Copyright © 2020 Albuquerque Journal
As the coronavirus began to take hold in New Mexico in mid-March, state officials knew that nursing and assisted living homes held a vulnerable population. So the state took steps to protect the residents, banning most visitors and urging temperature checks to detect the virus in staff.
Yet, even with the state public health restrictions, which were based in part on federal guidelines, the COVID-19 virus came out of hiding in the following weeks. An explosion of cases erupted inside New Mexico long-term care facilities – a trend seen across the country.
More than 342 long-term care patients in New Mexico have tested positive, with 79 people dying of the highly contagious disease as of Friday. Another 238 staff members at the homes and assisted living centers have tested positive.
The number of impacted long-term care facilities in the state doubled in the span of four days earlier this month.
Part of the increase in positive cases is likely due to the state mandating testing in late April in all of the state’s 71 nursing homes, said state Department of Health Secretary Kathy Kunkel.
But the expanded testing led to the discovery that employees at some homes had been spreading the virus without knowing it.
“There were staff who were asymptomatic who were positive,” Kunkel told the Journal last week. “So that was a huge problem. I’m glad we uncovered it.”
With just 10 people infected statewide back on March 12, state officials hoped to head off the virus by announcing a public health order to restrict visitors to long-term care facilities, exempting patients receiving end-of-life care.
On Friday, the state reported a total of 4,673 positive cases and 181 deaths.
“This disease keeps teaching us,” Kunkel said. “We keep learning more and more, and I would say that on March 12 there was no indication that if you were asymptomatic that you could be shedding the virus. And now we know better, unfortunately.
“Had we known that, we would have found a way to test March 12. But on March 12 we were still fighting for the resources to do the testing that we needed to do.”
Some 5,315 people live in New Mexico’s nursing homes. Another 4,435 residents live at about 268 assisted living facilities.
The nation’s first major COVID-19 outbreak came at a Washington state nursing home in February. Forty residents died, putting health officials everywhere on notice.
“Everyone knows the most vulnerable population are the elderly, elderly in a congregate setting. We’ve watched other states struggle with this,” Kunkel said. “The concern, the anxiety that this could happen to us was always there. We did take every precaution that we knew of. I think the one problem we did not anticipate was asymptomatic staff. There’s just not words to express how bad we feel.”
On Friday, 31 long-term care facilities reported positive COVID-19 cases.
As the long-term care COVID-19 cases mount in New Mexico, the push for testing, mitigation and prevention is in overdrive.
“Once there’s a positive, I can send in a rapid response team. We can test everybody. We can keep coming back to test. We can evaluate. Are you really doing everything you can in terms of infection control?” Kunkel said.
“But the better practice is to keep that out in the first place.”
With industrial grade products, the New Mexico National Guard is beginning to disinfect all nursing homes in the state. And,there are other new prevention strategies.
The DOH discovered that some senior care facilities reporting no positive cases were using disinfectant spray on staffers’ shoes as they come in. And those facilities required staffers headed into work to change into scrubs.
“So that’s been mandated for all the facilities in the state,” Kunkel said.
Bernalillo County Fire Department’s emergency management division, with expertise in toxic hazmat containments, has been enlisted to train EMS departments statewide to teach nursing home facilities how to better prevent an outbreak.
“We’re going to do everything we can to keep it out,” said Katrina Hotrum-Lopez, secretary of the state Aging and Long-Term Services Department. “There are no easy answers to this. Every day we get up, and this team attacks this aggressively.”
Cases spread quickly
In the 30 states that report this data, there are now more than 16,500 deaths in long-term care facilities, as of April 29, according to the Kaiser Family Foundation. For 10 states, this represents half or more of their COVID-19 deaths.
On April 28, the state identified a dozen residential facilities in New Mexico as having COVID-19 cases. Within four days, on May 2, that number had doubled to 25. Most were either in Albuquerque or the hard-hit area of northwest New Mexico.
But one nursing home outbreak occurred in the northeastern New Mexico town of Clayton, population 3,000. The town’s three positive cases so far were identified as all coming from the Clayton Nursing and Rehab Center.
By Friday, the virus had been detected in 31 senior care homes. Seven of those were deemed to be high risk by the state Department of Health after reporting 10 or more positive cases.
Deaths have been reported at 11 of the facilities. About half were nursing homes, the others assisted living.
State officials interviewed by the Journal last week declined to say whether they expect the deaths to mount.
But the spike has prompted the DOH to begin deploying a SWAT-like response team at facilities with a high number of positives. Tests have been administered to 100% of staff in those homes, Kunkel said, and other measures are taken to combat further spread.
“What we’re finding in our facilities is that staff are tired and everyone is working around the clock and we need to make sure these facilities are sterile and clean. We try to eradicate the infection, ” Hotrum-Lopez said.
Bernalillo County’s emergency management division has hazmat expertise that can help.
“They are experts in isolating an infection or the problem, and establishing hot, warm and cold zones (for containment purposes),” she said.
“They’re teaching staff (at nursing homes) how to use the appropriate PPE, how to put it on and take it off appropriately, and which PPE to use in which zone,” Hotrum-Lopez said.
DOH spokesman David Morgan said in an email that “nursing homes and assisted living facilities are on board with testing.”
Kunkel added, “I would say they are panicked at the first sign of a respiratory infection. They are desperate to identify a problem and address it as quickly as possible.”
Any facility with at least one positive COVID-19 case among residents or staff is now testing all residents and staff weekly, Morgan told the Journal.
At the remaining nursing homes and assisted living facilities with no COVID-19 cases, the DOH is doing “surveillance testing” of 15% of residents and staff weekly to try to stay on top of any new cases and prevent spread.
Staff without symptoms
Kunkel said keeping up with requests for COVID-19 tests is a daily challenge.
On March 12, as the state instituted the visitor restrictions, the state lacked the capacity to test at long-term facilities as extensively as it does now, she said.
“All through that time, the governor had to fight to get the state the resources and by that I mean swabs. Just the resources to do that kind of testing, that was something we still have to struggle with,” Kunkel said.
In New Mexico, 36% of nursing home facilities had deficiencies related to infectious disease control, according to a 2017 Kaiser Family Foundation analysis.
Moreover, a Medicare.gov website states that the average number of health deficiencies found by inspectors at New Mexico nursing homes was 11.5 over the past three years, higher than the national average of 8.2.
But Kunkel said it isn’t fair to blame the senior care facilities with COVID-19 outbreaks for improper or nonexistent infection control.
“The CDC didn’t tell us that asymptomatic staff could be passing this with absolutely no symptoms at all. We’ve been mandating that you take your staff’s temperature on the way in and the way out. That was the CDC’s guidance on how you protect people.”
But that kind of screening missed the asymptomatic employees.
Prior to the COVID-19 crisis, the DOH reviewed and ensured infection control protocols at the facilities, Kunkel said.
“I don’t think nursing homes were cavalier,” she said. “From my perspective, nursing homes and assisted living facilities have been compliant. I just think that the recommendation from the CDC (about asymptomatic transmissions) didn’t come fast enough.”
Linnea Forsythe, the state long-term care ombudsman, said most of the concerns and complaints from families and residents who have contacted her independent agency have focused on the ban on visitors, staff not wearing PPE and the quality of patient care.
Before the pandemic hit, families and the ombudsman’s office could visit patients in the facilities “and see what was happening,” Forsythe said.
Now, the state public health order prevents even ombudsman staff from entering the facilities. So Forsythe has sent 350 computer tablets into the senior care facilities so patients can contact her agency. DOH inspectors perform compliance checks via computer.
Kunkel said residents of long-term care facilities “have every right to be frightened.” But she wants them to know that “we’re every day looking for greater protection. Every day.”