Nursing homes in Jefferson County were blindsided this week by a letter from the county health department telling them to take in residents who are recovering from COVID-19 and still test positive.

“For the past month, Alabama nursing homes have been doing everything they can to prevent COVID-19 from entering their buildings,” said John Matson, communications director for the Alabama Nursing Home Association.

“Now, Jefferson County Health Officer Dr. Mark Wilson wants nursing homes to accept patients who have tested positive for COVID-19 even though they still exhibit symptoms and have not fully recovered.”

Matson said the decision goes “against sound medical advice.”

In a statement, the Jefferson County Health Department (JCDH) said it is following the CDC guidelines for treating COVID-19 patients in healthcare settings.

“We are also working in conjunction with the Alabama Department of Public Health as it relates to relevant state guidelines,” according to the statement.

In the letter that Wilson sent to area nursing homes, Wilson cites “the possibility that our hospitals will not have the capacity to care for a large number of patients infected with COVID-19” as part of the reasoning behind telling nursing homes they can accept COVID-19 patients without a negative test.

Matson told AL.com that the association began getting calls Tuesday from member nursing homes, alarmed at the letter.

“For weeks we haven’t allowed family members and volunteers to visit our nursing homes, and our families understand why,” he said. “Now they can’t visit, but we’re supposed to admit someone that’s COVID-19 positive?”

The elderly and those with medical conditions are considered the most at risk of serious illness and death from COVID-19. Nursing homes were among the first types of facilities in Alabama and nationwide to implement strict lockdown procedures at the beginning of the epidemic. In one nursing home in Washington state, more than 50 residents contracted the virus and at least 19 deaths were tied to the facility.

Wilson’s letter says the JCHD endorses the CDC’s non-test-based strategy because of limited testing supplies available in Jefferson County. The health department says patients who have tested positive for COVID-19 could be admitted to nursing homes three days after fever is gone and respiratory symptoms have improved.

Matson said the nursing home association has instead directed its members to follow guidelines from the American Medical Doctors Association, a trade organization for nursing home doctors, which say nursing homes should only admit former COVID-19 patients who no longer display symptoms and have two negative COVID-19 tests.

“We’ve told our members to follow the guidelines set forth by the American Medical Directors Association because those are the doctors that practice in nursing homes and they understand the people we care for better than any group of physicians,” he said.

Wilson’s request only applies to nursing homes in Jefferson County, Alabama’s most populous county, which operates a health department independent of the state health department. Matson said he wasn’t aware of any similar letters from the state.

The JCHD request comes the same week that a Birmingham nursing home, Cherryhill Rehabilitation & HealthCare Center, announced a resident had tested positive for COVID-19.

Statewide, Alabama nursing homes have reported eight confirmed cases of COVID-19 in six Alabama nursing homes. Two employees tested positive in a Hoover facility and another case was reported in Vestavia. The rest are in other parts of the state, including Dothan, Opelika and Northport.

Read more: Coronavirus confirmed in six Alabama nursing homes

Matson said neither Wilson nor the JCHD had contacted the association with followup information. He said nursing homes are already stretched thin, with no federal money allocated to help them fight the virus.

“Our nursing homes need resources to prevent the spread of COVID-19,” he said, “not orders from government officials to bring this horrible virus into the very place where our most vulnerable citizens live.”

*Updated at 7 p.m. 3/31/20 with a statement from the Jefferson County Health Department.