Will testing for more viruses in care homes be helpful? Help us find out!

Adam Gordon is Professor of Care of Older People at the University of Nottingham and President of the British Geriatrics Society. Here he talks about ongoing work with colleagues at Imperial College London and the University of Oxford to understand the role of multiplex testing in care homes. You can find him on Twitter @AdamGordon1978

Winter infections have always been a problem for care homes and the residents that live in them. Those of us working in care of older people usually enter the festive season knowing that we’ll spend much of our time caring for care home residents affected by flu, pneumonia, and norovirus. Individual residents often fare poorly, and their difficulties are compounded when homes have to close due to outbreaks.

It wasn’t until the COVID-19 pandemic that the public - and public health - consciousness fully grappled with the harm associated with winter infections in care homes. During the first wave of the pandemic, 48% of deaths with COVID in England were in care homes. The closure of care homes associated with outbreaks has led to substantial harm to residents and their families, and the human rights issues around this are still subject to ongoing challenge in the courts.

It’s right to ask at this time both how can we keep residents safer from winter outbreaks, and also how can we manage outbreaks in a way which is less harmful to residents and their families? Central to this is testing for winter outbreaks, so that we know when people have infections.

During the pandemic, lateral flow tests became established as the default way of testing for COVID-19 at the point of care. This was because these tests were cheap and readily available. As part of the CONDOR platform, we tested other technologies, including point-of-care polymerase chain reaction (PCR) and antigen tests. Many of these were more sensitive and specific than lateral flow tests. Many of you will now be using the technologies we evaluated if you work in NHS acute care.

The CONDOR platform also showed that these technologies could be deployed in care homes, and that they were safe and usable in this setting. The disadvantages by comparison with lateral flow related to the cost per test and the availability of the technology.

As we move into the post-pandemic phase, though, these novel technologies open up a new horizon: the possibility that we can use multiplex tests to test for multiple different infections at the same time. Tests are available for COVID-19, influenza and respiratory syncytial virus (RSV). This type of technology could potentially be useful in a care home setting. It might enable staff to work out more quickly what type of infection a resident has, enabling them to choose the right treatment or isolation approaches, for example. This, in turn, could help prevent outbreaks - or it could make them shorter and less severe.

At the same time, it’s possible that care home staff might be overwhelmed by multiple test results, particularly if there were outbreaks of more than one virus in the same home at the same time.

We are looking for those working in or with UK care homes to respond to a questionnaire we have developed about multiplex testing, to better understand where it might fit. We need to know whether care home staff think it might add value, or whether it might add complexity or lead to confusion.

Please help us by answering our survey here: https://imperial.eu.qualtrics.com/jfe/form/SV_9HNOALwafVrzTBI

We hope to use these insights to shape future research into multiplex testing in care homes.