Coronavirus surges across nursing homes as facilities plead for tests

The number of nursing homes and other long-term care facilities with confirmed COVID-19 cases more than doubled in the first eight days of April, according to the Washington Department of Social and Health Services.

Senior care centers have been at the center of Washington state’s coronavirus crisis ever since an outbreak at the Life Care Center in Kirkland led to the nation’s first deaths associated with the virus in late February.

As of Friday, 169 facilities around the state had at least one confirmed case, up from 80 at the end of March, according to state data shared by an association of long-term care facilities.

Two-thirds of the nursing homes in Washington now have a confirmed or suspected case of coronavirus, as do nearly one-fourth of assisted-living facilities, according to Deb Murphy of LeadingAge Washington. Her association represents mostly non-profit providers of housing and care for seniors in Washington.

“The numbers are astounding,” Murphy said.

A person “suspected” of having COVID-19 has symptoms but has not been tested or received test results and might be one of many influenza patients in nursing homes during the ongoing flu season. Murphy said the state’s numbers could easily understate the coronavirus trend as well.

“We don’t have sufficient testing available to really know the real numbers,” she said.

Department of Social and Health Services spokesperson Chris Wright said 221 COVID-19-related deaths were associated with long-term care facilities in Washington as of April 7, or more than half the state’s total at that time.

Nursing and assisted-living centers in Bellingham, Coupeville, Everett, Kennewick, Kirkland, Richland and Shoreline have each reported at least 25 COVID-19 cases, according to tallies by the New York Times and KUOW.

Murphy said the most plausible explanation for the apparent spread is that staff or visiting workers, like therapists or x-ray technicians, are coming to work infected but without symptoms and unwittingly bringing the virus in with them.

“We believe that to be the case because we’ve had a ban on outside visitors coming into the facilities now for about three weeks,” she said.

Senior-care providers have been pleading to get more test kits and more protective gear to help their residents and staff stay healthy.

Experience at the Ida Culver House Ravenna shows it can be done.

Squelching an outbreak

On March 9, one resident of the assisted-living facility in Northeast Seattle tested positive and another COVID-19-positive resident died. The next day, with the help of University of Washington researchers and a team from the Centers for Disease Control and Prevention, the facility did a blitz of coronavirus testing.

“We were able to get testing on March 10 and test all the residents and all the staff,” said Nisan Harel, vice president of operations for Era Living.

The company operates the Ida Culver complex and seven other retirement communities in the Seattle area.

Out of 162 people swabbed for coronavirus at the Ravenna facility, three residents and two staff tested positive.

“We fortunately found very few patients who were positive for the coronavirus, and of those, to our surprise, most had no symptoms at all,” University of Washington infectious disease specialist Alison Roxby said.

“If we can find out who's infected, we can keep them separated from people who are not infected,” she said.

With test results in hand and the invisible COVID-19 cases revealed, Ida Culver House was able to squelch an outbreak.

The two staff who tested positive were sent home. The three positive residents were strictly isolated.

Their caregivers wore full protective gear and had their patient-care assignments narrowed so they didn’t switch between infected and uninfected residents.

Dining-room meals and other group activities were canceled facilitywide, non-essential visitors were banned and the frequency of surface cleaning doubled.

A week after the first tests, a second round found only one new COVID-19 case: another resident who had no symptoms at the time.

“Even though they had two residents who were very sick with COVID-19, they did not see a facility outbreak,” Roxby said.

She is the lead author of a rapidly published study on the avoided outbreak in the CDC’s Morbidity and Mortality Weekly Report.

As of early April, the Ravenna complex of 90 senior apartments had one positive resident and one positive staffer.

While residents of assisted-living centers are generally more independent and have more space to themselves than residents of nursing homes, stopping a fast-spreading virus is no small task in any community where people are clustered together.

The average age of residents at Ida Culver is 86, and most have at least one chronic medical condition.

Harel said four of Era Living’s eight facilities in the Seattle area have “one or a few more” confirmed COVID-19 cases.

Harel said it has gotten more difficult to acquire test kits since the early days of the outbreak in early March.

“We still have been unable to do a full, broad testing of every one of those other three communities,” he said.

Other nursing facilities that did widespread testing later in March have been unable to prevent large outbreaks.

After “multiple” residents of a wing at a CRISTA Senior Living center in Shoreline tested positive for the virus, officials there arranged on March 29 to test everyone who lived or worked on that wing, symptoms or no.

But the virus had beaten them to the punch: 26 residents and 16 staff had COVID-19, the tests revealed.

The CRISTA nursing center emphasizes prevention and early detection for residents and staff and follows isolation protocols whenever someone tests positive, according to a CRISTA Senior Living webpage on the outbreak. The Christian nonprofit houses nearly 700 seniors in Shoreline and Silverdale.

“Each resident and staff member is very important to CRISTA, and our leaders are working with residents and families to provide updates, guidance and as much information as possible while respecting privacy laws and the individual rights of each person affected,” the CRISTA website states.

CRISTA officials have not responded to multiple interview requests from KUOW.

Testing, testing

Delays and difficulties obtaining COVID-19 tests have plagued hospitals and long-term care facilities near and far.

“This was a national public health failure,” LeadingAge’s Murphy said. “We just lack the supply chain at this point. Every state is in the same boat.”

“As medical practitioners, we are standing ready to do as many tests as we possibly can,” UW’s Roxby said. “I would love to do that. I've done it after work, I've done it on the weekends, but at this time, we are limited by this critical resource that we don't have enough of.”

King County announced on Thursday that 23,000 COVID-19 test kits would be distributed to help first responders, health care workers and people in high-risk settings like nursing homes and homeless shelters, thanks to donations from University of Washington Medicine and others.

At least 100,000 tests have been performed in Washington since early March.

Roxby said we should be thinking in terms of millions of test kits, not thousands, for widespread testing to replace the current recommendations of only testing certain symptomatic people.

Harel said widespread testing of people living and working in confined settings like nursing homes would help save lives.

“We need to prioritize the people that are vulnerable and help the companies that are protecting those people by providing them more resources,” Harel said.

LeadingAge Washington learned Thursday night that Amazon had approved its request to let long-term care providers as well as hospitals have priority access to Covid-related supplies.

Roxby said the real heroes of this crisis are the front-line workers like janitors and aides in nursing homes.

“Many workers are new to the United States, may not have English as their first language and do an amazing job caring for our parents and grandparents in these facilities,” Roxby said. “And it's very important that they have all of the personal protective equipment that they need to do this very important job.”

Additional reporting by Austin Jenkins.