Jones-Harrison infection preventionist: ‘Our best approach is to prevent, prevent, prevent’

The Southwest Journal is documenting the coronavirus pandemic by recording the personal stories of Minneapolis residents and workers whose daily lives are in a state of flux. As the outbreak evolves, we will be checking in with the participants regularly. Read all of the stories here.

All interviews are conducted over the phone, and conversations are edited for length and clarity.

Barb Joyce, infection preventionist, Jones-Harrison senior living 

Testing is keeping our numbers low. The good news is our residents aren’t sick. The sad news is we’re in this location, Hennepin County, where the numbers are still kind of crazy. So we have to be careful.

The first area we’re focused on is our staff who are traveling for vacation. They deserve to do whatever they want to do, but going onto an airplane, or into areas with high instances of COVID, is a concern. Depending on what they’re doing and where they’re going, I might tell them I want a phone call before they come back into the facility. If they attend a wedding, we’ll evaluate their exposure together and determine whether they need to be tested. This is taking a lot of my time. 

We’re also focused on preparing for the cold-weather months and our influenza season. Part of me is concerned with how we don’t know how it’s going to evolve. And then the other part of me thinks how we’re doing such a good job with the social distancing and masking that we may see less influenza this year. We’re preparing for the worst, hoping for the best. I can’t even imagine what it would be like to be sick with both viruses. 

I have health care workers who are still feeling the effect of COVID for months after. Some still don’t have their sense of smell back after close to 12 weeks. And nobody knows 100% if you can get it twice. So our best approach is to prevent, prevent, prevent. You see the asymptomatic carriers, and I’ve joked, “Sometimes I wish I’d test positive, because then I’d have a 10-day vacation.” But that’s a joke — it’s bad humor — because I don’t want the chance of how this virus will affect my body for the rest of my life. 

We’re still finding the balance in following the regulations about visitation while we are still experiencing COVID exposures. Last week we had two health care workers test positive; both of them are still asymptomatic. Our residents have tested negative through the whole month of August.

Visits are going well. The issue is families want more, and we have to limit based on the staff supervision we have. Our activities staff is in charge of these visits and, with their time spent watching one-on-one visits, it’s making it harder for them to bring programs and joy for the people in the units. We might have two residents in the courtyard and 60 residents upstairs who aren’t getting the benefit of our music therapist. If you have to live in a nursing home, your best friends are the recreation therapists because they know you the best on your likes, your dislikes, your past.  

The testing is still a big issue and a hot topic. The CDC tried to slip in a new guidance, without telling anybody, that if you’re exposed to someone who’s COVID positive, you don’t necessarily need to be tested. We have always said it’s better to be tested and to know that you’re not shedding than to potentially expose others. The CDC got a lot of heat from doctors and the director kind of backstepped a little, but the website still hasn’t been changed. It’s interesting, is all I’ve got to say. [Minnesota health officials continue to urge testing of asymptomatic people with known exposures.] My hope is we’re being fed the best information out there, because I don’t have time to go down the rabbit hole.

In the state of Minnesota, the governor’s doubling down on his testing strategy. Yesterday, the state gave us an on-site COVID analyzer. It is a single machine on which you can do “point-of-care” antigen testing. 

It will not replace the testing we’re currently doing. We’re still mandating weekly staff testing using an RT-PCR test that is more accurate than antigen testing. That takes about 14 hours to accomplish for all our staff. With no residents testing positive, we decided about three weeks ago we would reduce our testing of residents to something called target testing — essentially contact tracing. If we don’t see positive tests, we’ll back away from testing units and just do random testing, but we’re not there yet.

Each single antigen test takes about 15 minutes to analyze. So if one person goes around and tests about 200 employees, it would take 50 hours — and who has 50 hours to focus on one little aspect of testing? So we’re still in the developmental phase figuring out how we’re going to use this antigen testing, knowing that it takes more time, is less effective [the test yields up to 15% false negatives] and there is some literature saying it works better on symptomatic residents. Right now, I would only use it if someone had a sudden onset change in condition as my first line of determining is this person testing positive. 

But the RT-PCR tests are $70-$80 each and I’m sending 200 per week to the Mayo Clinic. Another lab we use for our resident testing is even more costly. So it’s costing us a lot of money. The state donated the antigen machine and 576 test kits. I’m not sure yet how much it will cost to buy more, but we may also be able to use the machine to test for influenza and strep in-house. 

The Minnesota Department of Health and LeadingAge don’t have guidance on how to use them. We don’t even know how it works yet. There’s a hundred-page manual we have to comb through. It would be nice to do an on-site analysis within hours, rather than days.

But we need some time to figure it out. 

I’m concerned with a teacher in our family who’s going back to in-school teaching. I think the numbers that went up this past week are probably a direct result of in-room schooling. I’m nervous for the future for the school kids and of both the social isolation and the stress the kids are living with right now, as well as the risk of long-term effects. I don’t want to read in the newspaper about ICUs with children and about teachers put on ventilators because they are being forced to go back into the school against their will. 

I’m good with how our facility is running. Our nurses feel like we’re in this new normal, and nobody’s bucking the system anymore saying, “Why do we have to? Why do we have to?”

Personally, I’m more of an introvert, so I’m doing well with what I have at the house. I have two grown kids who are in our bubble, and I have a dog, Mabel, a rescue pitbull mix — our therapy dog — that reduces our stress level. She’s just a cuddler. 

Barb Joyce and her “therapy dog” Mabel. Submitted photo

VOICES FROM THE PANDEMIC

 You can read all of the stories here.