Nursing home outbreak: ‘What we really feared’
Despite seemingly doing everything right, a long-term care facility in Haywood County is now reporting 36 cases of COVID-19, spread among residents and staff.
“It’s awful. Since the 1990s, North Carolina has been ahead of the curve as far as infection control. Since the 1990s you had to have at least one nurse trained in epidemiology,” said Lisa Leatherwood, administrator of Silver Bluff Village. “We have three. We implemented visiting restrictions, had state regulators visit, we tested every single person who comes in.”
Still, the virus made it into the facility.
“Silver Bluff was doing everything they could do correctly ahead of this, and yet this has still happened,” said Dr. Mark Jaben, Haywood County’s health and human services medical director. “That reminds us that you don’t want to mess with this, because once it gets in it’s very hard to contain.”
Leatherwood said that 85 staff members had been tested when Haywood County conducted a mass test back in April, all negative. Further testing took place in May, and regular screenings thereafter, but the facility reported its first case July 13.
“Just in terms of disinfecting they’ve been fastidious about that,” Jaben said. “And in screening staff. They’ve not had visitors since very early in this thing. What makes this maybe larger than others is you’ve got a confined group of people in a closed space. I think the other thing it points out is the contagiousness in the pre-symptomatic stage. It’s a real eye-opener.”
Patrick Johnson, public health director for Haywood County, acknowledged how dangerous coronavirus can be in such settings.
“When the virus gets into a long-term care facility, that population is already in the high-risk category,” Johnson said. “We’ve seen this in Buncombe, Henderson, and nationwide. Silver Bluff worked hard to prevent this. We’ve been pleased with what they’ve done.”
Silver Bluff Village was founded in 1962 by Leatherwood’s grandparents; before serving as administrator, she was the director of nursing for 30 years, beginning in 1987. Leatherwood’s mother was administrator until Leatherwood’s husband took the post, retiring in 2017.
The facility, near Bethel, contains several different buildings including a skilled building, an assisted living building, and a multi-unit assisted housing unit. In total, there’s capacity for about 196 residents, all with varying degrees of independence.
Leatherwood said the facility did receive some funding from the CARES Act’s Paycheck Protection Program, which was helpful in trying to keep staffing levels up.
“We had quite a few [staff members quit] when COVID first hit North Carolina, but when we got hit, we had a few more walk out,” she said. “The ones that are here, they are very dedicated.”
Employee screening continues, and Leatherwood’s been giving them hazard pay as well, but PPP funding also helped her find personal protective equipment, which Leatherwood said became scarce and shot up in price once the pandemic began in earnest.
Since the outbreak began at Silver Bluff, quarantine and isolation wings were established, and some staff members were assigned to care for people in them, to reduce the number of people coming in and out of the wings.
Test result returns have also slowed in recent weeks, with the two-day turnaround seen in May and June now longer, at five to seven days.
That makes it harder to identify people in the pre-symptomatic phase of coronavirus infection, meaning they can transmit the virus before knowing they even have it.
“The way it gets in is by staff, not on purpose,” Johnson said. “I think one employee brought it in early on after going on vacation and getting exposed.”
Johnson’s advice to staff at Silver Bluff — and any other congregate living facility — is to exercise extreme caution in off-duty behaviors.
“Be diligent to avoid bringing it in,” he said. “Don’t attend gatherings, avoid crowds. If leaving the county, be very careful. Although many people right before the start of school like to go on vacation, this might be a good time for a stay-cation. Throughout all the contact tracing we’ve been doing, we’ve been hearing words like Pigeon Forge, Hilton Head, Charleston, Myrtle Beach and Florida.”
Johnson said other skilled nursing facilities and congregate living facilities are at risk for the same type of outbreak.
“This will be the same thing in schools — a parent will get it and give it to their kids, who will bring it into school,” he said. “If everybody’s interested in keeping students and staff safe, this might be a good time to skip the vacation.”
Jaben also commended Silver Bluff for their transparency.
“They’ve been very straight with people, and that’s what we should be doing with this,” Jaben said. “Just the facts.”
The takeaway, according to Jaben, is that even with responsible, cautious behavior, infection is still possible.
“All the public health recommendations are really a package of actions,” he said. “They all come together. Doing one or the other doesn’t reduce your risk as much as doing all of them together. Even doing all of them doesn’t eliminate the risk.”
Leatherwood said she’s grateful for the community’s support and understanding during the outbreak.
“What keeps me going is our residents and staff,” she said. “Our families have been wonderful, their comments like, ‘we trust you,’ that means the world. When you’ve worked a full shift in PPE and you come home and see on Facebook that someone’s posted a positive comment, it just means the world. We’re going to do everything possible to get through this and get things back to normal.”