COFAR blog

Since early April, the coronavirus has been found in group homes run by more than 80% of the providers to the Department of Developmental Services (DDS), and in more than 3,400 residents and staff in the Department’s system.

Yet, according to the state’s online Weekly State Facility Reporting site, only between 7 and 12 residents are currently COVID-19 positive in the entire DDS group home system. That report stated that its data was current as of June 30.

How is it possible that the virus could have infected so many people in the system on such a widespread basis since April, and yet so few people are currently infected?

Have more than 1,300 residents alone recovered from the virus, as the weekly report claims, or is the low number of residents listed as currently positive wildly inaccurate?

It may be impossible to answer that question, given what appear to be:

• a significant slowdown since May in actual testing for the virus in the DDS system,
• an apparent reliance by DDS on reporting by the providers themselves of the number of COVID-positive residents and staff in their group homes, and the number who recovered, and
• major gaps in the data reported by both DDS and the Department of Public Health (DPH) on the incidence of COVID-19 among persons in Massachusetts with intellectual and developmental disabilities.

First, there appears to have been only a minimal level of testing done in the DDS system over the past month and a half, and virtually no on-site monitoring by DDS of the group home system. As I’ll discuss below, the downturn in testing since late May appears to correlate strongly with reporting by DDS of continuously lower numbers of new positive cases during that period.

Secondly, without the testing to determine the ongoing level of infection, DDS has apparently been relying on the providers to report accurately to it. It is unclear, however, how the providers are able to determine whether residents or staff are COVID-positive if they are not being tested.

It would seem that the most the providers can report with any degree of confidence is whether residents and staff are displaying symptoms. But as has been widely reported, asymptomatic or pre-symptomatic people can still be COVID-positive and are able to transmit the virus to others.

Thirdly, with regard to gaps in the data, the weekly state facility reports do not include the number of currently positive staff in provider-run group homes, so we have no idea what the total number of positive people in the system is right now.

The latest weekly state facility report states that as of June 30, a total of seven residents in provider-run group homes and less than five residents in state-run group homes are currently positive with COVID-19. The report also states that a total of 1,346 residents in all group homes in the DDS system had recovered from the virus.  No information is given of the number of staff in provider-run group homes who are positive or the number of recovered staff.

“Recovered” individuals are defined in the reports as those who “have tested negative or have met symptom and time-based recovery guidelines issued by the the state DPH and the federal CDC.” (my emphasis).

The definition of recovered individuals appears problematic because those symptom and time-based recovery guidelines state only that a staff worker can return to work if they have been symptom-free for a total of three days. The guidelines don’t ensure that the individual is not still COVID-positive or potentially capable of transmitting the virus to others.

Nevertheless, it appears DDS has been relying more and more on reports by providers of the number of people in group homes displaying symptoms, and is no longer relying on testing to determine the number who are currently positive.

DDS has never answered our repeated question as to whether and where retesting is being done throughout the group home system. The Department also stated that it keeps no records on the number of residents reported as symptomatic. And it has no records on the number of staff who have refused testing.

Positive test numbers have closely tracked the rate of testing

The level of mobile testing done in the DDS group home system by the state’s only contractor for that work, Fallon Ambulance Service, has slowed continuously since a peak of testing activity by the company in late April.

As of July 1, only 80 percent of the residents in the system appear to have been tested, leaving some 1,600 residents and an undetermined number of staff untested since Fallon began on April 10.

In addition, group home staff are not required to be tested and providers can refuse testing in their residences if they report that none of the residents are symptomatic.

All of those factors appear to raise questions whether the apparently declining level of positive COVID-19 cases in the group home system might not, in fact, be due to the lack of testing.

We used DDS data to show what appears to be a strong relationship between a sharply declining rate of testing for the virus since April and declining numbers reported by DDS of new positive cases among residents and staff in the system. In both cases, the numbers have trended downwards since a peak in late April or early May.

Source: DDS data reports

Both the daily rate of testing and the number of new positive cases show large spikes in late April-early May. The daily testing rate graph shows the spike occurring April 29. The positive cases graph shows the spike occurring on May 4, just five days later.

From late May onward, both graphs show lower numbers of average daily testing and positive COVID cases than had been the case in early May.

Prior to announcing a new, less restrictive policy on visitation last week, DDS Commissioner Jane Ryder stated in an email to COFAR that the number of new COVID cases “have been decreasing in DDS residential programs, much as they have across the state.” She added that DDS believed the reasons for that decline include “the visitation restrictions adopted in March…along with hand hygiene, testing, and mask use.”

Ryder didn’t note the decline in testing itself, and didn’t respond to our questions about the lower rate of testing and the possible impact it was having on the numbers of reported cases.

The administration appears to believe that if the providers are reporting fewer people showing symptoms, there isn’t a need for testing of either residents or staff. Perhaps their strategy is that if the numbers of symptomatic people start to rise, they will ramp the testing back up at that time.

In the meantime, let’s hope the providers are reporting the situation in the group homes correctly to DDS. We have no way of knowing for sure.