Stubborn virus up again in R.I. nursing homes

More than six months into the COVID-19 crisis, the disease is continuing to spread in Rhode Island nursing homes.

Some homes that had dealt with more than 100 cases in the spring are seeing new ones crop up. Others that were untouched throughout the first waves of disease are now dealing with their first outbreaks as the state braces for the fall.

“The battle is definitely not over,” said James Nyberg, director of LeadingAge RI, which represents nonprofit nursing homes and assisted-living facilities in Rhode Island. “They’ve all done everything humanly possible to keep it out; it’s just the insidious nature of the virus.”

Like Rhode Island in general, nursing homes are seeing an overall uptick in cases after a summer lull. In the two weeks leading up to Wednesday, the state reported at least 70 new cases among nursing-home residents, according to Department of Health data. That’s more than double the number reported over the two-week span leading up to Aug. 12.

Assisted-living facilities in Rhode Island have also seen increases in coronavirus cases. In the two weeks leading up to Aug. 12, new resident cases in assisted-living facilities were in the single digits. In the two weeks leading up to Wednesday, there were at least 25 new resident cases in assisted-living facilities.

The numbers are still well below those seen during the peak of the pandemic.

In just one week in late April into early May, for example, coronavirus cases among residents of nursing homes and assisted-living facilities jumped by at least 300, according to state records at the time. (And probably more: The data is presented in ranges, making exact calculations hard to come by; the increase might have been more than 400.)

It’s hard to pinpoint exactly why the more modest upticks in September have happened, said Joseph Wendelken, a spokesman for the state Department of Health. But opening up family visits at the homes is not believed to be driving it, he said. Visitation, while relaxed compared to the peak of the pandemic, is still “tightly controlled,” Wendelken said.

“In facilities that have had more than two new cases in the last two weeks, we are doing comprehensive, on-site infection control surveys,” Wendelken said. “And we have a Congregate Setting Support Team that can go on-site to help get infection control measures in place, if requested by the facility.”

Publicly, the state publishes fresh data every Wednesday on cases and deaths among residents of nursing homes and assisted-living facilities. It presents the data in ranges — a certain facility had between five and nine new resident cases. It does that because the numbers can fluctuate. But it allows a broad view of the situation among the people most vulnerable to the disease: older people, people in frail health and people who live in close quarters.

For this story, the Department of Health also provided a more detailed analysis of the last few weeks, which confirmed an uptick in the last month among not just residents, but also staff of nursing homes and assisted-living facilities.

According to that data, 69 new infections among staff and residents of nursing homes and assisted-living facilities were reported between Aug. 23 and 29. A week later, that dipped to 49, but then rose to 129 the week after that. Between Sept. 13 and Sept. 19, there were 83 new cases among staff and residents of nursing homes and assisted-living facilities, a dip from the week before but still 20% above that last full week in August.

With hard-won experience, nursing homes in the state have had success in controlling the virus once it’s inside, according to representatives for the industry. In the spring, outbreaks sickened scores of people in some facilities. These days, when they’ve happened, the outbreaks have been relatively small.

Small, but in some homes unavoidable.

“You can’t keep the virus out of the country, you can’t keep it out of the state, and it’s very difficult to keep it out of homes,” said Scott Fraser, president and CEO of the Rhode Island Health Care Association, which represents mostly for-profit nursing homes.

It’s difficult to say what exactly is leading to the uptick, Fraser said. His group has pressed the state to do even more testing — of patients discharged from hospitals, for example. Fraser said the state recently pulled back on the number of negative tests that a patient had to have before being sent from a hospital to a nursing home, from two to one.

And although nursing home staff are tested regularly, outside vendors — like therapists or hospice care workers — have had fewer opportunities to get tested, Fraser said. Some have come to the homes asking if they could get tested there.

“Our homes have been fighting for six months now to keep this virus out, and doing as well as we possibly can to fight it,” Fraser said.

Nobody interviewed for this story could definitively say, or even confidently surmise, what’s causing the upticks.

What’s clear is that the infections are still happening, and people are still dying.

As of Wednesday, between 795 and 799 residents of nursing homes have died after testing positive for the virus since the pandemic began, about 72% of the total number of COVID-19 deaths in the state. About 40 nursing-home resident deaths associated with COVID-19 have been reported in the past month and a half.

Also as of Wednesday, 58 nursing homes in the state have had at least two COVID-19 cases. That’s about two thirds of licensed nursing homes in Rhode Island.

That number, too, is increasing as the weeks wear on, leaving fewer and fewer homes untouched by the virus.

Heatherwood Rehabilitation and Health Care Center in Newport, for example, was added to the list of homes with at least two cases on Sept. 9. It had never had a case before, according to Tim Brown, a spokesman for the facility. Brown said there were two cases total, and both have recovered; no more cases have been identified in the weeks since.

“Our country is still experiencing a global pandemic,” Brown said in an email. “We are glad that the number of cases in nursing homes has decreased significantly, but we know that this crisis is not over. Throughout this pandemic we are doing everything we can to protect our staff and our residents, and we remain vigilant and dedicated to limiting the spread of COVID-19 and limiting its impact in our communities.”

St. Elizabeth Home, a nursing home in East Greenwich, was also added this month to the list of homes with at least two cases. A spokeswoman, Mary Rossetti, said in an emailed statement that one of the cases was in April, and the second on Sept. 5. Neither had symptoms.

“We recognize that until there is a vaccine there will be positive cases in Rhode Island, and therefore there is potential for transmission within congregate-living settings,” Rossetti said. “Our best defense is continued weekly testing of our staff (236 individuals are tested each week at Saint Elizabeth Home), and continued vigilance in employing best infection control practices, safe visiting, and screening of staff and visitors.”

The biggest new outbreak has occurred at the Grandview Center, a Cumberland facility with a five-star rating from the federal government. The outbreak started the week of Sept. 7, sickening 17 residents and 18 staff members within 10 days. Then it spread, with a total of 30 residents and 21 staffers testing positive as of Thursday, according to Dr. Richard Feifer, the chief medical officer at the facility’s parent company, Genesis Healthcare.

The facility has also reported its first two deaths.

“Our thoughts and prayers go out to those impacted by COVID-19 during this difficult time, especially the families of the two residents who have passed away,” Feifer said in an email.

Facilities like the Grandview Center have learned a lot about how to keep the virus at bay, Feifer said. And they’ve made huge strides since the pandemic began. Personal protective equipment is now more widely available. They are testing much more than they’d been able to before, with shorter turnaround times. Residents and staff alike are rigorously screened, Feifer said.

“With all that said, COVID-19 is a complex virus that is hard to detect and can take weeks to present itself,” Feifer said. “We may never really know who or what started the outbreak at Grandview Center, but COVID-19 could have been introduced by an asymptomatic employee or a hospital admission.”