Nursing home residents across Ohio have been hit hard by the coronavirus, with at least 40 deaths linked to the pandemic, including at least three in Franklin County.

But the overall total isn’t known, and neither are the locations of more outbreaks, because many local health departments and the Ohio Department of Health won’t release details requested by Gannett Ohio reporters — not specific names of patients, just locations and the numbers of coronavirus cases and deaths in each location.

On Friday, the Wayne County Health Department said all five coronavirus deaths in that northeastern Ohio county were connected to one nursing home, a statement rebutted by the administrator of Glendora Health Care Center in Wooster. Ten residents and 10 staff members at Glendora have tested positive for coronavirus, the health department said.

"We have 20 cases (at Glendora)," Wayne County Health Commissioner Nicholas Cascarelli said in a phone interview on Friday. "Not all of those are confirmed because the definition for a case changed. Some of those could be presumptive. If a clinician deems they’re a probable COVID-19 case, they would be included in that number."

The lack of statewide information along with the inability to do widespread testing in nursing homes puts residents and staff members at risk and is frustrating some operators. They contend that not knowing how pervasive the virus has become within long-term care facilities is hampering their response.

"We really need to know what are we dealing with here," said Peter Van Runkle, head of the Ohio Health Care Association, which represents the state’s for-profit nursing homes.

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Nursing homes have been locked down for nearly a month since Gov. Mike DeWine banned all visitors to protect elderly residents who are more vulnerable to the virus. That hasn’t stopped it from spreading to those facilities where staff members and specialized health care workers are still coming and going.

Outbreaks at two nursing homes in Miami County near Dayton have left 12 dead and dozens more sick, while another in neighboring Darke County has killed seven. In the Youngstown area, 12 have died from the virus at long-term care facilities. Another five have died at a facility in Alliance, the Stark County Health Department reported this week.

But many other counties aren’t disclosing any information or are only providing limited details about cases in their nursing homes. It came as a surprise this past week, Van Runkle said, when Ohio Health Director Dr. Amy Acton announced that the virus had been found at 20 nursing homes in Cleveland and Cuyahoga County.

Not knowing where the outbreaks are happening, he said, could allow the virus to spread if a nursing home happens to hire someone or take in a patient from one of those facilities.

A woman was admitted to a Hilliard nursing home near the end of March without knowing that an employee there had tested positive just days earlier. Ann Mayfield told The Dispatch that her 80-year-old mother left the nursing home less than a week later and soon after was diagnosed with the virus, but it’s not clear where she was infected.

As of Thursday, 13 residents and 13 employees had tested positive for COVID-19 in Franklin County assisted-living facilities and nursing homes, according to data from Franklin County Public Health. Three of the 26 have died.

In addition, eight residents of nursing homes in Columbus and Worthington, which are under the separate jurisdiction of Columbus Public Health, have tested positive for the disease, said department spokeswoman Kelli Newman Myers.

Summit County Public Health has refused to release information on COVID-19 cases or deaths in nursing homes or even identify specific nursing homes with cases, including denial of a public records request filed Friday by the Akron Beacon Journal. On Thursday, it said only that Ohio had 254 long-term care residents who had tested positive.

Last month, the department confirmed a case at Ohio Living Rockynol in Akron after the facility’s owner issued a news release. Rockynol last week said its senior living community has a "minimal" number of confirmed COVID-19 cases.

"We are dealing with the fact that you will be able to identify persons that died in these nursing homes as positive COVID-19 cases based on just the obituary or by requesting death certificates for all persons who died in a certain nursing home," health department attorney Tabitha Stearns wrote to the newspaper.

To date, the state is leaving it up to local health agencies to release that type of information and won’t confirm the names of facilities because it doesn’t want to take the chance of revealing the identity of someone who tested positive, said Ohio Department of Health spokeswoman Melanie Amato.

The other big concern among nursing homes is that testing is being concentrated in hospitals. "We’ve made it very clear to the state that long-term care ought to get higher priority. Right now, they’re second in line," Van Runkle said.

The problem, according to the state health department, is that there simply aren’t enough test kits to blanket-test everyone in a nursing home.

"The bane of my existence is the fact that we can’t do this," Acton said. "We have everything set up to do it. We have the ability to do mobile units and go to prisons and go to nursing homes. We have staff to do it once we have more testing."

Ohio and its county health departments have been getting tests to where they're needed even though they seem to be in shorter supply than in other states, said Julie Beckert, a spokeswoman for Toledo-based HCR ManorCare, which operates skilled nursing facilities across the country.

The state has set up "strike teams" to assist local health departments when there are positive tests in nursing homes.

"Where we see that a nursing home is struggling because they don’t have enough gear, the very little bit of gear we have left we’re trying to direct to them," Acton said. "We’ve been able to sort of squash the hotspots as they occur. Time will tell how well we do in that."

Associated Press Reporters John Seewer and Andrew Welsh-Huggins contributed to this report along with Emily Mills of the Akron Beacon Journal and Jack Rooney of The Daily Record in Wooster.