Health officials believe it may have been spread by employees who unknowingly had coronavirus.

Seventy additional residents and employees at a nursing home in Texas City have tested positive for COVID-19, bringing the total number of cases at the facility to 83, the Galveston County Health District announced Friday.

The first case of COVID-19 at The Resort at Texas City was reported on Saturday. After the cases climbed to 13 during the week, the health district and the University of Texas Medical Branch tested an additional 146 residents and employees on Thursday. Some of those results are still pending.

Galveston County Local Health Authority Dr. Philip Keiser said based on what they saw during a visit to the facility on Saturday, the staff is following CDC guidelines. He said they think the cases may have been spread by several employees.

"There’s no way that we can prove this, but we believe that there may have been some employees who had accidentally contracted COVID, and then had gone to work," he said at a press conference Friday. "One of the things that we’re learning about this virus is that there are a lot more asymptomatic cases out there than anybody ever dreamed up. So it shouldn’t be surprising that this could happen at a place."

The Resort at Texas City is a 135-bed facility about an hour southeast of Houston. Keiser said the nursing home has cohorted the patients together on a separate hallway away from everyone else.

He also said the health district is issuing an order requiring additional safety restrictions for long-term care facilities, including nursing homes and assisted living locations, in Galveston County during the pandemic.

"I think it’s important that given what we know now, and given what we know about the population of long-term care facilities and their vulnerability, that we double down so that we can protect them as best we can," Keiser said.

Under the order, employees who work at a facility with a confirmed case will be prohibited from also working at other facilities.

"It was a surprise to us to realize, but this is a fairly common practice, people will often work at more than one facility," Keiser said.

This has raised concerns that healthcare workers could be unknowingly spreading coronavirus across locations.

Keiser said there are a few other long-term care facilities in the county with a smaller number of confirmed cases.

The order also requires long-term facilities with positive cases to notify family members and "at the very least, put a sign on the front door letting the public know there is a COVID-19 positive resident within the facility," the health district wrote in a release.

Long-term facilities will also be prohibited from taking residents outside the grounds except for in an emergency or for dialysis.

“We are gravely concerned about the spread of this virus within nursing homes because of the close proximity and vulnerability of the residents,” Keiser said in a press release announcing the first 13 cases Thursday.

In Montgomery County, The Conservatory at Alden Bridge, an apartment complex for seniors in the Woodlands, is also dealing with a coronavirus outbreak that has resulted in the death of three men.

And in San Antonio, 67 residents at a nursing home have tested positive for COVID-19, resulting in one death.

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