As the novel coronavirus illness took hold inside the Life Care Center of Kirkland last month, the disease likely spread from the facility to at least three other nursing homes, according to a New England Journal of Medicine report.

The report was one of two released Friday examining transmission of the illness within Seattle-area nursing homes, including Life Care, where more than 160 people have been sickened. Of those who have fallen ill at Life Care, 35 have died of COVID-19 since late February, including a visitor, placing the Kirkland nursing home at the forefront of the nation’s health crisis.

The other report, released by the Centers for Disease Control and Prevention (CDC), examined an outbreak inside another King County nursing home where a staffer tested positive for COVID-19 on March 1, just after the cases were confirmed among residents at Life Care. In that facility, which was not identified by the CDC, the staff member had worked two different days with symptoms of the illness before it spread among the facility’s 82 residents.

Together, the two reports offer a look at how COVID-19 may have spread among facilities through nursing home workers. Some 30 skilled nursing facilities in King County have identified at least one confirmed case of the disease caused by the new coronavirus.

“A similar outbreak could happen at any facility,” Dr. Jeff Duchin, health officer for Public Health — Seattle & King County, said in statement. “That’s why preventive measures, such as limiting visitors and excluding symptomatic staff, are so important.”

In the New England Journal of Medicine report, researchers found staff who worked at Life Care also worked at two of the three nursing homes that were the focus of their study. The third facility in the report had accepted two patients who were recent residents of Life Care.

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The report, which does not identify the nursing homes, said staff who worked in multiple facilities while ill could have potentially introduced Covid-19 into other nursing homes.

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The report is not critical of practices at Life Care Center, saying there was no indication its practices placed residents at greater risk than at other facilities.

The first person from the nursing home confirmed to be infected with the new coronavirus illness was a woman in her 70s who was hospitalized on Feb. 24 with fever and difficulty breathing. On Feb. 27, “an astute clinician” at a local hospital requested she be tested for the coronavirus, and the positive result came back the next day, the report says.  The Seattle Times earlier reported that staff at EvergreenHealth in Kirkland sent two samples from patients to the CDC on Feb. 27, both of which came back positive. The report does not name Evergreen but the circumstances appear identical. The woman died on March 2.

A public health investigation was launched Feb. 28 with a CDC team arriving on March 1. They conducted phone interviews with residents, visitors and health care workers confirmed to be infected and attempted to track and notify people they had come into contact with.

The investigation, which included testing 118 of Life Care Center’s residents, also revealed seven people who were infected, but showed no symptoms at the time.

Both studies noted that several nursing home patients tested positive for COVID-19 even though they exhibited no symptoms, underscoring the need for more precautions to keep the disease from spreading.

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In the CDC report, investigators found a practice of screening for symptoms rather than testing could result in a failure to identify a significant number of residents as having the illness.

The release of the studies comes as a union representative for nursing home workers in the area says a “tremendous lack of testing” has emerged as a concern for many. 

Adam Glickman, a secretary and treasurer for SEIU 775, said many haven’t been tested who would like to be, including those who face heightened risk of serious illness from the novel coronavirus because of their age or ongoing health issues. The union represents long-term care workers in Washington and Montana.

“It’s become a dangerous job and one increasingly in which workers have to face decisions about going to work and protect their residence,” he said.

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