As the state of Virginia moves into its third stage of re-opening and local cases of COVID-19 rise again, there have been new and growing outbreaks of COVID-19 in local long-term care facilities. The Virginia Department of Health has received reports of 48 cases at Cedars Healthcare Center in Charlottesville and six cases at the Albemarle Health and Rehabilitation Center in outbreaks that began July 10. Heritage Inn in Albemarle County has reported 43 cases in an outbreak that began on June 30. Cedars Healthcare Center and Heritage Inn have each reported at least one fatality related to the virus.

Dr. Laurie Archbald-Pannone, a University of Virginia geriatrician and the lead physician of UVA Health’s GERI-Pal program — an interprofessional team of physicians, nurse practitioners, and nurses who are working to support local long-term care facilities in preparation for and outbreaks of COVID-19 — explained how the living configuration and demographic of long-term care facilities. 

“Residents in long-term care facilities live in a communal setting in close proximity to each other and often have multiple comorbidities. When you live in close proximity to other people — that can put us at risk for any type of infection spreading more quickly than if we’re able to social distance. And then on top of that, when we have multiple comorbidities and are potentially medically vulnerable, we can have more significant outcomes from an infection as well. And that’s something that we’ve seen through this whole pandemic,” Archbald-Pannone said.

Jessica Coughlin, the emergency coordinator for the Thomas Jefferson Health District, additionally noted that the network of care makes it easier for a virus like COVID-19 to spread.  

“You have a lot of people living in the same environment being cared for by the same individuals, so things are easier to move from person to person,” Coughlin said.

The Virginia Department of Health guidance for long-term care facilities advises assigning staff to specific residents to minimize the number of staff members each set of residents contacts face-to-face. Additionally, the guidance recommends minimizing the number of face-to-face interactions between residents and staff, maintaining a 6-foot distance between all individuals in the facility, and restricting in-person visitors. If visitation is not allowed, the guidance recommends permitting compassionate care visits in end-of-life situations on a case-by-case basis, with careful screening for symptoms and use of personal protective equipment.

“It’s very hard not to see your loved ones. But it’s just it’s a very risky situation putting residents in contact with their loved ones when their loved ones have been out in the community and could have picked up COVID anywhere,” Coughlin said. “Doing more virtual visits is going to be the best way to protect them.”

Cedars Healthcare Center adopted such preventative measures — including education efforts, new cleaning protocols, symptom screening of staff members, and minimized contact — when the pandemic first began to spread in the United States.

“We established very strong preventive measures back in March, to try and keep COVID from coming into the building in the first place. And they were very successful until recently,” said Cedars Healthcare Center spokesperson Fred Stratmann.

Now that COVID-19 has been detected among residents and staff, Stratmann discussed the steps Cedars Healthcare Center is taking to contain the virus and care for those who have tested positive. COVID-positive residents live temporarily in an isolation unit while residents who are at risk or are new admissions to the facility live in an observation, for a minimum of 14-days.

Nevertheless, confirmed cases among residents have increased from 10 to 48 over the past week.

Residents who have tested positive for COVID-19 receive anticoagulants and amino acid supplements as is medically-appropriate. Stratmann said medical research indicates blood clots and strokes are a factor in a lot of COVID-19 fatalities and suggests that amino acid supplements could be helpful to COVID-19 recovery. Additionally, the Cedars Healthcare Center’s physical therapy department has instituted a program called proning, which Stratmann described as “the strategic positioning of the residents to make sure that they’re not getting fluid buildup in their lungs.” Fluid buildup in the lungs has been linked to acute respiratory distress syndrome, a factor in many COVID-19 fatalities.

“Now that [COVID-19] is in the building after about four months of trying to prevent it, we’re aggressively fighting it and doing the best we can to ensure the health and well-being of our residents as well as the safety of the non-COVID-positive residents,” said Stratmann.

The directors of Heritage Inn and the Albemarle Health and Rehabilitation Center did not return multiple requests for comment left with receptionists.

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Karen Moulis, an Albemarle County resident whose mother resides in an senior living community near Roanoke that had an outbreak within the past month — from which all staff and residents have since recovered — said that the outbreak occurred despite original strict precautions and good communication.

Moulis said she thought her mother’s home was being extremely careful at first. “We were feeling really comfortable with the precautions they were taking,” Moulis said. “As hard as it was not to be able to go down and visit her, I didn’t really want to. I wanted to make sure that she was safe and that the residents were safe.” 

However, as the pandemic wore on, “they started sort of lightening up a little bit and letting some people come and start to visit in the independent living [section] that didn’t include her,” Moulis said. “The timing was such that that’s when several cases were reported in some of the employees and then a couple of different residents at the facility. So they went back to a very, very strict shut down and multiple layers of testing. … I believe they just lifted that again.”

“They’ve done a pretty good job of communicating what’s going on, which I appreciate because it’s really scary,” Moulis added. “When they discovered the cases, they went to, like, full lockdown. Mom was told to remain in her little tiny apartment, was not allowed to have the door open, was not allowed to see anybody. [The staff] had to be in full PPE when they walked in. As comforting as that was to me, that was upsetting to Mom, to not really understand why she couldn’t leave her door open and go out and visit with the other residents.”

During such outbreaks, the Thomas Jefferson Health District is notified of the outbreak and their entire epidemiology team works with the long-term care facility to help orchestrate solutions.

“We facilitate prevalence surveys to get everyone in the building tested. We’re in constant communication regarding testing, regarding personal protective equipment and regarding their staffing needs, and we really work to facilitate solutions to problems that come up throughout the outbreak. So it’s very dynamic,” Coughlin said. She explained that the Thomas Jefferson Health District is partnered with both the UVA Medical Center and Sentara Martha Jefferson Hospital, as well as emergency management, and that the health district works with these partners to help the long-term care facility meet the needs of their residents.

“I think the biggest thing the general community needs to know is even if they’re not in direct contact with the patients, the people who work there are. So as a whole community, we need to be limiting the spread. We need to be wearing our face coverings. We need to be socially distanced, washing our hands, staying home if we’re sick,” Coughlin said. “As a general community, we need to be doing all the things that we’ve been saying this whole time and really stick to it until we can get this pandemic in a much more stable situation.”

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