria.co.za, or contact 087 654 8833.
Press Contact:
Mantis Communications
Kerry Simpson
Tel: 079 438 3252
Email: kerry@mantiscoms.co.za