Nine crucial days: Without local medical staff help, Life Care had to wait on a federal strike team

The 63-year-old man turned blue and struggled to breathe, the Life Care Center worker told an emergency dispatcher by phone on March 1. The man hadn’t traveled out of the country, to Asia, Iran, or Italy in the last two weeks, the worker said. But she noted that days earlier two people -- an employee and a resident -- at the Kirkland assisted living facility had been diagnosed with coronavirus.

Staff would also succumb to the virus, and at one point, the Life Care Center had lost a third of its staff to the virus, with the remaining caregivers working 18-hour shifts. Of 180 employees, 55 have now tested positive for coronavirus. But even as international focus zeroed in on the nursing home, Life Care wasn’t getting outside help, said spokesperson Tim Killian. It took nine days, from the moment the outbreak became known, for an outside medical team to come to Life Care -- a strike team from the U.S. Department of Health and Human Services. During that time, 18 residents from Life Care died.

Instead, Killian said, during those nine days they were swamped with paperwork from government agencies “asking us to spend administrative time searching down email lists and filling out documents and paperwork,” he said. “We were just doing everything we could to provide care to the patients that needed it.” Jeffrey Duchin, the health officer for Public Health, Seattle & King County, said he asked hospitals to offer staff, but he didn’t get that help.

“I personally would have thought that we would have been able to muster more staff from our local healthcare system,” Duchin said. “But I think everybody at this point was already experiencing some degree of COVID-19 stress, and didn't feel like they had staff that they could spare.” “I would have thought we would have had a more robust reserve,” he said. As of this writing, 35 people connected with Life Care have died -- that’s 12 percent of all residents and staff. Those deaths make up roughly half the coronavirus death toll in Washington state.

Day 0: Before the outbreak became known On February 27, Seattle & King County Public Health’s communicable disease program received what they believed was a usual winter time message from Life Care. The nursing home had several residents who had fallen ill with a respiratory bug. Public Health had received 19 notifications of flu outbreaks at other facilities. Life Care’s situation did not immediately cause alarm. That same day, officials from the EvergreenHealth hospital in Kirkland notified Public Health that they had two patients with unexplained pneumonia, one of whom had been a resident at Life Care. A second nearby hospital reported a similar case, instead it was an employee. The patients were unlikely to have coronavirus, public health said. There wasn’t yet evidence that the virus had spread between people living in the area -- what is known as community transmission. But the CDC had changed testing criteria, and patients with unexplained severe respiratory disease or pneumonia now qualified.

DAY 1: Outbreak becomes known The next day, on Friday, February 28, public health learned that 20 residents and 18 staff members at Life Care were ill, and that their flu tests had returned negative. Life Care implemented verbal warnings about the outbreak and provided additional protective gear for visitors to wear, due to the sheer amount of illness at the center. In the days that followed, policy went from discouraged visitation to eventually no visitation at the facility, Killian said. Public Health guided Life Care to use the common protocols used to contain the spread of the flu: create cohorts and limit movement within the facility. And then, that Friday evening, two batches of results showed that four people in the Seattle area had tested positive for coronavirus, two of whom were connected to Life Care. It was at this point that Public Health leaders reached out to the Department of Health and the Centers for Disease Control and Prevention.

Soon after, EvergreenHealth community hospital in Kirkland informed county public health that one of their patients with coronavirus had died. It would be the first coronavirus death in the U.S. DAY 2: CDC team deployed The CDC deployed a team of 18 to King County the next day, and in the next six days, the CDC and Department of Health carried out walk-through evaluations, gauged training and supply needs, and examined response activities. The CDC conducted infection prevention training, gathered information on staff absences, reviewed clinical data from resident records, and continued their evaluation of the circumstances. They conducted personal protective equipment training and discussed communication challenges. DAYS 3 & 4: Administrative help doesn’t cut it, Life Care says For Life Care, however, the administrative tasks were not enough. To those inside, it felt like the nursing home was managing the outbreak alone as public health officials took notes on the sidelines.