A local “strike team” has been assembled to try to prevent COVID-19 from running rampant through Fredericksburg-area nursing homes—and to deal with outbreaks when they occur.
Dr. Donald Stern, acting director of the Rappahannock Area Health District, last month called together a group of community partners that includes the National Guard, Mary Washington Healthcare, local emergency managers and first responders in an effort to stem the tide of deaths in long-term care facilities. Members would be called upon to test residents and staff for the virus, to take care of the sick if staff couldn’t and to arrange for the mass transport of infected patients.
The group also started regular communications with representatives from the area’s 21 long-term care facilities to gauge their level of preparedness, staff and personal protective equipment.
“We wanted to know about their readiness in case they had a case,” Stern said, adding that most were aware of infection-control guidelines. “We have not had a major issue with long-term care facilities.”
That’s not been the case throughout the United States, where one-third of all virus deaths have happened in such facilities. Virginia’s death toll is even higher; almost 60 percent, or 681 of the state’s 1,159 COVID-19 deaths, have occurred in nursing homes and assisted-living facilities, according to the Virginia Department of Health.
The local health district, which includes Fredericksburg and the counties of Caroline, King George, Spotsylvania and Stafford, thus far has been spared that level of carnage.
To date, there have been two outbreaks involving 16 people at local facilities—one in King George County and the other at a small, residential-type setting—but no deaths among patients or staff, said local health district spokesperson Allison Balmes–John.
Dr. M. Stephen Mandell Jr., senior medical director and vice president of Mary Washington Healthcare and a member of the strike team, credits social distancing measures. He believes that people staying at home, away from each other, has kept hospitals from being overrun with infected patients—just as restricting all visitors at long-term care facilities has limited the spread of the virus among the most vulnerable populations.
The local group also has acknowledged “the sober recognition of lessons learned from other communities on how rapidly it can become a true disaster,” Mandell said.
Starting Tuesday, the strike team will start its first large-scale testing event as a preventive measure. Soldiers and airmen with the National Guard will set up operations at one of the area’s long-term care facilities and test every resident and staff member there. The guardsmen hope to test every facility and homeless shelter in the area as quickly as possible, said Balmes–John.
Tests will be provided for free—which will save facilities considerable expense, given that each test costs about $150. When federal officials recently suggested more testing in nursing homes, the American Health Care Association and National Center for Assisted Living estimated it would cost $8.7 million in Virginia—and $440 million nationwide—to test every resident and staff one time.
Regular testing was unsustainable, the groups reported, without state and federal funding. The national government on Friday announced it would distribute almost $4.9 billion to nursing homes to help them battle COVID-19.
Locally, the health district is working with facilities to organize the testing, said Balmes–John. The emergency manager in each locality is contacted, then the action is approved on the state level, and National Guard teams are requested.
Guardsmen conduct the testing and send the tests to a lab. When there are positive cases, the local health district does contact tracing to see who else may be infected. If there are numerous cases in one facility, district staff members provide guidance on “cohorting,” or isolating all those sickened, in one area, Balmes–John said.
The local district did a similar exercise on May 8—but it was after there had been an outbreak of COVID-19, not before. Guardsmen tested 220 staff and residents at Heritage Hall in King George after four people there had confirmed cases. Test samples were sent to a University of Virginia lab on a Friday afternoon and results returned Sunday night, Stern said last week.
Heritage Hall ended up having 10 people with COVID-19—seven workers and three residents, who were already hospitalized for other reasons. There have been no other cases since then, and the facility was thankful to have “the full partnership and support of our local health district,” said spokesperson Jennifer Eddy.
“Knowing the full scope of what we were dealing with allowed us to better protect and serve all of the residents and staff,” she said.
‘STAND UP A TEAM’
The local health district also has arms of its strike team that can respond to facilities where an outbreak might be “getting out of hand,” Stern said. For instance, if the health district isn’t getting support from the local management or corporate owners, or if staff hasn’t shown up for work because they’re sick or scared, “we can stand up a team immediately to go in, in case a facility is in trouble,” Stern said.
Having a plan is good for long-term care facilities and hospitals, which could be paralyzed by the sudden arrival of 15 to 20 critically ill patients, Mandell said. The concept is similar to a field hospital in Mary Washington Hospital’s parking garage, where COVID-19 patients would have been triaged, if there had been an abundance of them.
Medical teams planned for it, hoping they would never have to use it.
“That’s what we’ve kind of learned these past few months, when everything is such a rapidly evolving learning process. You recognize areas that place you at quite a vulnerable stage,” Mandell said. “How do we preclude these events from occurring and help to support them if they do, early on, to hopefully truncate an outbreak?”