Six weeks after long-term care facilities first emerged as a deadly front of the coronavirus pandemic, Washington state says it’s now aiming for widespread testing in the facilities.
The state’s goal is to get enough supplies to allow for universal masking of staff and to test all residents and employees in facilities with COVID-19 cases. The state has thousands of test kits ready, with more on the way. But it’s unlikely the supply will cover the approximately 200 facilities with cases, much less all 4,100 group care facilities in the state, and it’s unclear when the state will receive enough.
Across the country, officials have focused on the rising death toll at the facilities, where residents live in close proximity and are often at high risk because of age or medical conditions. In Washington, around 300 people from these facilities had died as of Friday, making up half the total deaths in the state, according to data from county health departments.
The full scope of the crisis is unclear, as no agency is tracking the number of cases in facilities across the state. The state Department of Social and Health Services (DSHS) has made errors tracking which facilities have infections, and it only recently began gathering information about the number of cases to help the state distribute supplies. And the state Department of Health infrequently releases counts of deaths from these facilities.
“We have been playing catch-up to some extent, and have been from the onset of coronavirus,” said Bill Moss, assistant secretary for DSHS’s aging and long-term support administration. “Better availability of testing is also something we’re still catching up on.”
The lack of data has been a national blind spot. The federal government has come under pressure for not publicly tracking cases in nursing homes, and most states have either not kept track or are unwilling to share data. The New York Times identified at least 7,000 coronavirus deaths from long-term care facilities nationwide by Friday afternoon, representing about a fifth of the total deaths in the country.
This is despite the early warning from Life Care Center of Kirkland, which showed how devastating the disease can be in these facilities. At least 167 cases, including 43 deaths, have been linked to the nursing home since the outbreak was discovered in late February.
More resources promised
As Gov. Jay Inslee has sent back federal ventilators and a field hospital to help areas harder hit across the country, he requested that a federal medical team sent to Yakima redeploy to long-term care facilities across the state.
For weeks, many of those facilities struggled to manage a crisis they couldn’t see. They were told to only test residents and employees with symptoms, even in the face of growing evidence that people can spread the disease without them, because of a lack of testing supplies.
The testing guidelines from the state DOH haven’t changed, but public messages from officials have shifted.
“Long-term care facilities are really at the top of our priority list right now for trying to get supplies and this testing out there,” state Secretary of Health Dr. John Wiesman said at a news conference last week, citing concern that employees may unintentionally spread the disease.
The focus will be on facilities with at least one confirmed case, but also those that have employees or residents with respiratory illnesses, said Dr. Kathy Lofy, the state health officer.
“We want to be really aggressive and start testing in those facilities as well,” Lofy said.
It’s what the families of residents have begged for over the past month. But officials still have a long way to go.
The state said it has 6,000 test kits ready to go, with another 10,000 on the way. As of Thursday, state health officials had not finalized plans to distribute the kits, which contain a swab and a tube with a substance that preserves the sample. They did not provide details about personal protective equipment (PPE), but said there is still a statewide shortage.
In King County, the Seattle Flu Study said it will provide 2,000 tests to health care workers in facilities and University of Washington Medicine donated some of the test kits it was able to get from China, 8,000 of which will go specifically to long-term care facilities.
Public Health — Seattle & King County is using most of those in nursing homes that haven’t yet confirmed cases, but the supply won’t cover the 14,000 people at those facilities officials want to test.
Washington officials have also discussed taking more drastic actions, such as sending residents who test positive to designated facilities with dedicated staff, to keep them separate. Federal regulators and Inslee recently cleared facilities to transfer residents even if they appeal.
“That’s something that will likely move forward,” Moss said in a call with long-term care providers Thursday.
The benefits of testing
Nisan Harel credits broad-based testing for slowing the spread of the virus at Ida Culver House Ravenna, where five residents and two staff members tested positive – including one resident who died.
But testing about 160 residents and staff members wasn’t easy, according to Harel, the vice president of operations for Era Living, which operates Ida Culver House and seven other Seattle senior communities.
“It’s really a matter of being a loud voice … and making sure everyone understands that without testing, we don’t know who has the virus and it could spread,” Harel said last week.
Ida Culver had to communicate with multiple agencies, and it received a swift response partly because it was among the first facilities to have a case after Life Care Center of Kirkland.
UW and Centers for Disease Control and Prevention (CDC) officials agreed to test everyone as part of a study of how the disease spreads in independent and assisted-living facilities.
Era Living has faced more hurdles in testing at its four other facilities with at least one case. The company initially received some test kits from UW and secured additional ones through a lab based in Alabama. Getting results has taken up to a week.
Problems with tracking
State officials still don’t have a clear view of the situation at long-term care facilities because of a lack of tracking and accurate data.
The state DOH said it plans to start posting a count of total cases and deaths from long-term care facilities online at the end of the month. More detailed data has been mostly unavailable.
The state provided a list of facilities with COVID-19 cases for the first time last week after weeks of requests from The Seattle Times. The delay, officials explained, was to ensure the list was accurate.
But soon after The Times published the list provided last week, some facilities that were incorrectly included by DSHS received frantic calls from employees and the family members of residents.
At first, the agency said errors must have stemmed from bad information from the facilities, which are required to report outbreaks to DSHS and local health departments. But as the complaints continued, DSHS acknowledged at least a dozen were mistakenly listed.
“We did have a data-entry error on the first list that was disclosed and we feel bad about that,” Moss said. “I think we know about every facility with a COVID positive. As a matter of fact, I know we do.”
But the agency is warning there may still be some errors, which The Seattle Times found on the updated list. And the lack of more detailed data from DSHS makes it difficult to see the full picture.
For example, Regency North Bend Rehabilitation and Nursing Center is on the list, even though Administrator Adam Dold said the only employee who tested positive got sick while out of the country and hasn’t returned to work since. No residents have tested positive, he said.
“To associate us with facilities that do have the disease is really unjust to the employees that have been working here really hard,” Dold said.
The Seattle Times is publishing a list of the facilities from DSHS it was able to verify through reporting. It does not include the 36 adult family homes that have reported cases, which have six or fewer residents, because DSHS has withheld the facilities’ names after determining disclosure might violate residents’ privacy. It also doesn’t include 19 senior-living organizations that have reported cases, as they care for clients at their homes.
The Seattle Times did not include about 30 facilities it has not yet verified and added facilities such as Careage of Whidbey, which DSHS removed after erroneously concluding the nursing home had only suspected cases. The facility has had 60 people associated with it test positive, according to Island County Public Health. Eight have died.
Seattle Times reporters Ryan Blethen, Joseph O’Sullivan and Mary Hudetz contributed to this report.