Why One Nursing Home In West Virginia Is 'Ground Zero' For The Coronavirus
As of Thursday morning, March 26, Sundale Nursing Home in Morgantown has 28 confirmed cases of the coronavirus and is being called “ground zero” for the outbreak in West Virginia.
Health reporter Kara Lofton spoke with Dr. Lee Smith, executive director and county health officer for the Monongalia County Health Department, who has been helping coordinate the response to the outbreak.
***Editor's Note: The following has been edited for clarity and length.
Lofton: Over the past couple of days, there have been some cases in Sundale Nursing Home of coronavirus. Can you give us an update of what's going on there?
Smith: The original patient was identified in a hospital setting. They had been in the nursing home, and then had some fever, and lethargy, and then was admitted, and then tested in the acute care facility and was coronavirus positive. And so that started us looking at the nursing home, both the number of patients as well as the number of staff.
There are approximately 100 patients and approximately 150 employees. And so we started in the wing where the patient had been living before transfer and started with the group there and so it went from one, and then when we were done with the entire support staff and the patients, we had done 40 patients and about 20 staff. And out of that we got four of the staff that were tested positive for coronavirus and a total of 16 patients from that wing.
In explanation as to why you don't get an immediate number...we've been working with the various hospitals and labs that can perform the test. This is very early into the testing here in West Virginia. And so there is not a surplus of testing equipment. And so the laboratory specimens tend to be batched and then get reported out. But what one hospital may report out [occurs at] a different time as another lab and so they come out somewhat sort of piecemeal. And then we returned to the nursing home the following day and did the other two wings and the remaining [people], the staff. And so we're waiting now for the results of the rest of the testing.
Lofton: So at this point, everybody in the nursing home has been tested, is that right?
Smith: Every patient has been tested. And every staff member that has clinical responsibility has been tested. Now there are some people that are very low risk, and they have been sent to get testing through some of the drive-throughs. And their results will probably take a couple of days to get back, but everyone will have been tested. The most important were those that work clinically, and the patients themselves.
Lofton: So the low-risk staff who were sent to drive-through testing, is that because of a lack of available tests?
Smith: The West Virginia University lab and the state office laboratory services have the ability to do testing that you get the results back the same day. It's not a send out to one of the third party labs, which usually takes several days to get the answer. And so trying to be judicious in the utilization of these precious resources, we wanted to get [quick test results for] those staff that had clinical responsibilities, as well as the remaining patients in the nursing home. Those staff that were low risk, meaning that they did not have clinical responsibilities or worked in the office, etc., then they can be tested, [but] we don't have an immediacy to know their status in terms of whether they are corona positive or negative. But we want them to be tested to make sure we've covered all the bases in this institution.
Lofton: At first there was one positive case, then there were four and [then] 16, and there are a couple more tests pending. Why the rapid increase in this population? Why are we seeing this kind of spread?
Smith: A couple of reasons for that: I think that the one to four to 16 is somewhat artificial, meaning that we can't get 100 patients tested immediately, and we can't get 150 staff tested immediately. So we did this over the course of two days. And so the results are somewhat trickling in. So it gives you an artificial appearance that maybe this is just expanding. You know, the virus has been present because it takes a couple of days for people to become symptomatic. And so I really can't comment further until we have all the data in terms of how people are testing positive or negative.
But what we do know is that nursing home patients, by usually their age, are a vulnerable population. They may be more sedentary, they may have multiple medical problems. They may be immuno-compromised. There are usually an assortment of various reasons that people end up residing in a nursing home. So we sort of collectively think of them as vulnerable. And we really want to guard against this becoming a widespread disease. That's why it's important to get, you know, your hands around the entire problem and understand what's going on in this type of environment.
Lofton: Well, and I mean, additionally, nursing homes are congregate living. I mean, it's difficult to sort of socially isolate when you live in a group living space. So given that, what can nursing homes do to protect themselves?
Smith: Limiting the number of visitors, making sure that friends and family that do show up are not ill, that they take the proper precautions that go for anybody, not just friends and family but anyone visiting a nursing home whether it's, you know, some form of physical therapy or speech pathology, then all people coming through the door need to have, you know, a temperature [taken], wear a mask, wear gloves, eye shields, particularly if they're going to be interacting with the patient. So don't want to bring something in from the outside. And now we know that there are patients who are positive, we want to try and limit that spread among the other patients. So knowing the diagnosis of whether a person is positive or negative, [this] allows us to put the negative patients in one area and those that are positive in another area.
Lofton: Now that the coronavirus is in the nursing home, I mean it is very contagious, is there anything that the nursing home can do to slow the spread?
Smith: This particular nursing home has been very aggressive in making sure that they're wiping down surfaces and decontaminating rooms, to make sure that each person is wearing appropriate personal protective equipment. And I think that is the majority of our efforts at this point in time. Certainly [we are] limiting contact to those who are positive so that they don't have the ability to, you know, to potentially spread any disease to those who are unaffected.
So, I think that the things that you've heard over the last couple of weeks is social distancing and good hand washing and covering your sneezes and wearing the eye protective gear, and the masks, and the gloves – [these] are all important in trying to limit any type of spread.
Lofton: Some of the residents are being quarantined on site while a few have been transferred to the hospital. What is the criteria for being transferred to the hospital?
Smith: If a person were to require an admission to an acute care facility – meaning that they had an acute illness that could not be cared for at the level of care that's available in a nursing home – then they would be transferred to a hospital. Usually, that is when a patient becomes acutely ill in terms of having fevers or respiratory distress. In this elderly population, we don't tend to see as many of the symptoms of the non-productive cough and the high fever and that. We do see that people can struggle with low oxygen settings and that would be a reason to transfer them to a higher level of medical care.
But we do know there [is] an entire spectrum where people fall in terms of how they respond to the illness. There are some people who have very few symptoms whatsoever. And that's why we have asymptomatic carriers, and particularly in the young people, but there are people in the nursing home who are not showing any signs or symptoms of the illness, yet they test positive. And so if they are able to maintain their activities of daily living and require no acute medical care, then it's perfectly reasonable to have them sequestered in a nursing home, just limiting their interaction so that they don't inadvertently spread the virus.
Lofton: Talking about inadvertently spreading the virus, we know that health workers themselves are at risk of contracting coronavirus. And then a few workers have tested positive. Some of the concern that we're hearing from people who work in healthcare is taking coronavirus back to their families. What are staff being told to do at this time?
Smith: So the CDC has a pretty clear set of criteria on what to do if you have been in a situation where a healthcare provider is exposed to somebody that they're suspicious of having coronavirus, what we call a person “under investigation.” If it's just a person under investigation, there are no work restrictions, if the healthcare provider wore their mask, their eye protection and their gloves. And that goes the same for people who have [been] diagnosed with coronavirus if the healthcare provider is exposed to somebody with documented COVID-19, they have no work restrictions so long as they wore a full face mask and their personal protective equipment during the time of exposure.
And so we know that those individuals who have taken the necessary precautions really don't have a risk of bringing this home to their family. And so that's another reason why it's so important that people use the correct personal protective equipment in terms of eye protection and face mask and gloves, frequent hand washing to keep the spread to themselves, but also to keep it from spreading to their homes.
Lofton: Part of the conversation nationally is a shortage of adequate personal protective gear that is appropriate for coronavirus. I mean, what do people do when you run out?
Smith: Well, we've been very fortunate not to have experienced any run out of the equipment. We have experienced some shortages and, you know, one of the benefits to living in rural America is that people tend to share resources. And so we are getting in some supplies from the federal government as well as from the state. And we're pushing those out from the health department to the hospitals, but also to other first responders and making sure that the police have the equipment that they need as well.
There are many people who are making face masks, and we think that's a grand idea and very useful for the community. They’re not a replacement for an N-95, which is a NIOSH approved mask that filters 95% of the particulates out of the air. But they're certainly fine to use for non health care issues or if you just have a low-risk interaction with someone, or if you want to sort of use N-95 and cover with this to give you some extra usage out of it.
So we haven't experienced PPE shortages to the point that we've had to go without. But you know, I think that this whole episode of this pandemic has shown that there are some deficiencies in the supply lines. We've gotten somewhat lazy and allowed things to be made overseas, and we got caught not having them at the moment that we need them.
But I think all that is going to be improved with a little bit of time.
A lot of people right now nationwide are looking to public health for a very robust response. And while we can do that with some ability here in Monongalia County, we're one of the larger health departments in the state. Unfortunately, there are probably half of the health departments in the state [that] are run with him four or three or less employees.
The problem with public health is it tends to stay in the background and funding gets cut here and there. And now that it's crunch time, you know, it's time to have a robust response and it's somewhat difficult. And so we have asked for partnerships with various groups. And the one group I want to sing their praises has been the West Virginia National Guard. Adjutant General Hoyer heard our call and sent National Guard troops up to help us with the collecting specimens in the nursing home. And I would not have been able to do that without their help.
And so in two days time we were able to assess everybody in the nursing home, and I just feel very honored that we had that ability... I don't know that that can be repeated throughout the state. But we're looking for those partnerships and for people to step up and help with this response. And I think that we found an able partner and so I'm very happy to have them.
But both [Mon General and WVU Medicine] are working together. You know we have a common enemy. And I think that's something that unites people. And I'm very happy to be where we are. Unfortunately, we're at the very beginning of this response. In the next couple of weeks we will be getting a lot of positive individuals, and our job will be beginning to try and run these contacts down, to have an understanding of how this is being spread, and how we can maybe limit it.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.