Asymptomatic COVID-19 carriers a serious threat to the elderly

BARRY KAGANSON

It’s becoming clear that the biggest battle the medical community is facing is in identifying carriers. Previous screening strategies focused on identifying symptoms, however a lot more can be done.

Pre-symptomatic transmission – people who pass on the virus before they show any symptoms of COVID-19 – has been well documented. The incubation period for COVID-19, which is the time between exposure to the virus (becoming infected) and the onset of symptoms, is on average five to six days, however it can be up to 14 days. During this period, also known as the “pre-symptomatic” period, some infected people can be contagious. Therefore, transmission from a pre-symptomatic case can occur before the onset of symptoms.

Senior housing and care providers in South Africa have to act quickly before they start to discover high rates of asymptomatic or pre-symptomatic cases among residents and staff in their communities.

To protect residents in senior living communities, testing combined with stringent containment measures is vital. Until now, most risk-mitigation strategies in senior living environments have been focused on identifying symptomatic people – those with raised body temperature, a cough, and so on, as well as restricting visitor access. However, this doesn’t deal with the real risk of asymptomatic transmission via staff.

Many staff who work with the elderly in senior living communities make use of public transport to get to work, and run the daily risk of becoming infected. It’s therefore imperative for senior living communities to take other steps to mitigate this risk by, for example, housing all such staff on site to reduce commuting and thereby protect the virtual “bubble of safety” around its senior living communities.

However, as lockdowns in South Africa are progressively eased, the staff of more industries will return to work. In spite of the nation’s best efforts to be prepared, we need to accept the fact that infection levels in South Africa will rise in coming weeks. In fact, Professor Salim Abdool Karrim, currently leading South Africa’s ministerial advisory committee on COVID-19, has warned that South Africa’s COVID-19 infection rate will probably peak only toward the end of winter 2020. While the 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 well be asymptomatic poses a “silent threat” which requires serious consideration.

Given that infection rates are due to escalate, all retirement communities should have a joint containment and testing strategy in place among their commuting staff. One such successful model we’ve implemented is that all commuting staff are housed on site, or nearby, to prevent them having to commute. They are “quarantined” for seven days prior to commencing their 14-day shift. During this quarantine period, they undergo nasal swab testing by a private pathology lab, and the 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’s reasonably certain, medically and symptomatically, that they aren’t COVID-19 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. 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 wouldn’t be helpful in the case of staff who commute daily and are therefore at daily risk of infection.

The quarantine gives us the opportunity to stabilise the staff environment, obtain clear test results, and prevent any infected persons from entering our communities. It also 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.

With proper identification and quick mitigation, we believe the spread and impact of this disease can be limited among the elderly in senior housing and care facilities.

• Barry Kaganson is chief executive of Auria Senior Living, which develops, owns, and manages a portfolio of senior living communities throughout South Africa.