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Report: Nursing home staff brought in virus

Staff were unaware they were infected

MOHAWK VALLEY — The state this week issued a detailed COVID-19 report on nursing homes that local health officials appear to mostly agree with.

But county officials are also proud of their own agency’s independent actions working with local entities during the coronavirus pandemic.

The New York State Department of Health on Monday released an in-depth, 33-page analysis of nursing home data which found COVID-19 fatalities in nursing homes were related to infected nursing home staff.

According to a DOH news release, the virus spread was widely “unknowingly” caused by staff in New York state’s nursing homes. This is according to the report titled, “Factors Associated with Nursing Home Infections and Fatalities in New York State During the COVID-19 Global Health Crisis.”

New York state has about 100,000 nursing home residents housed in 613 nursing home facilities statewide.

In Fulton County, nursing facilities include the Fulton Center for Rehabilitation and Healthcare in the town of Johnstown, Wells Nursing Home in the city of Johnstown, and Nathan Littauer Nursing Home in Gloversville. In Montgomery County, they include Palatine Nursing Home and Rehabilitation Center in Palatine Bridge, Edward L. Wilkinson Residential Health Care Facility in Amsterdam and the St Johnsville Nursing Center. .

DOH conducted an in-depth analysis of self-reported nursing home data that finds that COVID-19 fatalities in nursing homes were related to infected nursing home staff.

The DOH analysis found these major points:

— Timing of staff infections correlates with the timing of peak nursing home resident mortality across the state;

— Nursing home employee infections were related to the most impacted regions in the state;

— Peak nursing home admissions occurred a week after peak nursing home mortality, therefore illustrating that nursing home admissions from hospitals were not a driver of nursing home infections or fatalities;

— Most patients admitted to nursing homes from hospitals were no longer contagious when admitted and therefore were not a source of infection.

— Nursing home quality was not a factor in nursing home fatalities.

According to data submitted by nursing homes — in many cases under the penalty of perjury — approximately 37,500 nursing home staff members (one in four of the state’s approximately 158,000 nursing home workers) were infected with COVID-19 between March and early June. Of the 37,500 nursing home staff infected, nearly 7,000 of them were working in facilities in March; during the same period, more than a third of the state’s nursing home facilities had residents ill with the virus.

Fulton County Public Health Director Laurel Headwell said she agrees that COVID-19 was largely introduced into nursing homes unknowingly by infected individuals.

“I do also think that as residents were able to transmit the virus as well if they were taken out to appointments or if they had been moved from one nursing home to another or a rehabilitation facility,” Headwell said. “If a resident was not isolated at one facility, they had the ability to become infected with COVID-19 and then transmit it once back at the facility which they were residing at.”

Headwell said she doesn’t think it was a coincidence that the timing of staff infections correlated with timing of peak nursing home mortality. She noted the data that DOH analyzed shows 18-25 days is the average length of time between COVID-19 infection and death. That data is supported by the staff reporting symptoms and the peak of fatalities, she said.

The state feels nursing home admissions from hospitals were not a driver of nursing home infections or fatalities, but Headwell said “we can’t be 100 percent sure of this.”

“It might not have been the driver, but it was still possible for patients to come from a hospital to a nursing home that was asymptomatic with COVID-19,” she added. “With limited testing, especially in the beginning, it was possible for this to be a contributing factor.”

Headwell said she agrees “quality” of the nursing homes was not a factor with COVID-19 fatalities.

Regarding the findings, she added that nursing homes and hospitals worked in conjunction together to test individuals who were leaving the hospital to be admitted into the nursing home facility. Negative tests were requested which alleviated the risk of admitting contagious individuals into nursing homes from the hospital.

Headwell said limiting visitations played an important positive role in keeping cases down.

“Visitation was not allowed starting March 13, which reduced a large amount of transmission that could have come into the nursing home facilities by visitors,” she said. “By limiting the visitation early on it did not allow for visitation to be a large factor with the transmission of COVID-19.”

Montgomery County Public Health Director Sara Boerenko also said she agrees with the state finding that the virus was brought into nursing homes via staff, employees and visitors.

“But it’s not just COVID,” Boerenko said. “It is all viruses. Viruses do not move on their own. People move viruses. Those living in facilities do not typically leave. The exposure comes from the outside, in. This is why in Montgomery County, we worked with the nursing homes and the adult care facilities to limit and shut off visitation from outside family.”

Boerenko said Montgomery County has also been delivering and working to get personnel, protective equipment, or PPE into these facilities since March 21. She said the county purchased and distributed test kits for these facilities back on March 27.

“We did not just sit by and wait for something to happen in a facility,” Boerenko said. “We took a very proactive approach in order to prevent an outbreak in a facility that cares for the most vulnerable.”

Boerenko said she and Montgomery County Executive Matt Ossenfort made it a “priority” to monitor and work with each agency caring for the elderly to prevent what we saw happening in other states such as Oregon in late February, and early March.

“So this approach was learned from not wanting an outbreak in a nursing home in Montgomery County,” she said. “We were very lucky that we had the ability to take a proactive approach to working with our facilities to get PPE to staff and residents in need in order to protect everyone. Montgomery County houses approximately 771 patients in nursing homes and adult care facilities. We only had six cases of COVID in those 771 residents. I would say our facilities and staff did a great job at making sure residents were well taken care of and safe.”

Boerenko said St. Mary’s Hospital has been an “excellent partner” with the county Public Health Department during this crisis.

She also commented on the state report finding that nursing home “quality” was not a factor in nursing home COVID-19 fatalities.

“I think that the quality and care of nursing home residents is dependent on the community,” Boerenko stated. “Montgomery County has an aging population and the facilities here are often used via generations. Our community holds the nursing homes and adult care facilities to a high standard. The proof that a community can work together to care of and keep residents safe is evident in the low numbers in Montgomery County as a whole.”

In Montgomery County, she said patients that were positive and needed medical care, were not returned back to the nursing facility until a negative test was recorded and several times, residents have been tested multiple times to ensure accuracy of the results.

“I truly believe shutting off visitation to the nursing homes is what saved lives,” Boerenko said. “I know families want to see loved ones. I have a grandmother that I have not seen since her birthday in February. But I know that I could not deal with the heartache of being that one person that could have brought COVID into a facility.”

Why were infected nursing home staff able to likely infect residents in the nursing homes?

The report said that in March, the federal government’s Centers for Disease Control and Prevention (CDC) did not suspect that asymptomatic people were likely to spread the infection. There was no CDC recommendation for testing nursing home staff until recently. The CDC guidance issued during February, March, and April also varied in its recommendations,

Also, the CDC also issued guidance on March 7, that stated certain asymptomatic healthcare personnel exposed to others with the virus were “not restricted from work.”

Roughly 20,000 infected nursing home workers were known to be COVID-19-positive by the end of the month of April. These workforce infections are reflective of the larger geographic impact of the virus’s presence across the state.

“It is likely that thousands of employees who were infected in mid-March transmitted the virus unknowingly-through no fault of their own-while working, which then led to resident infection,” the release said.

DOH also examined the potential impact of DOH’s March 25, admission policy. A survey conducted by DOH shows that approximately 6,326 COVID-19-positive residents were admitted to facilities between March 25 and May 8; this finding is supported by an independent analysis done by the Associated Press on May 22. However, an analysis of the timing of admissions versus fatalities shows that it could not be the driver of nursing home infections or fatalities.

DOH further analyzed the period of time patients stayed in hospitals prior to admission to nursing home facilities. Preliminary data show that residents were admitted to nursing homes a median of nine days after hospital admission. Health experts believe that individuals infected with the virus are most infectious two days before symptoms appear and that they are likely no longer infectious 9 days after symptom onset – thus by the time these patients were admitted to a nursing home after their hospital stay, they were no longer contagious.

DOH also considered the impact of visitation into nursing homes as a cause of infections. A review shows that prior to nursing home visitation being suspended completely on March 13, there was no tracking or testing of family and friends who were present in the facility, and any asymptomatic or symptomatic visitor could have been granted access.

“Given what we now know about how widespread the virus was in New York prior to testing availability in February and early March, there is a high likelihood that COVID-positive visitors entered nursing homes, although there is no specific data to support this assumption, and so ultimately this is inconclusive,” the report said.

State Sen. James Tedisco this week also weighed in on the report, telling the Cuomo Administration on the nursing home investigation: “Thanks, we’ll take it from here”

He said the DOH report is not the final word, renewing a call for an independent bi-partisan investigation of 6,200 COVID-19 nursing home deaths

“The families of the over 6,200 people who lost their lives in nursing homes across New York state during the COVID-19 crisis deserve answers and a fair and unbiased investigation to find out what really happened that led to these tragic deaths,” Tedisco said. “I appreciate the work of the state health commissioner, who is appointed by the governor, but this report should not be the final word on this subject. Given the magnitude of deaths during this terrible crisis, the families need the truth about what happened and some degree of closure over the loss of their loved ones and that can only be achieved through complete and total transparency.”

New York Senate Senate Republican Leader Rob Ortt and Assembly Republican Leader Will Barclay are demanding what they call an “independent investigation into Cuomo’s nursing home cover-up.”

“Cuomo’s phony, whitewashed report can’t bury the facts and Republicans will not rest until we get truth and justice for the families who lost loved ones at the hands of his deadly mandate,” the state Republican Party said in a press statement.

Michael Anich covers Johnstown and Fulton County news. He can be reached at manich@leaderherald.com.

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