Delaware’s long-term care facilities have been hit hardest during the COVID-19 pandemic, accounting for 124 deaths, or nearly two-thirds of the state's 193 deaths as of May 6.
In Sussex County, 43 nursing home residents have died, nearly a quarter of all COVID-19 deaths in Delaware, according to the most recent data on nursing homes released by Delaware Division of Public Health April 30.
In response, Gov. John Carney announced May 5 a universal testing program for all residents and staff of long-term facilities. Division of Public Health will provide facilities with tests, testing supplies, training and support. Expanding COVID-19 testing capacity for vulnerable populations is a requirement of federal guidance for economic reopening.
DPH spokesperson Jen Brestel said the universal testing program has multiple phases. The first phase began May 6, she said, when facilities began submitting requests for testing supplies and when tests began being dispatched.
“This is all hand-in-hand with a broader testing effort throughout the state and broader availability of testing for both symptomatic and asymptomatic individuals,” Brestel said.
Brestel said each resident will receive a point-of-care bedside rapid antibody test first; based on results, they may then proceed to a nasopharyngeal PCR test as part of a PCR-sparing strategy. Staff will receive a nasopharyngeal swab PCR test at the facility.
Resident and staff testing frequency will be left to the jurisdiction of the facilities and medical staff, Brestel said.
“Ongoing testing will be influenced by subsequent occurrence of disease within the facility, transfer of residents in and out of the facility, and the cohorting of staff within the facility,” she said, referring to assigning different staff to those who test positive and those who do not. “If the facility chooses to not undertake additional testing evolution, staff members can get tested through their primary care provider or at one of the large community sites that are occurring throughout the state,” she said.
State Sen. Ernie Lopez, R-Lewes, said the rapid-result test has a 48-hour turnaround time.
“That will give staff greater confidence,” Lopez said, noting facilities have been short-staffed due to a lack of testing. “Many were scared to go to work.”
Lopez said the high mortality rate in nursing homes is not unique to Delaware.
“The nation as a whole is seeing this,” Lopez said. “But it’s unique to us, because it’s our family and friends.”
Lopez said he has received phone calls from many family members with loved ones in nursing homes, asking him to check on their condition because they are unable to get through to staff. Lopez said he and other state legislators have been working to ensure nursing homes are returning calls to family members to update them on their loved ones’ conditions.
“For eight weeks, they’ve been unable to visit their loved ones at the nursing home, and those family members are the first line of defense,” Lopez said. “They’re used to visiting their loved ones every day and constant contact with staff. The lack of communication has been a virus in itself that has caused a lot of pain.”
Beebe Healthcare President and CEO David Tam said patients from long-term care facilities have stabilized after a recent spike. He said increased testing at those facilities has enabled health officials to identify cases sooner, allowing residents and their families to make decisions on treatment.
DPH reported April 30 that Sussex deaths include 27 residents of Genesis Healthcare in Milford, nine residents of Harrison House Senior Living in Georgetown, three residents of Atlantic Shores Rehabilitation in Milford, and three residents of Harbor Healthcare in Lewes. Brandywine Senior Living in Rehoboth also reported one death.
In a May 1 email to residents and family members, Harbor Healthcare stated it would communicate all new positive cases of residents and staff. At that time, 25 residents and eight staff members were positive for COVID-19, and four residents and two staff members had recovered. The letter also stated Harbor Healthcare can now test all residents to establish a baseline of COVID-19, regardless of symptoms.
Mary Peterson, who left retirement to serve as DPH long-term care incident commander, said in an interview the infectious virus is easy to transmit, particularly in confined quarters such as nursing homes, where residents are more vulnerable.
“I call this disease a silent killer,” Peterson said. “It just devastates their bodies. They don’t have the immune system to fight this virus.”
Peterson said each facility reports to her every day, and part of the report includes verifying required PPE on hand. Facilities are required to calculate their inventory and usage rate, she said, and any time there is a need, the facilities can send a resource request form and PPE will be sent, usually withing 24 hours.
Although she said Division of Health Quality nurses are ensuring staffing and COVID-protocols are followed, she said facilities with staffing shortages can request and receive help through DPH medical reserve corps.
“This is hitting our long-term care providers hard,” Peterson said. “It’s devastating not only to the families whose loved ones are getting sick, but also to the staff that works with these residents. They work with these patients on a daily basis.”
Peterson said she anticipates the need for grief counseling once the pandemic is over, due to the amount of serious illness and death care providers are witnessing.
Peterson said nurse surveyor teams observe facilities and document any deficient practices to educate staff on best practices, and nursing home physicians are being educated on determining the cause of death for residents, many of whom have underlying health conditions, and how to document death certificates during the crisis.
Peterson said Delaware is testing more people than other states and also required PPE before the CDC announced its requirements.
“We tried to catch this and stem the tide,” she said. “The issue in the beginning was community spread by asymptomatic individuals. Once that happened in some of our facilities, it spread like wildfire.”
Despite that, Peterson said, “Quite honestly, there is more chance to be infected in the community than in the nursing home.”
All staff must wear full PPE, including gown, gloves, goggles and face shield, she said, regardless of where they work. Nursing homes are also required to set up COVID-19 positive and negative units, with dedicated staff for each.
Residents who are COVID-19 positive or presumptive positive must wear a mask; if they are unable to tolerate face masks, a tissue must be placed over their faces to prevent spread of the virus, Peterson said.
“This disease is only four months old,” she said. “Fighting it is like building the plane while you’re flying it.”
Editor’s note: Reporter Nick Roth and editor Laura Ritter contributed to this report.