The federal government on Tuesday clarified that fully vaccinated staff members at nursing homes do not have to submit to routine COVID-19 testing, though both vaccinated and unvaccinated residents and workers must still receive tests if they show signs of infection or in the event of an outbreak.

“Upon identification of a single new case of COVID-19 infection in any staff or residents, all staff and residents, regardless of vaccination status, should be tested immediately, and all staff and residents that tested negative should be retested every 3 days to 7 days until testing identifies no new cases of COVID-19 infection among staff or residents for a period of at least 14 days since the most recent positive result,” the Centers for Medicare & Medicaid Services (CMS) wrote in an updated memo to State Survey Agencies.

The loosening of restrictions on routine testing also does not apply to the significant percentage of nursing home workers who have not yet achieved full vaccination.

“Routine testing of unvaccinated staff should be based on the extent of the virus in the community,” CMS observed. “Fully vaccinated staff do not have to be routinely tested. Facilities should use their county positivity rate in the prior week as the trigger for staff testing frequency.”

Those frequencies remain the same as they’ve been for the duration of CMS’s mandatory testing protocols for nursing homes: Once a month in counties with COVID-19 positivity rates lower than 5%, once per week if it falls between 5% and 10%, and twice per week if it’s greater than 10%.

As before, routine testing of asymptomatic residents is not required unless a positive test turns up elsewhere in the building.

“Facilities may consider testing asymptomatic residents who leave the facility frequently, such as for dialysis or chemotherapy,” CMS advised. “Facilities should inform resident transportation services (such as non-emergency medical transportation) and receiving healthcare providers (such as hospitals) regarding a resident’s COVID-19 status to ensure appropriate infection control precautions are followed.”

CMS defines full vaccination as two weeks after the second shot of a two-step vaccine, or two weeks after the single administration of a one-dose inoculation. “Unvaccinated” refers to anyone who does not meet those criteria, including those whose status is not immediately known.

Early research has shown limited cases of “breakthrough infections” — or positive COVID-19 cases after full vaccination — in nursing home staff and residents, though with substantially lower death rates than during the peak of the crisis in long-term care.

In one Kentucky facility that suffered an outbreak of a novel COVID-19 variant, vaccines reduced the risk of symptoms by 87%, according to a Centers for Disease Control & Prevention (CDC) analysis. Across all Chicago nursing homes, fully vaccinated residents accounted for just 4% of COVID-19 cases logged since the start of the vaccine clinics in December 2020, with a single death and no confirmed secondary transmission to other residents.

“To protect SNF residents, it is imperative that [health workers], as well as SNF residents, be vaccinated,” the authors of the CDC-published study on the Kentucky outbreak wrote. “A continued emphasis on strategies for prevention of disease transmission, even among vaccinated populations, is also critical. Timely implementation of infection control strategies after outbreak identification likely contributed to the rapid decline in new cases during the second week of the outbreak.”

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