The discovery over the weekend of 66 Covid-19 cases at a single Orchard Park nursing home raised alarms that the virus could spread unchecked among the region’s most vulnerable population – the frail elderly – because there aren’t enough tests and personal protective equipment available.
Forty-one patients and residents and 25 employees tested positive for the virus at Father Baker Manor in Orchard Park – the highest number of cases related to a single Western New York facility since the pandemic began.
But Catholic Health officials on Monday suggested that Father Baker Manor could be more the norm than the exception when it comes to the concentration of Covid-19 positive cases in health care facilities.
The nursing home was able to detect those cases only because Catholic Health recently received a shipment of nearly 1,000 kits for a rapid test that the health system can process in its own laboratories, said Mark Sullivan, president and chief executive officer. Between Thursday and Saturday morning, Catholic Health tested anyone who was living or working at the facility – about 350 people in all.
"If you tested every building in Western New York that had patients in it, more than likely you're going to end up with a very similar positive result, so the fact that we tested the whole building is really what led to the numbers," Sullivan said in an interview with The Buffalo News. "There's not a single place in New York State that tested a whole building. There's not another building that's tested every resident."
Other nursing home and assisted living administrators acknowledged they don’t have that kind of testing capability and would struggle to contain the virus.
"We had sent one person out for testing who showed minimal signs, and that test came back negative. It took us seven days just to get the results back. I know there hasn’t been extensive testing,” said Mark Ferreri, administrator of Briarwood Manor, an assisted living facility in Lockport.
Briarwood Manor has 120 residents and 77 employees. Ferreri called facilities like the one he oversees the “forgotten child” in the health-care delivery system.
"If we had a case here, unfortunately we do not have the gowns and face shields to care for these individuals, and we’ve been unable to get them from our county or any other local suppliers or national suppliers," Ferreri said. “If we get a rash of these cases like Father Baker, we’re not geared to care for them like Father Baker may be, which in turn, would cause a surge on the hospital system.”
The Elderwood nursing home chain has not done comprehensive testing, despite having 11 confirmed Covid-19 cases among 1,600 residents at 17 locations in Western New York, said spokesman Chuck Hayes.
Clinical teams at the Elderwood facilities were focused on monitoring the temperatures and vital signs of residents for symptoms.
"We have tremendous confidence in the clinical expertise of our staff," Hayes said. "That's our number one defense against the virus."
Using data to adjust
The virus was first identified inside Father Baker Manor on Thursday, after two patients who shared a room in the facility’s subacute care unit were found to have fevers, Sullivan said.
Test samples from the two patients sent for processing to the University of Rochester Medical Center returned positive, prompting testing to be expanded to 20 patients who were in the subacute care unit. Those tests also were processed in Rochester, and 19 of the 20 patients were positive for Covid-19.
On Friday, Catholic Health officials received 960 of the several thousand rapid test kits that they had ordered weeks ago from Cepheid, a California firm.
They used those kits, which can be processed on Cepheid equipment owned by Catholic Health, to test 116 long-term care residents and 120 employees on Friday. An additional 108 employees were tested on Saturday.
Of the 138 patients and residents tested, 97 were negative. Of the 212 employees tested, 187, or 88%, were negative.
“If we had followed the standard protocol of only searching for patients with symptoms, we would have only identified 10 percent of the total cases within the facility, and it would have been days and days of delay before we found other cases,” said Dr. Kevin Shiley, Catholic Health’s medical director of infection prevention and control.
Sullivan said Catholic Health is waiting on nearly 4,000 more rapid test kits from Cepheid and also needs swab kits that are in short supply. The ability to test rapidly and more broadly was critical to stemming the spread of the virus, he said.
"We're able to adjust, but you can't adjust without testing," he said. "In order for us to act, we need to have data. In order for us to adjust, we need to have data."
Less than a third of the residents who tested positive were showing symptoms of the virus, said Shiley.
Those who tested positive have been isolated in a wing of the nursing home that has a separate entrance, Sullivan said. Employees who tested positive were being told to quarantine at home.
“All the associates that were tested said they felt fine,” said Sullivan. “Almost all the residents said they felt fine, except for the two residents who were tested for fever.”
'Doing all the precautions'
Mike Cirocco of Elma said his brother has lived at Father Baker Manor for about eight years and staff called him on Friday to say that three people had tested positive for Covid-19.
“He’s got to be scared. He’s there alone,” Cirocco said.
Cirocco said his brother had not tested positive and he was able to speak with him on Apple's FaceTime video and audio calling service.
Kathi Mahany of Orchard Park she’s been concerned for weeks about the potential for the virus to sweep through any nursing home.
Her 88-year-old mother suffers from dementia and has been living at Father Baker Manor for more than four years. She tested positive for Covid-19 and has been moved into the isolation area, said Mahany.
Mahany said a social worker has called her or her sister each day to provide an update, and so far their mother has not shown any symptoms and has adjusted well to the move into a new room.
Mahany doesn’t blame the nursing home or its staff for the outbreak. Even prior to banning visitors, the facility was taking the temperature of visitors and other precautions, she said.
“They were doing all the precautions we felt were necessary at the time,” she said. “We luckily saw her just before they did the lockout.”
Visitors have been banned at nursing homes in New York since March 12, when the governor issued an executive order in response to the Covid-19 pandemic.
Gov. Andrew M. Cuomo said the nursing home visitation ban was necessary to protect elderly people who are especially vulnerable to the effects of the novel coronavirus.
New York State took that step after at least 35 people died in a Covid-19 outbreak at a nursing home in the state of Washington. There were 129 confirmed cases linked to the Life Care Center in Kirkland.
Despite the ban on visitors, Catholic Health officials said they believe the coronavirus came into the facility from the outside.
Striving for continuity
Advocates for the elderly expressed concern about nursing homes relying on temporary and “agency provided” health care workers who may inadvertently transfer the novel coronavirus from one nursing home to another, because temporary staffers often work at multiple locations.
“There was that cluster of Covid cases out in the Seattle area and the federal government cited workers who were employed at multiple long-term care facilities as a potential factor in the spread of the virus,” said Lindsay Heckler, supervising attorney at the Center for Elder Law & Justice in Buffalo.
Heckler encouraged facilities to stick with the same staff and ensure that all staff have proper protective equipment.
Shiley described handling the outbreak of cases at Father Baker Manor as similar to fighting a wildfire.
“Some of the embers from that fire may have already spread beyond where the smoke is and you just can’t see it yet,” he said. “So, we have to find all of those little embers and put them into the same area where we can contain them, and care for those patients.”
Sullivan said “a handful” of families have taken their loved ones out of the facility and are now caring for them at home.
But keeping continuity was paramount for many residents who consider Father Baker Manor their home, he said.
“Disrupting their lives can be detrimental to them,” he said.
Moving any resident who has Covid-19 will have to be coordinated through the county Health Department, added Sullivan, who advised against it.
“Their best place to be is in a facility where we’re monitoring them regularly and we have the oxygen available for the progression that this disease takes,” he said.
Staff Reporters Lou Michel and Mary Pasciak contributed to this report.