Health care group: 4 employees at long-term care facilities, 1 resident test positive for coronavirus in Iowa

Doris Thirtle got the sobering news Saturday that not only had the coronavirus reached her small Iowa town, but that someone who works in the retirement community where she and her sister live had been infected.

Thirtle, 80, lives in one of the cottages abutting Pleasantview Home in Kalona. Her 88-year-old sister, Emma Jean Schrock, lives inside the care center with 56 other elderly residents.

“It’s scary that it has hit here,” said Thirtle, who is largely confining herself to home. “It’s bad that I can’t get in to see my sister. I don’t know if she’s understanding exactly what’s been going on.”

The Iowa Health Care Association confirmed to the Des Moines Register earlier Wednesday that five people at four long-term care facilities in the state have tested positive for the novel coronavirus. Four of those cases involve employees, including one at Pleasantview. In the fifth case, a resident was diagnosed with the highly contagious virus.

Iowa Health Care Association said only that the facilities were in Dubuque, Linn, Poweshiek and Washington counties.

Two of the facilities are identified

But representatives of the facilities themselves have released more information.

The Washington County case was at Pleasantview, where a worker there reported the positive test Friday evening, according to Jeffrey Schmidt, executive director of the facility.

That person did not provide direct care to residents, Schmidt said. The worker is in self-isolation and under medical supervision, he added.

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In the meantime, all residents and their family members have been notified. Visitors are restricted and group activities canceled. Employees have been limited to a single entrance and are being monitored for symptoms of the coronavirus.

In the Linn County case, two workers at Heritage Specialty Care nursing home in Cedar Rapids reported Tuesday morning that they had tested positive for COVID-19. The calls came in 90 minutes apart, said Jason Bridie, a spokesman for Care Initiatives, which owns the nursing home. Bridie said Wednesday it is unclear how the employees were exposed to the coronavirus, but their cases did not appear to be linked.

Both of the Heritage workers directly cared for residents there. One had not worked since March 18; the other since Friday, Bridie said. They sought medical attention over the weekend and were tested for the virus.

“It’s our belief that they weren’t showing any symptoms while working,” Bridie said. “We don’t know exactly who right now they would have been working with,” among the 110 residents of the home.

Staff at Heritage have since been checking on each resident twice a day, taking their temperatures and looking for symptoms, such as coughing or respiratory distress, that might indicate the presence of COVID-19. With an elderly population during cold weather, some of those symptoms often present, Bridie said.

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Bridie said the facility’s medical director, working with the individual residents’ primary doctors, will determine if COVID-19 tests are advisable.

All four nursing home workers and the one resident identified Wednesday are receiving medical care and will remain in isolation for at least 14 days, according to Brent Willett, president and CEO of the Iowa Health Care Association.

"All four facilities are in contact with all staff and resident family members and are doing everything they can to support them," he said in a statement.

The other two long-term care facilities affected have not been identified.

The virus can spread quickly in nursing homes

Nursing homes can be ripe for the quick spread of COVID-19, said Dr. Swati Gaur, chairwoman of the Infection Advisory Committee for the Society for Post-Acute and Long-Term Care Medicine. And elderly people are more likely to succumb to the coronavirus if they contract it.

Gaur said data from China and Italy show a fatality rate of 16-18% among those over age 65.

“It’s like a double jeopardy, almost,” she said of the presence of COVID-19 in nursing homes.“…They are being provided care by the staff that is going from room to room. This is the patient’s home. It’s hard to isolate them. We talk about nursing homes as if they are sterile settings, with everything going perfectly. We need to understand that we can have the best infection-control practices and it can still spread very quickly.”

There may be no more frightening example of that in the U.S. than what happened at the Life Care Center in Kirkland, Washington. That facility reported to state officials on Feb. 26 that it had an outbreak of severe respiratory illness, something staff had been noticing for a couple of weeks, the Seattle Times reported.

The illness was COVID-19. Of the 120 residents there, 37 had died as of Tuesday, according to the Associated Press.

The Life Care Center story is a reminder of what can go wrong, Gaur said.

The Iowa Department of Public Health contacted every nursing home in the state, some 444 of them, before the coronavirus was first detected in Iowa on March 8, Gov. Kim Reynolds said at her Wednesday news conference. The goal was for each care facility to have a contact person with the state, Reynolds said.

IDPH has issued a series of guidelines that nursing homes are asked to follow. Those include limiting visitors and screening staff members as they arrive to work each day for signs of the coronavirus.

Danielle Pettit-Majewski, an administrator for the Washington County Public Health Department, said she’s been impressed with the way care facilities here have adapted in light of what happened in Washington state.

“They have been incredibly responsive and proactive and taking steps to protect their residents,” she said. “Not allowing people to congregate. Taking meals in their rooms. Limiting visitors.”

Gaur recommends that nursing homes go even further. She said they should plan as if one or more of their workers will test positive for COVID-19.

In addition to being screened daily, Gaur said caregivers should wear protective masks whenever they are within six feet of a resident. She estimated that the average nurse in a long-term care facility handles 25 to 30 patients per day, a much higher volume than in a typical hospital. That means anyone who falls ill can spread the disease to a large segment of the nursing home’s population.

Residents who get the coronavirus should be rigorously separated, Gaur said.

“They should be almost like in a sealed-off unit where things are not going back and forth to other patients,” she said. “Don’t share staff or equipment that is being used on them. Once COVID-19 is present, it needs to be contained immediately.”

That may not be possible with staffing levels at Iowa nursing homes, particularly the smaller ones. But Willett said in his statement that the cases reported Wednesday in Iowa show that steps to screen staff and residents “are working.”

"These screening processes enabled facilities to detect these cases quickly and respond ... they have implemented protective protocols, notified residents, families and staff members and contacted public health officials," he said.

"We respectfully ask the public not attempt to visit long-term care facilities at this time," he added.

For Thirtle, in Pleasantview, she's found an alternative to visiting her sister. On Monday, she got on the phone and stood outside Pleasantview’s main building, where she could watch through double-glass doors as Schrock spoke back to her.

“I pray it doesn’t last too terribly long,” Thirtle said of the COVID-19 pandemic restrictions.

Barbara Rodriguez covers health care and politics for the Register. She can be reached by email at bcrodriguez@registermedia.com or by phone at 515-284-8011. Follow her on Twitter @bcrodriguez.

Mark Emmert covers rural life and the coronavirus for the Register. Reach him at memmert@registermedia.com or 319-339-7367. Follow him on Twitter at @MarkEmmert.

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