A COVID-19 outbreak at a Bremerton hospital that started in early August, possibly with a staff member, has grown to 45 cases.

Of the 45 cases, 30 are employees of St. Michael Medical Center and 15 are patients. The number is likely to go higher, said Dr. Gib Morrow, health officer for the Kitsap Public Health District.

“We expect this count to grow as the hospital continues comprehensive testing of staff and patients,” he said during a Monday news conference.

The state Department of Health (DOH) and Kitsap Public Health announced the outbreak at St. Michael’s Bremerton facility Friday evening. At the time, the two departments said there were “more than 30 cases” at St. Michael, which was formerly known as Harrison Medical Center and is part of the Tacoma-based CHI Franciscan system.

The three units where staff and patients tested positive for COVID-19 are still housing patients already admitted, but new patients aren’t being taken in, said Dr. Michael Anderson, chief medical officer for CHI Franciscan.

Anderson said he doesn’t know which three of the hospital’s units had the positive results.

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On Aug. 4, St. Michael officials notified Kitsap Public Health that an employee had tested positive for COVID-19. The health district conducted a case and contact-tracing investigation and determined that the ill employee had no close interactions at the hospital.

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That might not have been the case because on Aug. 13, five more cases were connected with one unit at St. Michael, and Kitsap Public Health suggested testing all staff and patients in the affected unit, declaring an outbreak Aug. 14.

As tests kept coming back positive, Kitsap Public Health recommended that testing continue, staff be screened before starting work, visitation restricted and interaction between units limited.

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The hospital is now only allowing visitation when a patient is dying, a surgical patient needs a ride home, or staff need to give at-home care instructions for a discharged patient.

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The next step is to bring in infection specialists from DOH to look at St. Michael’s process to figure out where there are problems, said Dr. Scott Lindquist, the state epidemiologist.

Patients in the three units with positive cases will be tested again, and testing and screening will continue for staff, Anderson said.

Employees from St. Michael and Kitsap Public Health have been notifying patients discharged from the units touched by the outbreak. That hasn’t happened for other patients and their families who were in the facility when it was known the virus was spreading.

Tristan Ferguson was in the hospital two weeks ago visiting her 82-year-old father, who was admitted to St. Michael on Aug. 10 and discharged Aug. 12. He was admitted to the VA Puget Sound in Seattle on Aug. 13.

Ferguson said she spoke with a nurse who said the unit her father was in is used for COVID-19 patients.

Ferguson said she, her sister and mother showed up at the hospital around the same time and were all allowed to see her father despite the one-visitor-per-day limit at the time. The three of them didn’t know this wasn’t supposed to happen until a nurse told them, but the nurse let all three stay.

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The hospital hasn’t contacted any of them, she said.

“I would think they would have contacted every visitor during that window of infection,” she said.

Contacting former patients and any close contacts is labor-intensive, so it was decided to begin with “the biggest bang for our buck” and start with units where individuals tested positive and work their way out to other patients and visitors, Anderson said.

“We start from the center and then work on out from there,” he said. “Even this press conference is one of the means we’re using to notify others that may have been affected by this.”

It is likely that these cases were a result of the first employee who tested positive early in the month, but that can’t be known for sure, Anderson said.

The high rate of community spread in the region makes it difficult to pin the St. Michael outbreak on one person, Lindquist said.

“There was so much community exposure going on in the Puget Sound area at the same time that it could have been any [number of] possibilities,” he said.

There have been 942 cases of COVID-19 in Kitsap County and nine deaths.

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