An outbreak of at least 13 positive COVID-19 cases at a Grafton long-term care facility — including one death — has been traced to a worker, meaning other nursing homes in the state that rely on staffing services could be at risk.

Village Pointe Commons in Grafton has been in the spotlight following a death last week, but a health official in Ozaukee and Washington counties fears other facilities could be facing the same peril.

Bailey Murph, Washington Ozaukee Public Health Department senior public health strategist, said Wednesday night the department has "found evidence that COVID-19 is being spread by caregivers.”

Three long-term care facilities are being monitored as sites of either an outbreak or potential outbreak in Ozaukee County and two in Washington County, according to officials.

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Kirsten Johnson, director of the Washington Ozaukee Health Department, said the department has done extensive contact tracing and testing to identify who is COVID-19 positive. She sounded a warning to other counties and care facilities where the state's most vulnerable populations live: They should be testing for coronavirus now.

“I know what I’m saying is dire, but because of our extensive contact tracing, this is coming to light for us ahead of others,” Johnson said. “I hope what we’ve learned can be implemented across the state to prevent other deaths and other people from being critically ill.”

Johnson said the risk of spreading the virus is very high, particularly when it comes to agencies that service multiple facilities.

“I think it’s in other communities and other long-term care facilities, they just don’t know it yet.”

It’s not unusual for people employed by health care staffing agencies to work at more than one facility. Many nursing homes that provide long-term care have struggled not only with a severe shortage of workers but also Medicaid rates that don't cover their costs, forcing numerous private nursing homes in Wisconsin to close in the last few years.

Last weekend the Wisconsin National Guard sent half a dozen military medics to Village Pointe Commons for three days to augment nursing home staff until a long-term staffing solution could be found.

The Ozaukee Washington Health Department has been working with Aurora Medical Center in Grafton to test residents and employees at long-term care facilities. That testing has been expedited by the Milwaukee Health Department Lab “because it’s associated with an outbreak,” Johnson said.

Wisconsin's testing priority for people suspected of being infected with coronavirus changed Wednesday. Moving to the head of the line are residents of long-term care facilities, prisons and jails with unexplained fevers or signs of acute respiratory illness.

Johnson said she is hopeful the state is at the “front end of this" to stop the rapid spread of the deadly virus, particularly to people at most risk.

Each of the 13 staff and residents who have tested positive at Village Pointe Commons had some coronavirus symptoms, but Johnson said some of the symptoms were very mild.

“I don’t think Village Pointe Commons is unique, I think what’s unique is that our ability to look at this closely has brought this to light,” Johnson said.

A spokesman for Capri Communities, the company that owns Village Pointe Commons, said they have added extra staff; are following all local, state, federal guidelines; and are closely monitoring residents and staff. All employees are screened for symptoms and have their temperature checked before they start work.

The Ozaukee Washington Health Department has issued three orders since Saturday that Johnson said should be adopted statewide:

First responders and EMS should wear personal protective equipment (PPE) when responding to a medical call of any sort at a facility.

Staff at all long-term care facilities should be wearing PPE and all residents should be quarantined in their rooms.

All staffing agencies and hospice agencies that provide services to facilities should be limited to providing services to one facility to limit the potential of spreading the virus.

As of Thursday, there were 25 confirmed cases of coronavirus in Washington County and 22 in Ozaukee County. Between those counties, there has been one death.

Robert Blackbird, 91, died last week at Village Pointe Commons where he had been in hospice care. It wasn't known that he had been infected with coronavirus until post-mortem tests were conducted.

“We know there are staffing shortages, it’s just going to get worse as people become sick,” Johnson said. “So whatever we can do now to mitigate some of those things, I think we need to do (them) to prevent even more dire circumstances and outcomes.”