On Tuesday morning a pipe-smoking resident rolled his motorized wheelchair down one of the compound’s paved, tree-shaded paths. He said he did not believe covid-19 was there, and that restrictions were “overblown.”

“They’re having residents not have their meals [together] and gather in large groups. I think it’s already been blown out of proportion,” said the man, who declined to identify himself as he steered toward a crosswalk, adding that he “was heading out.” The man zoomed off to a congested strip of shops, cafes and restaurants in the Seattle suburb.

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The incident reflects the growing confusion and concern about the response of Seattle-area nursing homes to the pandemic, where the coronavirus has taken root in at least 11 such facilities, as well as the broader implications nationally. Some relatives of nursing home residents have criticized facilities for not taking preventive steps soon enough. At least 31 people have died from the virus in the state and nearly all are associated with Life Care Center nursing home here or four other long-term care facilities nearby.

Alarmed by the speed with which the virus is tearing through nursing homes, senior-living communities and other places that cater to the elderly, Washington Gov. Jay Inslee (D) issued a proclamation Tuesday, requiring long-term care facilities limit visitors and screen workers. Nursing homes nationwide, as well as the Department of Veterans Affairs, the government agency that runs 134 of them, also adopted similar rules for sites where the elderly live. In an address to the nation Wednesday night, President Trump recommended that nursing homes suspend nonessential visits.

“If you do the math, it gets very disturbing,” Inslee said Tuesday at a news conference, referring to the rapid rate at which the virus is spreading.

None of the companies that own the facilities have said how the virus was introduced, and they may not know. But the fast spread in Seattle-area nursing homes could stem from repeat visitors or even patients or workers who moved among the homes, health-care officials said.

A potential spread by health-care workers is “a concern I’ve heard, and it’s something the Department of Health is going to have to look at,” said Robin Dale, the president and chief executive of the Washington Health Care Association, a nursing home trade group in the state.

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Long-term care sites have a turnstile of workers, volunteers, clergy members and guests who treat, entertain, minister to and chat with residents, all of whom could potentially introduce or spread the virus. Specialty care workers also visit multiple facilities in the area, such as certified nursing assistants who help patients with daily tasks such as bathing and eating, and physical therapists who help them regain their mobility after a fall.

Timothy Killian, a spokesman for Life Care Center of Kirkland, the hardest-hit facility, said that “frequent overlap between nurses working here and working at other facilities” occurred before the outbreak. Since the covid-19 outbreak was confirmed on Feb. 29, he said, nurses are restricted to Life Care in Kirkland to prevent the spread.

Cathleen Lombard, a visiting licensed practical nurse who signed up to work at Life Care Center more than a week ago, said she told a nursing colleague that it “was just a matter of time” before covid-19 spread to other locations.

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“We're doing the best we can here to contain the virus,” she said. “I also work at a school. That's my regular job. I have decided to not go back to that school until this is over. As a parent, I would not want a nurse coming into my child's school if they had been here.”

Patients, too, could have spread the virus while moving from one facility to another. Madison House Independent & Assisted Living Community in Kirkland disclosed that a resident who lived at its facility from Feb. 27 to March 3, after moving from Life Care Center, has tested positive for covid-19 at a hospital, where the person remains.

“We cannot definitively state the source of transmission, but the affected resident did come to Madison House from another facility that subsequently disclosed having multiple confirmed covid-19 cases,” Eric Hanson, a spokesman for Koelsch Communities, which owns Madison House, said in an email.

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Although there is still much to be learned about covid-19, research points to the disease being deadlier for older and at-risk patients. A recent World Health Organization report found that the case fatality rate for covid-19 patients older than 80 in China was 21.9 percent, while patients of all ages with no underlying chronic conditions had a fatality rate of 1.4 percent. WHO declared the outbreak a pandemic Wednesday.

The Centers for Disease Control and Prevention said the virus is typically transmitted through respiratory droplets produced when an infected person coughs or sneezes.

Introducing the virus to a long-term care site has been particularly perilous in the Seattle area. About 59 percent of the 366 confirmed cases of covid-19 in Washington state as of Wednesday afternoon were people older than 60, according to state health department data.

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“We know this is a fatal disease, all too frequently for those particularly of age and those who have chronic conditions,” Inslee said.

Inslee’s rules to stanch the spread of the disease now limit residents to one visitor a day, and each visitor must be screened for the virus, including having a temperature below 100.4 degrees. Employees and volunteers also must be screened before each shift.

Efforts to stop the spread to nursing homes are moving quickly beyond Washington. VA on Tuesday announced plans to bar visitors at its nursing homes nationwide, except for cases in which residents are at the end of their lives. Kentucky Gov. Andy Beshear (D) also directed nursing homes and other long-term care facilities to stop taking visitors, except when they are receiving end-of-life care.

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Life Care Center, just northeast of Seattle, shows how rapidly the virus can decimate a single facility, particularly one that seemed to be caught unaware. Sixty-seven of the 180 employees were out with covid-19 symptoms as of Wednesday. Residents dwindled from 120 to 47, with dozens ending up in the hospital. More than half of the current residents have tested positive for the coronavirus.

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Twenty-two people associated with the facility have died in the past three weeks — more than half of total deaths in the U.S. so far. Typically, three to seven residents die each month at the facility. Residents and visitors said the devastation felt unimaginable only a few weeks ago when the nursing home scheduled a string of festivities, including a musical performance by a country music duo, a painting class and a Valentine’s Day cupcake bar, according to a calendar of events.

Now those festive moments are chilling because health officials say the virus had already taken hold among some residents, who were unaware, and spread quickly.

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“They had no clue of the risk,” said Cheri Chandler, 58, whose parents often visited a friend there.

Relatives and friends of residents in nursing homes across the Seattle area worry that nursing facilities are waiting until they have a positive covid-19 test to implement significant precautions. And they worry that visitors may not be warned if they came in contact with someone infected. Life Care, for example, said it called each resident’s family but doesn’t have the “manpower” to call all visitors.

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Chandler’s parents, Pat and Bob McCauley, ages 79 and 80, visited a friend at Life Care numerous times until Feb. 28. That’s when a nurse said they had to wear a mask because of a respiratory virus. The couple “high-tailed it out of there,” Chandler said. Her father was furious and tried to alert public health officials.

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Now her parents are “scared to death,” and their friend, who tested positive for covid-19, died at a hospital this week. Chandler said her father has a cough, her mother has a fever and both have now been tested for covid-19. They haven’t yet received the results.

“Why aren’t they just making an announcement that anybody who stepped foot in Life Care should be quarantined?” she said. “A lot of people are in denial and just want to put their head in the sand. And those are the people that are killing other people. … It’s just a mess.”

Issaquah Nursing & Rehabilitation Center, 20 miles south of Life Care, is now experiencing an outbreak. On Friday, the facility said one of its residents had been transferred to a hospital earlier in the week and subsequently tested positive for covid-19. By Saturday, a second resident had a positive test, and on Sunday, the facility reported a third.

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Late Monday, the nursing home reported that one of those residents — whom local health officials described as a woman in her 80s — died of the disease over the weekend. On Wednesday night, the company said seven residents tested positive for covid-19 and are in on-site isolation, as well as two staff members with the disease who are in off-site quarantine. The company did not update the status of three other residents with covid-19 who it said were in off-site quarantine Monday.

“Our hearts are heavy with grief,” the company wrote on its website.

At the Ida Culver House Ravenna in Seattle, five residents have tested positive, including one who died, and two staff members also tested positive. The company said Wednesday that neither staff member works at “any other senior living community or facility.”

Like a wildfire that jumps from one tinder box to the next, one area long-term care facility after another reported covid-19 cases this week. At least eight other facilities in the Seattle area that cater to the elderly reported residents, staff members or both testing positive for the virus. That included the first patient who died in the area, who originally was reported to be at home.

The Gardens at Juanita Bay, where the man on the scooter lives, is a senior citizen community of about 50 people who share meals inside a chalet-like building steps from Lake Washington. Officials there said in a news release that they had taken “extreme precautions” to protect residents, such as screening visitors and closely monitoring residents for signs of the virus.

On Friday, a resident was taken to the Seattle VA Medical Center and tested positive on Monday for covid-19, said Kevin McNamara, the regional operations manager for Transforming Age, which runs the facility. He said they did not share staff members with Life Care.

But Julie Schuller, whose 94-year-old mother has lived at the facility for several years, said it was only after the virus was confirmed that residents were asked to stay in their rooms and began having meals delivered to them. Schuller said the steps came “a little too late.” Now she wants her mother and other residents to be tested and to ensure that the facility is protected from infection.

“It’s a very helpless feeling,” she said.

Her mother, a retired nurse, is confining herself to her apartment.

Not so for the man who zoomed away from the Gardens. Schuller confirmed that he lives there. The Gardens has advised residents to remain in their apartments and to isolate themselves from gatherings, McNamara said.

“However, public health officials and the CDC have not put our facility under quarantine,” McNamara said. “Therefore, residents may leave the property if they wish to do so.”

The man drove his scooter up 100th Avenue Northeast on Tuesday, zipping past apartment complexes, markets, bus stops and pedestrians. He passed a young woman in eyeglasses, a man jogging with his dog and another man bundled in a hat and gloves.

He ultimately rolled into a smoke shop and bought a 16-ounce bag of pipe tobacco, said shop owner James Jeong, 52.

Jeong said he has been meticulous about using sanitizer on his hands after every customer pays. But he was rattled that someone from a nursing home affected by covid-19 had come into his shop.