Pima County authorities had reported 51 deaths from the new coronavirus as of Friday. A large share of the dead appear to have been residents of one south Tucson nursing home.

At least 20 residents have died during the outbreak, many or all with COVID-19 symptoms, according to one employee with knowledge of the deaths who did not want to be identified because the person wasn't authorized to speak for the facility. That number probably undercounts the actual toll, the employee said, because patients who were never tested or who tested negative but later developed symptoms may not be reported as COVID-related deaths.

County and state health officials refuse to release information about deaths in care facilities, citing patient privacy.

But the county medical examiner's office — which only rarely reviews deaths that occur in medical facilities — provided a list of six COVID-19 deaths it has confirmed. Of those, at least one was a resident of Sapphire of Tucson Nursing and Rehab, according to a relative. And at least two Tucson-area funeral homes contacted by The Arizona Republic said they already have handled deaths from the site.

A spokeswoman for Sapphire said she could not provide an accurate count of the deaths attributable to COVID-19, the disease caused by the new coronavirus, because some patients may not have been tested before they died and others may have had chronic conditions that contributed to their death.

The facility, at 2900 E. Milber St., has been ravaged by the virus for weeks.

On March 30, Sapphire confirmed to The Republic that 24 of its residents and three employees had tested positive for COVID-19. After declining to provide an update, Sapphire on April 14 confirmed to The Republic that the number of confirmed cases had doubled to 50 residents, and that 24 employees had been infected.

"Please be cautious when attempting to use information provided by 'employees' who may or may not have access to accurate information," Sapphire spokeswoman Jeanine L'Ecuyer said in a statement in response to questions about how many patients had died.

The outbreak of the virus at the nursing home coincides with others across the country, in facilities where residents at high risk live in close quarters, often cared for by staff with too much work or too few resources. Nursing homes from Washington state to New York have been the scenes of scores of deaths.

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About 250 employees work at the Tucson nursing home, which on the federal Centers for Medicare & Medicaid Services quality rating scored two out of five stars.

Yet Arizona only recently began requiring nursing homes to report COVID-19 cases in nursing homes, and still doesn't collect information about positive tests for nursing home staffers.

In Maricopa County, more than half of all COVID-19 deaths have come from nursing homes as of this week. But Pima County hasn't released similar information.

So reports of deaths of Sapphire residents must be surfaced one by one.

'No way to get out'

Lloyd Henry Franklin II, a retired TV repairman, lived at Sapphire for about six years after fracturing his hip and suffering other health problems. He would have celebrated his 64th birthday next month.

His sister, Eva, who lives in Ridgeland, South Carolina, said she hadn't heard from him in a while so she posted a message on his Facebook page on March 21, asking, "Bubba, please post something, so I know you're OK."

She never got a response. A week later, she learned her brother was in the hospital with symptoms of COVID-19. On March 28, he died. Two hours after he died, test results came back confirming he had COVID-19, she said.

"I feel like people in nursing homes are stuck in a death trap with no way to get out," she said.

Her voice broke as she recalled her older brother. Growing up in South Carolina, he would aggravate her, but he also was a fierce protector. He moved to Arizona in 1984 and later married and raised a son and daughter.

She is haunted that her brother spent his final days isolated from family because of the highly contagious virus.

"For them to die alone, it just makes it doubly worse," she said.

Just two days before Franklin died, another Sapphire resident, Jesus Robles, died on March 26 after testing positive for COVID-19 at a hospital, his sister, Nora Gonzalez, told Tucson news station KGUN 9.

After being injured in a car accident, Robles, 47, had lived with quadriplegia and had been a resident at Sapphire for the last four years, Gonzalez said.

The Pima County Medical Examiner's Office ruled the immediate cause of his death as complications of COVID-19 respiratory infection.

"He was our centerpiece," his sister said a TV interview. "They told him when he had his car accident that he was not going to live no more than five years. He survived 18 years."

The Republic contacted about a dozen funeral homes in Tucson asking whether they had handled arrangements for residents of Sapphire who had died from the new coronavirus. Two mortuaries confirmed handling arrangements for Sapphire residents. It was unclear how many such cases they had handled. Some declined to answer, others didn't know or referred calls to their corporate offices.

Sapphire employees are following infection prevention procedures, L'Ecuyer said, and those who believe they may have been exposed or are developing symptoms are told to leave work and isolate themselves at home. Sapphire is also covering the cost of hotel rooms and meals for staff members who don't want to risk exposing their families by returning to their homes, she said.

"It has not been without complication; our staffers have already been asked to leave one hotel and had to be relocated quickly," L'Ecuyer said in the statement, which also thanked the local tourism bureau and Tucson Mayor Regina Romero for assisting in the relocation of Sapphire employees.

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Nathaniel Sigal, a spokesman for the mayor, said Friday that the mayor's office was aware of COVID-19 cases at Sapphire reported in the news media last month, but he didn't have information on deaths at the facility. He said that "any fatality is absolutely tragic."

The worry is 'something awful'

Beatrice Ard, affectionately known as "Miss Bea," broke her ankle at her Tucson home on March 8. After being hospitalized, she was taken to Sapphire on March 12 to rehabilitate, said her grandson Gerren Ard.

The family was unable to visit their 77-year-old grandmother, he said, because, like nursing homes nationwide. Sapphire had banned nearly all visitors as a precautionary measure against the highly contagious virus.

He said he learned on March 29 that there had been a COVID-19 outbreak at the facility, first by talking over the phone with a roommate of his grandmother and then later from an automated telephone call from the facility.

He said the family was told on April 3 that his grandmother had contracted COVID-19 and was back in the hospital. His grandmother has underlying health conditions that include chronic obstructive pulmonary disease, high blood pressure, asthma and type-2 diabetes, he said. Shortly after arriving at the hospital, she fell and fractured her hip and had to have surgery.

His grandmother had two words to relay to the family after her hip surgery, he said. They were: "No Sapphire."

After a few weeks of what her grandson describes as "awful worry," she is doing better.

He looks forward to his grandmother returning home when she's well enough to bake her famous sweet potato pies, crochet and read the thrillers she loves.

"We haven’t seen her and she hasn’t had a good cooked meal in a long time," he said.

County, state won't release information

Pima County Health Department Spokesman Aaron Pacheco said the county could not release specific information on long-term care facilities that have had deaths or cases of COVID-19.

While the county cannot release specifics, "we have committed a great deal of resources to try to prevent, identify, and respond to cases in these types of settings," he said.

Arizona, unlike many states, has not released statewide figures on the number of coronavirus cases in nursing homes and just began gathering that information under an executive order signed by Gov. Doug Ducey last week.

Long-term care facilities, such as nursing homes and assisted-living facilities, are now required to report to the state weekly the number of residents who test positive for COVID-19 and how many are hospitalized. But the executive order does not require them to report deaths related to COVID-19. Nor does the order require that facility names be made public.

The state's largest advocacy group for retirees, AARP Arizona, has asked the state to release to the public which long-term care facilities have had confirmed cases of COVID-19.

Minnesota and Oklahoma are among the states listing facilities with residents who have tested positive. And just this week, Ohio Gov. Mike DeWine and the Ohio Department of Health followed suit after pressure from families and news media.

Across the country, residents of long-term care facilities are among the most vulnerable populations to the highly infectious virus. Many are elderly and have underlying health problems. Federal and state officials have issued several mandates since early March, including banning nearly all visitors and requiring stringent infection control.

More than 3,600 deaths nationwide have been linked to COVID-19 outbreaks in nursing homes and at long-term care facilities, an alarming rise in the past two weeks, according to The Associated Press. The AP's tally is based on media reports and state health departments.

The latest count of at least 3,621 deaths is up from about 450 deaths 10 days ago. The true toll is likely much higher, experts say, because most states don’t include in their counts the people who died but were never tested for COVID-19.

Arizona Department of Health Services spokesman Chris Minnick would not say when the public will see the information gathered through Ducey's executive order. He implied that the state plans to release “aggregate statewide level data” and did not respond when asked if that meant the state wasn't planning to release the names of facilities with confirmed COVID-19 cases.

Arizona's lack of information concerns advocates for families who have loved ones in long-term care facilities.

“How many body bags do we have to see being carried out of nursing homes before they start ponying up this information, they start being transparent and just being honest?” said Brian Lee, executive director of the Texas-basedFamilies for Better Care. “The longer this virus lingers in these facilities, it’s going to show the recklessness of this policy decision to shroud this information.”

They don’t have time to wait for information as the rapidly spreading virus can change things by the hour, he said.

State officials are leaving families in the dark by not sharing the data they have quickly, he said. Families need as much information as they can get to make informed health care decisions for their loved ones.

“The longer (the state) sits on this, the more heartless they look,” he said. “It’s really become a guessing game whether or not there are outbreaks in nursing homes or assisted living.”

Do you have information about Sapphire or another Arizona nursing home with COVID-19 outbreaks? Reach the reporter at anne.ryman@arizonarepublic.com or 602-444-8072. Follow her on Twitter @anneryman.