Berta Lou Middlebrooks holds a sign up to the window for her son outside.

“It is so good to see you, and I love you,” she signed it: “Momma.”

Middlebrooks is very close to her son, Quinton Gaines Middlebrooks, 69. They used to live together, and since she went to the nursing home he’s spent most days by her side as a visitor. Now he sees his 90-year-old mother from outside her window.

“It’s pretty disheartening for both of us because we hug each other and give each other a kiss on the cheek,” he said.

Middlebrooks is in good spirits although she can no longer leave her room. She entered the Perry County Nursing Home in Marion about a month ago after falling and breaking a bone connected to her hip. She’s hoping to head home in a few weeks after doing rehab.

“She’s got a good personality, kind of funny a little bit, telling little funny things and making you laugh and all,” he said.

He said he’s worried about her, but the nursing home is the best place for her right now.

Berta Lou Middlebrooks holds up a sign for her son from her bedroom in the nursing home in Perry County.

Nursing home Medical Director Dr. William Lee stops by the home Thursday to visit some patients. He points out an outdoor seating area where patients often gather. But everything has quickly changed. As of today, residents’ families are not allowed to come inside. And rules change every day.

“(Usually) If they want to eat out here, they can eat out here. They can play rook. Sometimes we have music. A guy will bring a horse,” he said. “It’s also where people smoke.”

Large ashtrays sit on picnic tables under a large carport. Rows of rocking chairs remain empty, and a white nursing home van sits parked nearby.

The doors of the nursing home are locked. Lee passes a staff person scrubbing down a wheelchair with a hose and enters in through a back maintenance door, now being used for all access to the facility.

Dr. William Lee stands near the back door of the nursing home where residents typically gather

The home’s administrator, Sharon Phillips, has worked with Lee for 29 years since she started as an activities assistant.

She says she’s never dealt with anything like this.

“Madness,” she said. “Cause it’s so fluid, you might get one thing in the morning and then it’s a little stricter by that afternoon as far as information we’re getting.”

She says she gets multiple emails a day with new research and shifting guidelines from the CDC, the Alabama Department of Health, the Alabama Nursing Home Association and others.

Rocking chairs sit empty where nursing home residents typically congregate outside

For now, the home is isolating patients in their own rooms. Phillips says there’s been some consternation, but the more lucid patients understand.

She says her approach shifted almost two weeks ago when she realized this disease might be serious after Alabama had its first confirmed case.

Alabama State Health Officer Dr. Scott Harris has since issued an order banning all visitors to nursing homes in the state.

The nursing home has a disaster plan, but this scenario is distinct Phillips says.

Sharon Phillips stands with Dr. William Lee near the only door staff are using during the coronavirus outbreak

“We’ve had to think about our residents getting it or staff getting it, and what are we going to do when some of our residents get exposed to it?” she said.

The plan is to quarantine any infected patient within the nursing home unless complications require a trip to the hospital.

But Lee says he isn’t too worried about the state’s limited supply of ventilators for coronavirus complications, about 800 estimated by the Alabama Hospital Association. He doesn’t believe it will get to that point.

Modeling from the Imperial College in London predicted up to 2.2 million deaths in the United States in a worst case scenario where hospitals are overrun and ventilators are in short supply.

“If we’ve got every respirator in the state tapped out, it is Armageddon-ish. It is Old Testament," he said, but added he didn’t think it would get that bad: "I just don’t see it happening.”