HHS testing official warns Nevada must drop antigen testing ban

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The U.S. Department of Health and Human Services’ top testing official said Friday Nevada’s ban on rapid coronavirus tests in nursing homes could “endanger lives” and urged state health officials to immediately reverse course.

Assistant Secretary for Health Brett Giroir said Nevada would face unspecified enforcement actions if state health officials did not remove an order instructing nursing homes to discontinue use of point-of-care antigen testing machines made by two companies, Quidel and Becton, Dickinson.

HHS  “expects immediate action from Nevada to reverse its unwise, uninformed and unlawful unilateral prohibition,” Giroir said Friday in a phone call with reporters. “Lives are at stake and our administration is not going to allow actions to risk our seniors or any other vulnerable or underserved population.”

Nevada health officials did not immediately return calls or emails from USA TODAY.

On Oct. 2, Nevada officials ordered nursing homes and other long-term facilities to discontinue use of the antigen testing instruments authorized by Food and Drug Administration “until the accuracy of the tests can be better evaluated.”

 (Photo: Becton, Dickinson)

The Nevada Department of Health and Human Services chief medical officer and two other high-ranking health officials cited a high rate of false positive results at eight facilities that used the antigen tests, according to a bulletin for nursing homes and health-care providers.

But Giroir said Nevada’s ban represents a misunderstanding of the role of testing machines in screening large numbers of people who might unknowingly pass the virus to others.

HHS has purchased and sent rapid antigen testing instruments to nearly 14,000 nursing homes nationwide as part of a strategy to protect vulnerable seniors. Deaths in nursing homes represent up to 40% of total COVID-19 deaths in the U.S., Giroir said.

These antigen tests are less expensive and provide results more quickly than lab tests. The tests can quickly detect positive cases among nursing home workers, potentially saving infections that can rapidly circulate in a home where many residents have underlying medical conditions that make them more vulnerable.

False positives are inevitable, even when using more accurate lab tests, when relatively few people are infected, he said.

“There is no such thing as a perfect test,” Giroir said. 

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Nevada officials said eight nursing homes using the antigen instruments sought to confirm results at labs using a more accurate form of test, called molecular polymerase chain reaction or PCR. Only 40% of the antigen tests that delivered positive results were confirmed by lab tests – in other words, 60% were false positive.

Girior said Nevada’s figures show “an outstanding result, not a disturbing one,” because the rapid testing likely caught cases and prevented new infections from circulating in homes and potentially killing residents.

The trade-off is nursing assistants and other staff are held out of work for 48 hours, or however long it takes to confirm antigen tests with more accurate lab tests. 

“This is a minuscule price to pay for identifying and isolating those who are infected, infectious and who can devastate our elderly in nursing homes,” Giroir said.

In July, dozens of people who took rapid antigen tests at a Manchester, Vermont, clinic  were told they had the virus, only to be informed days later by state health officials that more accurate lab tests concluded they didn’t.  Quidel, the company that makes the rapid antigen test used by the clinic, stood by the original results. The FDA  informed Vermont it found no issues with Quidel’s instruments or how they were used.

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