At least 10 residents of a state-run nursing home for veterans and their spouses in Chester County have died of COVID-19 this month, and dozens of other residents and staffers have tested positive for the disease or exhibited symptoms, according to the county coroner and an internal report obtained by The Inquirer.

Officials in Pennsylvania have generally refused to disclose the number of COVID-19 deaths and cases at individual hospitals, nursing homes, and other care facilities. But a report circulating within the Pennsylvania Department of Military and Veterans Affairs (DMVA) indicates a dire situation inside the Southeastern Veterans Center, a department-run facility in East Vincent Township.

The coronavirus death toll at the nursing home climbed from one to nine between April 9 and Wednesday, the report shows. Chester County's coroner said Friday that a 10th resident who had tested positive died in the hospital. Even the infection-control nurse there tested positive for COVID-19, according to one staffer, who spoke on the condition of anonymity to protect their job.

In response to the crisis, body bags have been sent to the facility by the Veterans Affairs Medical Center in nearby Coatesville. The National Guard sent about 30 of its members on Wednesday to assist with nursing, housekeeping, and other activities. Additional emotional support services have been requested for staff.

But the scope of the outbreak inside the 238-bed nursing home isn't entirely clear.

The staffer said the number of COVID-19 cases and deaths could be higher. Under the protocol at the home, when two or more residents in one unit test positive for COVID-19, testing ceases in the rest of that unit. Others there who display symptoms of the virus -- which can include fever, nausea, shortness of breath -- are automatically treated as probable positives, according to the internal report.

"We're all freaking out. How do you know who has it and who doesn't?" asked the staffer. "This is bad."

The Southeastern Veterans Center, one of six extended-care facilities run by the DMVA, was rated this year by Newsweek as one of the best nursing homes in the state.

But as in other long-term-care facilities around the country, the coronavirus moved quickly through its elderly population as well as staff. At least 19 workers have tested positive for COVID-19, the report shows.

"We're just a step behind," the staff member said.

Nationwide, at least 6,900 people living in or connected to nursing homes have died of the coronavirus, according to a New York Times tally published Friday.

Christina VandePol, Chester County's coroner, confirmed the information contained in the internal report about COVID-19 deaths at Southeastern, one of several long-term-care facilities in the county that have reported a significant number of infections. Of Chester County's 52 coronavirus deaths as of Friday, 14 have been patients in such facilities, she said.

There has been some tension between VandePol's office and state officials regarding testing. The coroner wants all those who died from "presumptive positive" cases of COVID-19 to be tested.

"We have to certify cause and manner of death, and put our name on the ruling that it is our best judgment," VandePol said Friday. "Given our responsibility and our role, testing should be done regardless of whether other people in that facility have tested positive.

"If families have questions, telling them that someone died of a presumptive diagnosis when a test could've been done isn't enough," she added. "It should've been done."

VandePol acknowledged that a shortage of tests may prevent her preferred approach at the veterans center, and understands the state Department of Health's reliance on "epidemiological links," or cases in which people who have died are presumed to have the disease because they had face-to-face contact with someone who tested positive and displayed symptoms of the disease.

"These facilities may want to test everyone, but they may not be able to," she said. "From a medical standpoint, I would prefer to see everyone who is presumed to have COVID-19 to be tested for it."

The Chester County Health Department said in a statement Friday that it could not provide information on COVID-19 cases as they relate to specific hospitals or care facilities. "The Southeastern Veterans Center has been focused on proactive measures to try and prevent the spread of COVID-19, and has been taking ongoing guidance, and continues to work with the Chester County Health Department in this matter," it said.

Joan Zlogar Nissley, communications director for the DMVA, confirmed that as of Thursday there had been nine deaths among the department's six veterans' homes. The internal report obtained by The Inquirer showed that at the state's other five veterans homes, 12 residents had been tested and no test came back positive.

"When the concerns over COVID-19 first surfaced, staff at DMVA's six veterans' homes reviewed and updated infection prevention and control plans in preparation for a possible outbreak," she said in a statement. "DMVA also implemented heightened safety measures to include restricting visitors, canceling outings, discontinuing group activities, ceasing the use of volunteers, conducting daily health screenings for employees, and putting new admissions on hold."

The state barred visitors on March 12 at the six homes. Besides the Southeastern center, they are: Delaware Valley Veterans' Home in Philadelphia; Gino J. Merli Veterans' Center in Scranton; Hollidaysburg Veterans Home near Altoona; the Pennsylvania Soldiers' and Sailors' Home in Erie; and the Southwestern Veterans' Center in Pittsburgh.

Nissley declined to discuss any possible explanation for the concentration of cases at the Chester County home. She said officials at DMVA homes report positive test results to county, state, and federal public health agencies, and make sure that "follow-up protocols are accomplished."

This article is written by William Bender from The Philadelphia Inquirer and was legally licensed via the Tribune Content Agency through the NewsCred publisher network. Please direct all licensing questions to legal@newscred.com.