A day after a seventh child died from exposure to a virus at a long-term care center in Wanaque, state officials on Wednesday had few answers about the cause of the outbreak and parents raised questions about how the news was delivered to them.

Parents and unions representing nurses and other workers at the Wanaque Center for Nursing and Rehabilitation said they weren't informed of the severity of the outbreak until it was much too late. The 18 affected patients, including the seven who died, were all children, the Health Department said.

Kristine Deleg, whose 16-year-old daughter, Elizabeth Poulous, died Tuesday morning after being stricken with the adenovirus, said Wednesday that there was a heavy lag in communication.

Deleg said Elizabeth was admitted to St. Joseph’s University Medical Center in Paterson on Oct. 3, but that she wasn’t told about the adenovirus outbreak until she received a letter from the facility on Monday, nearly three weeks later. Elizabeth died the next day.

"There was definitely a breakdown in communication," Deleg said. "When you're dealing with this type of situation, and you're dealing with these children that are so fragile, that's something you have to do right away.”

Gov. Phil Murphy, speaking at a news conference outside the center on Wednesday afternoon, said, "We clearly need to understand the communication here."

Rosemarie McPartland of Bergenfield asked Murphy during the news conference to reassure her that her stepson Matthew, a patient at the facility for 31 years, would be OK. The two had a private conversation, but McPartland said afterward that she was still not satisfied with the way the outbreak has been handled.

She said she has yet to be notified by the center's staff about the outbreak. “I’m concerned about the kids with no voices," McPartland said. “I’m here to talk for the kids with no voice.”

EARLIER:Six children die after virus outbreak at long-term care facility in Wanaque

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Rowena Bautista, the facility's administrator, did not respond to requests for comment on Wednesday. Staff members at the facility referred questions to Braithwaite Communications, a Philadelphia-based marketing agency whose services include crisis communication. The company did not respond to calls or emails.

The facility is owned by a private corporation, Wanaque Nursing & Rehabilitation, whose officers are listed as Daniel Bruckstein and Eugene Ehrenfeld. The two are listed as officers in seven other care facilities across New Jersey. Neither could be reached for comment.

The facility has been barred from admitting new patients until the outbreak is declared to be over, the department said.

The state health commissioner, Dr. Shereef Elnahal, said the facility could not be closed, because few places in New Jersey are equipped to treat its patients, many of whom suffer from neuromuscular and respiratory problems caused by genetic syndromes, accidents at birth or abuse.

Adenoviruses are common viruses that affect the lining of the airways, intestines, eyes or urinary tract and are responsible for some colds, coughs, sore throats, pinkeye and diarrhea. Usually the illnesses are mild, but they can be deadly for people with weakened immune systems.

It may be "impossible or difficult to know" how the virus got to the facility, Elnahal said at the news conference.

The first case of a patient with the adenovirus was noted on Sept. 26, Elnahal said. The Health Department was notified of respiratory illnesses at the center, in the Haskell section of the borough, on Oct. 9, after the office closed for the day. Health officials began surveillance work at the facility the next morning.

State officials did not give specific dates for the deaths except for the seventh victim, who died Tuesday night.

Health officials conducted a surprise inspection over the weekend, during which they found "minor handwashing deficiencies," the Health Department said in a statement.

The facility has been cited for instances of poor patient care and unsanitary practices that could spread infection in annual reports from 2015 to 2018 by government inspectors.

Elnahal said it's rare that any facility would emerge from an inspection with no citations and said the ones that the Wanaque Center received in 2018 were "low-level."

Two unions that represent nurses and other health care workers at the for-profit facility criticized its management and ownership for poor working conditions.

“Since new for-profit ownership took over at Wanaque Center in 2014, workers have expressed serious concerns over worsening staffing levels, lack of adequate supplies and severe cutbacks to job standards," said Ron McCalla, a vice president of 1199SEIU, which represents 136 workers at the facility.

State Sen. Gerry Cardinale, Assemblywoman Holly Schepisi and Assemblyman Robert Auth, who represent the area where the facility is located, said state officials need to ensure that something like this never happens again.

"This deadly viral outbreak was clearly a preventable tragedy, and state officials must take immediate action to deliver justice to the families who are being forced to reckon with every parent’s worst nightmare — the loss of a child," the three Republicans said in a statement.

The outbreak has been confined to the ventilator unit, which holds patients who need mechanical support to breathe, Elnahal said.

As of Wednesday, the Wanaque Center had 49 children in the ventilator unit, which is licensed for 72 children, said Donna Leusner, a Health Department spokeswoman. An additional 20 beds are available for older children in another area, she said.

The Wanaque Center is licensed to house 135 adults and 92 children

McPartland said the center has always been clean and the staff members nice in the three decades she has been visiting her stepson Matthew, who suffered a brain injury in a car crash on Route 80 when he was a toddler.

"I feel terrible that this is happening," McPartland said. "I love the staff, but something is wrong today. “

Backed by power lines and sheltered by trees, the center is relatively isolated from its busy surroundings on Ringwood Avenue near a Route 287 exit.

Those who live or work nearby expressed sympathy for the families of the children. "It’s a shame," said Mike Borer of Westwood, who was interviewed at a strip mall on Ringwood Avenue near the center. “They're just starting their lives.”

Staff Writers Steve Janoski, Joshua Jongsma, Dustin Racioppi, James Nash and Keldy Ortiz contributed to this article.