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Health care workers at a Reno nursing home where a coronavirus outbreak has killed two people were told to use surgical masks for two days and to flip the mask inside out before wearing on the second day.

While CDC guidelines allow masks to be re-used in emergency situations, the guidelines are very clear that the outside surface of the mask — which can be considered to be contaminated — not be touched or come in contact with any other surface.

However, in a March 26 letter to staff obtained by the Reno Gazette Journal, management of the Lakeside Health and Wellness assisted living center told its employees to store their masks overnight in a paper bag and then re-wear them inside out on the second day.

"When returning the next day that you are scheduled, you will use the same mask as the prior shift, by turning it inside out and wearing it through your shift," the letter said. "That mask will then be discarded at the end of your 2-days."

Employees were asked to sign and date the letter, indicating that they would abide by the mask guidance.

One certified nursing assistant from Lakeside Health and Wellness, who spoke to the Reno Gazette Journal on condition her name not be used, said she was incredulous when she saw the letter.

"That doesn’t make sense to me," she said. "You're putting the exposed side back on your face. Of course I didn't turn it inside out. That's just common sense."

Lakeside Health and Wellness did not immediately return a call for comment Friday. On Thursday, the administrator said she was too rushed to provide comment on the outbreak.

State health officials confirmed late Thursday that they are investigating the outbreak at Lakeside Health and Wellness, a 189-bed facility on Plumas Street that provides short and long-term skilled nursing and rehabilitation services.

However, they would not provide details on the number of patients and staff who have tested positive for the coronavirus.

The nursing home is one of 20 statewide that have had one or more positive tests, according to the Nevada Division of Public and Behavioral Health.

The CNA who spoke to the Reno Gazette Journal said she is staying in a hotel for a 14-day quarantine after being exposed to positive patients and co-workers.

"I’m actually by myself in a hotel room so I don't expose my family," she said. "I have a 3-year-old."

She is worried because she has a headache and runny nose, which she said are the same symptoms her coworkers who tested positive had at the beginning. One of her coworkers is hospitalized, she said.

The CNA said she was notified by her employer on March 26 that one of her patients had tested positive for the virus. She described her job as being very hands on with patients.

"We are hands on care with the patients," she said. "We help them walk. We bathe them, brush their teeth, change their briefs. We feed them."

After that first patient tested positive, the CNA said staff was given gowns and masks to wear when interacting with patients. By the time she left work last week, however, she said they had run out of gowns.

"We were taking care of our sick patients using the regular hospital gowns, the patient gowns," she said.

She added that she doesn't plan to go back to work at Lakeside.

Dr. Jenny Wilson, REMSA's medical director, said it is difficult to comment on Lakeside's advice for re-wearing masks without knowing more details, but said her agency is not advising masks be turned inside out before reuse.

"It's definitely not a recommendation we are following," she said. "But obviously it is a really complex issue to what degree of personal protective equipment is adequate for each situation."

According to the CDC's website, if reusing masks becomes necessary, it should be done with caution.

"Face masks should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage," the guidance says. "The folded mask can be stored between uses in a clean sealable paper bag or breathable container."

Anjeanette Damon is the government watchdog reporter for the RGJ. You can reach her at adamon@rgj.com or follow her on Twitter @AnjeanetteDamon. If you care about shining a bright light on decisions made by your elected officials, please consider subscribing to the Reno Gazette Journal.