by Stacey Burling and Pranshu Verma, The Philadelphia Inquirer, March 24 2020
A Philadelphia nursing home said Tuesday that 11 of its residents and a contract employee have tested positive for the new coronavirus since March 19. Three residents and two staff members of a nursing home in Mount Laurel have also tested positive for the new coronavirus over the last week, the facility’s medical director said.
None of the patients has died but one from Philadelphia and three from New Jersey are hospitalized. James Garrow, a spokesperson for the Philadelphia Department of Public Health, said the department is investigating potential cases in two other city nursing homes, but declined to provide more information.
Nursing home residents are especially vulnerable to the new virus, a fact that became starkly evident during an outbreak of coronavirus at the Life Care Center of Kirkland, near Seattle, early in America’s experience with the new disease. As of last week, 35 residents who contracted the virus had died. The disease has found its way into at least 10 other senior facilities in the Seattle area. On Monday, the state announced 30 cases — 24 residents and six staff — at a nursing home in northern Washington state.
Brian Dries, a spokesperson for Renaissance Healthcare and Rehabilitation Center in Philadelphia, said one of the 123-bed facility’s residents began exhibiting symptoms of the disease caused by the new virus, COVID-19, on March 19. That patient, who is now hospitalized, was immediately placed in isolation and the Philadelphia Department of Public Health identified other residents who may have been in contact with the infected patient. Results from the other patients came back on Monday. Those who tested positive are being cared for in a separate section of the facility.
Dries said Renaissance does not know how the initial resident became infected. Visits to patients were stopped before the patient was identified, and the facility was following health department guidance about infection prevention, he said. He said the staff member who tested positive provided therapy to residents and had not been to Renaissance since March 11. The employee is recuperating at home.
“The facility is doing everything it can to ensure it stops the spread of this virus within the facility,” Dries said.
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He said family members are being kept abreast by phone and email. “Everyone’s very supportive, understands this current time that we’re all in,” he said. He said Renaissance has adequate protective equipment for staff. It is actively screening staff before each shift and has “implemented aggressive cleaning procedures.”
In a news release, Andrew Blank, medical director of the New Jersey facility, Laurel Brook Rehabilitation and Healthcare Center, said the residents of Laurel Brook were being treated at a regional hospital and the employees were at home with mild symptoms.
The 220-bed nursing home also said it is working closely with New Jersey and U.S. public health officials to contain spread of the respiratory virus. It is monitoring all residents and employees for symptoms and has told employees to stay home if they have any respiratory symptoms.
Before the outbreak, the facility also had suspended visitation for residents. That policy will continue, Blank said. Laurel Brook is encouraging family members to connect with loved ones through telephone and video calls, email, and other forms of messaging.
The Burlington County Health Department said it will be tracing contacts of people who have interacted with the five sick people but “cannot provide further details at this time.” The state Department of Health did not respond to questions.
Nationally, many senior facilities have greatly restricted visitors in an attempt to keep the new coronavirus out. Many fear they will run out of protective equipment for their staffs, a key tool in infection control.
Nursing home residents are often elderly and frail, a population at particularly high risk for death and serious complications from the new virus. Many also share rooms and need help with activities like getting dressed or brushing teeth. Social distancing between them and staff members is not an option.
Many nursing homes, including Laurel Brook, also have sections that specialize in shorter-term stays for rehabilitation after a time in a hospital. Those patients also must work closely with therapists and other staff members.
David A. Nace, a University of Pittsburgh physician, said that nursing homes have been doing their best to keep the virus out, but that it is inevitable that the new coronavirus will get into more facilities. “It’s unfortunate that, once it comes in, it will spread,” said Nace, president-elect of the Society for Post-Acute and Long-Term Care Medicine, which represents medical professionals who work in nursing homes.
Nace said that even well-run nursing homes are at risk for significant outbreaks. “You have a very vulnerable population in close contact,” he said. “I think we will see more [situations like Kirkland] despite best attempts and best efforts. Our hope is that we’ll get lucky with this.”
On the government’s Nursing Home Compare website, Laurel Brook received an overall rating of four out of five stars, with five stars for quality and three (average) for health inspections and staffing. In its most recent Nursing Home Compare rating, for Renaissance a federal website, it received an overall score of two out of five starts, or below average. It received four starts for quality, but two for health inspections and three for staffing.
Nursing homes, Nace said, serve multiple populations — long-term residents as well as people who have come for end-of-life care, such as palliative care and hospice. Long-term residents live an average of about two years after admission. People who come for rehabilitation after surgery or a heart attack tend to be younger and healthier. He said some nursing homes are currently balking at taking new admissions from hospitals because they’re worried those patients could bring the disease with them. He thinks staff members are the bigger risk, but said hospitals need to identify patients who have recovered from the disease, still have it, or have been exposed.
He outlined measures nursing homes should be thinking about once they have a known coronavirus case on campus:
- Tests should be reserved for people with symptoms, he said. While it might be nice to test everyone for the virus after a case is identified, Nace said that could lead to false negatives. Plus, “we still have profoundly limited testing ability in the United States. We don’t have enough tests to test everyone in the building.”
- Not all people with the disease will need to go to the hospital, and some nursing home residents have said they don’t ever want to go to a hospital again. “That’s something that we have to honor,” he said.
- If an infected resident stays at the nursing home, staff should make sure the door to his or her room is closed. If there’s a roommate, pull the curtain out between their beds. The roommate has already been exposed, so moving him or her to another room risks spreading the disease. If there’s a single room available, move the roommate there.
- Insist that all staff members wear masks and take droplet precautions at all times.
- Enhance daily cleaning, especially of high-touch areas like elevator buttons and computer keyboards.
- Take resident temperatures twice a day, every day. The threshold for concern is lower for the elderly than for younger people. “We decided to go with a temperature of 99 because older adults tend to mount lower temperatures,” said Nace, who is chief of medical affairs for UPMC Senior Communities. The health system has 36 facilities in 10 counties.
- Not everyone who gets COVID-19 gets a fever. Nursing homes also should monitor for respiratory changes as well as symptoms like diarrhea, muscle aches, and fatigue.
- Facilities, Nace said, should notify family members immediately when there’s a COVID-19 case. “Everybody should be aware of it,” he said.
“The first thing,” Nace said, “is don’t panic.”
Staff writer Allison Steele contributed to this article.
If you work in a nursing home or have a family member in a facility where someone has tested positive for the new coronavirus and would like to talk to a reporter, please email Stacey Burling at email@example.com.