After a college town’s coronavirus outbreak, deaths at nursing homes mount

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By Juliet EilperinBrady Dennis and Chris Mooney, The Washington Post, October 21 2020

‘The very thing we worried about’: In La Crosse, Wis., students partied in September. Then infections and deaths among the elderly began to rise.

Mayor Tim Kabat was already on edge as thousands of students returned to La Crosse, Wis., to resume classes this fall at the city’s three colleges. When he saw young people packing downtown bars and restaurants in September, crowded closely and often unmasked, the longtime mayor’s worry turned to dread.

Now, more than a month later, La Crosse has endured a devastating spike in coronavirus cases — a wildfire of infection that first appeared predominantly in the student-age population, spread throughout the community and ultimately ravaged elderly residents who had previously managed to avoid the worst of the pandemic.

For most of 2020, La Crosse’s nursing homes had lost no one to covid-19. In recent weeks, the county has recorded 19 deaths, most of them in long-term care facilities. Everyone who died was over 60. Fifteen of the victims were 80 or older. The spike offers a vivid illustration of the perils of pushing a herd-immunity strategy, as infections among younger people can fuel broader community outbreaks that ultimately kill some of the most vulnerable residents.

“It was the very thing we worried about, and it has happened,” Kabat said.

Local efforts to contain the outbreak have been hamstrung by a statewide campaign to block public health measures, including mask requirements and limits on taverns, he added. “Your first responsibility as a local government is really to protect the health and safety and welfare of your residents,” he said. “When you feel like that’s not happening and you have few tools or resources available to change that, it’s more than frustrating.”

As the number of coronavirus infections continue to soar in the upper Midwest, few places embody the nation’s divisions over how to tackle the pandemic better than Wisconsin. Even as the state’s weekly caseload has quadrupled in the past six weeks, bar owners and Republicans have thwarted some restrictions on public indoor gatherings, leaving public health professionals scrambling to contain the virus.

Wisconsin ranks fourth among states in daily reported cases per capita, with 59 per 100,000 residents. According to The Washington Post’s analysis of state health data, in the past week new daily reported cases have gone up more than 20 percent, hospitalizations have increased more than 26 percent and daily reported deaths have risen 22 percent.

La Crosse Mayor Tim Kabat. (Lauren Justice for The Washington Post)

In recent briefings, Wisconsin health secretary designee Andrea Palm said the state is doing worse than it was in March and April and has pleaded with residents to avoid going to bars and to practice social distancing.

“Wisconsin is in crisis, and we need to take this seriously,” Palm said last week.

Last week a judge in Wisconsin’s Sawyer County temporarily blocked an order from Gov. Tony Evers (D) limiting crowds in bars, restaurants and other indoor spaces to 25 percent of capacity, though a judge in Barron County reinstated it Tuesday. The Tavern League of Wisconsin, which represents the state’s bars, argued it amounted to a “de facto closure.” In May, the state Supreme Court struck down Evers’s “Safer at Home” order after Republican lawmakers challenged it, and a conservative activist has just sued to block Wisconsin’s statewide mask mandate.

Elizabeth Cogbill, who specializes in geriatrics and internal medicine in the Gundersen Health System, has been working 14-hour days since the pandemic began, staying late to talk to families who can no longer visit their elderly relatives.

Since June, Cogbill has been working with the county, other medical professionals and nursing home officials to curb coronavirus infections. They had managed to stifle several flare-ups without a death, until September.

In an interview, the 41-year-old doctor said that as the number of infections among young people began to rise six weeks ago, “I had this feeling of just terror.” She had watched similar community outbreaks throughout the country migrate from younger to older populations and hoped the same tragedy would not unfold in La Crosse. But it did.

“These are my people. These are my patients,” she said. “It entered our facilities and it just spread like wildfire. … I don’t have words to describe this experience.”

Recent data released by Johns Hopkins University and the Centers for Medicare and Medicaid Services shows that weekly cases in nursing homes rose nationwide in late September as the disease became more widespread in 38 states and the country entered its third coronavirus spike. That marked the first uptick in seven weeks in long-term care, after new cases dropped throughout August and early September.

Elizabeth Cogbill with her team Wednesday outside the Gundersen La Crosse Clinic in La Crosse, Wis. (Lauren Justice for The Washington Post)

To Paraic Kenny, a La Crosse-based cancer geneticist at the Kabara Cancer Research Institute who has turned to genetic sequencing to track the coronavirus, the nursing home deaths are a corollary of bringing students back to campus and allowing a party culture to reignite.

“Completely, completely, completely predictable,” said Kenny, who said he saw over 13 “overflowing” parties on a late-September drive home from work that took him through neighborhoods where many students live. “Everything we’ve known about this virus since January, everything we’ve known about 20-year-olds for the last 3,000 years — it’s predictable.”

In a new study that has not yet been formally peer-reviewed, Kenny found genetic links between a number of nursing home covid-19 cases — including several deaths — and large outbreaks in the local student population. Because the coronavirus mutates roughly twice a month, scientists decoding its evolution can construct detailed family trees that track the virus’s spread from one person to the next.

“Risks of rapid spread of SARS-CoV-2 among college-age individuals are not limited to college environs but pose a direct threat to older persons in the surrounding community,” the study states.

In addition to the genetic connections, Kenny noted that the large outbreak in the student population came first.

Several other researchers who read the paper cautioned that while students certainly could have fueled cases among vulnerable elderly residents, genetics in isolation cannot definitively prove that link. For instance, saying that two cases are genetically related or even identical does not necessarily prove who infected whom; it is also possible that a third party, perhaps one whose virus genome was never sampled by researchers, infected both separately.

Thomas Friedrich, a researcher at the University of Wisconsin at Madison who has done extensive genetic sequencing of the coronavirus, said that the only way to get more precise would be to conduct additional contact tracing or epidemiological investigations.

In an email, he compared the outbreak among college students to “a large fire, which can throw off sparks that start additional fires.” He added that “high levels of transmission among students in La Crosse absolutely increased the risk of outbreaks in skilled nursing facilities. [Kenny’s] data are totally consistent with this scenario, but they do not prove beyond a shadow of a doubt that specific viruses traveled from students to nursing home residents.”

Several factors complicate any genetic analysis of the Wisconsin outbreak, these experts said, including the large scale of the spread and the fact that only a small percentage of patients’ samples have been sequenced.

“Actually, finding any resolution when you have uncontrolled transmission like this is really, really difficult,” said Joseph Fauver, a postdoctoral associate in global health at Yale University who specializes in genetic sequencing.

Kenny and other experts, including local health officials, noted that because long-term care residents rarely leave such facilities, the virus somehow had to make its way in from outside. Cogbill said that in each facility where a resident died of covid-19, the virus also had turned up on the staff.

Across the country, colleges’ strategies for containing the virus have been uneven, often because some have greater resources than others.

The University of Wisconsin at La Crosse, for example, had the money to test roughly 3,000 residential students every other week but did not initially test 4,000 off campus.

“It’s a big challenge,” the school’s chancellor, Joseph Gow, said in an interview. “And we really legally don’t have much ability to regulate people’s behavior off campus. If someone is 21 years old and wants to have people come over to their apartment, you can’t really stop that. But we do encourage them not to do that.”

University of Wisconsin at La Crosse Chancellor Joseph Gow. (Lauren Justice for The Washington Post)

As infections on Gow’s campus surged last month, with positivity rates ranging between 36 percent and 78 percent, school administrators made the decision to shut down in-person classes for two weeks. They resumed Oct. 5Recently, the university has begun testing nonresidential students, targeting those who belong to campus organizations such as the marching band and sports teams.

“We know what the stakes are, and we’re really taking it seriously,” Gow said. But while students have been largely cooperative, the school cannot legally compel off-campus students to get tested and it lacks the capacity to test them all.

“We would like to know: Do we have any students who are working in assisted-living and long-term care facilities?” he said. “And if they are, we would like them to come in immediately and get tested.”

Some other universities are taking far more aggressive steps, such as the University of Arizona, which has poured at least $8 million into a far-ranging effort to curb the virus’s spread. It is regularly analyzing wastewater, an early indicator of infections, overhauling its ventilation systems and modifying its cafeterias to minimize personal contact. At one point the school had 240 to 270 new coronavirus cases a day. On Friday, it recorded zero.

In La Crosse, local officials praised university leaders for stricter measures that have lowered infections among 18-to-30-year-olds. “They’ve done a good job of adjusting behavior,” Kevin Fitzgerald, a doctor with the Mayo Clinic Health System, said at a briefing late last week.

Other health officials urged La Crosse residents not to grow complacent.

“We are all woven together as the fabric of this community,” said Cogbill, the geriatrics doctor. “And our choices have the potential to have an enormous impact on those around us.”

Elaine Becker, center, with daughters Sue Becker and Pam Severson. Henry Becker, Elaine’s husband of 64 years, died of covid-19 in La Crosse. (Lauren Justice for The Washington Post)

Pam Severson buried her father last week. Henry Becker, 86, died Oct. 9 after contracting the virus last month in his La Crosse nursing home.

Severson said she doesn’t blame anyone for her father’s infection. Exactly how he got sick will probably remain a mystery, and she said the staff was doing its best in an unenviable situation. But she bristles when she sees people not wearing masks or social distancing.

“They don’t realize what those actions can do,” she said. “They don’t realize what it’s like to see a family member have to be alone. They don’t realize how sick people are really getting.”

Becker had not had visitors since March, when his facility put strict protocols in place to keep out the virus. During his final days, family members would sit outside his window to be near him, even though he did not know they were there. His wife of 64 years, Elaine, was by his bedside in protective gear, holding his hand when he died.

Last week, the family organized a socially distant funeral Mass. The mourners remembered the Wisconsin native as a dedicated Catholic, a devoted father and grandfather, a master electrician who loved woodworking, bowling and his family.

A soloist sang “Ave Maria,” and they laid him to rest at the Gate of Heaven Cemetery.

Sarah Kaplan contributed to this report.

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