By Rick Green, Granite State News Collaborative
Despite all that has been learned and all the precautions taken, COVID-19 has continued to find its way into New Hampshire nursing homes with alarming regularity and deadly consequences.
The virus has killed 168 people just in current or recently closed outbreaks in congregate living facilities in the state, according to statistics compiled by the Health and Human Services Department. Hundreds more died in previous outbreaks.
A variety of factors may contribute to some nursing homes having a much worse experience than others, Health Commissioner Lori Shibinette said.
Rita Landry, who served in the Air Force during the Korean War, receives a COVID-19 vaccination at the New Hampshire Veterans Home on Dec. 23. The virus killed 37 people at the home in an outbreak that began in November.
It was initially thought that issues with ventilation systems played a common role in the worst outbreaks, but a study over the summer didn’t support that theory, she said.
There are indications that twice-a-week staff testing has been helpful in reducing outbreaks, compared to the spring when this testing was done once a week.
“The numbers tend to be smaller than what they were in the spring, when you look at the total number of people affected in the facilities,” Shibinette said.
“Other things: the older long-term care buildings, they are set up very different from an environmental and physical standpoint, the way the beds are set up, how big the rooms are, how big the common areas are. All those things are going to play a role in it. How many private rooms are in a unit versus semi private rooms?
“All those things we are sure play into the spread of COVID-19.”
But major structural changes at long-term care facilities aren’t easy to accomplish in the short term.
“We haven’t identified any specific commonalities that we can act on today to help curb that spread,” Shibinette said.
The U.S. Centers for Disease Control and Prevention has extensive guidance for nursing homes, given that residents of these facilities are extremely vulnerable to a virus that thrives in congregate living situations.
The guidelines, which range from mask use to assigning an infection control manager to restricting visitor access, provide no guarantee of success in keeping the disease out.
Meanwhile, there are signs that a vaccination program that started last month may finally be starting to reduce the impact of the disease in long-term care facilities, which account for 780, or about 74 percent, of the 1,057 deaths attributed to COVID-19 in New Hampshire since the start of the pandemic.
Dr. Benjamin Chan, the state epidemiologist, said a little more than half of a recent group of 65 people who died from the virus were associated with long-term care facilities.
“Now, this is a lower percentage from what we have typically seen in some of our death numbers over the course of this pandemic,” he said. “And so, we hope to -- we will continue to see if this trend continues. But hopefully this is actually an early indication, possibly, that the vaccination rollout in our long-term care facilities might be having a beneficial effect.”
Residents of long-term care facilities were in the first group to receive vaccinations, which began in December, and state health officials say that the overwhelming majority of those in this classification have received at least their first injection.
Many nursing homes were able to avoid outbreaks through most of the pandemic, only to have major problems late in the year.
An outbreak was reported at Golden View Health Care Center in Meredith last month. The outbreak is now classified as closed.
Cristina Michelle Alvarez, 46, who was employed at the nursing home as a licensed practical nurse, said she came down with the disease on Dec. 24.
She wasn’t feeling well and was given a rapid COVID-19 test at center. Minutes later, it came back positive.
Cristina Michelle Alvarez, a licensed practical nurse, who worked at Golden View Health Care Center in Meredith. She tested positive for COVID-19 in a rapid test at the long-term care facility on Dec. 24.
“I reported to the nurse I’m relieving and told them I had a positive test,” Alvarez said. “She said, ‘You’re going to stay and finish your shift.’
“I was flabbergasted at that response.”
Alvarez said the facility allowed staff members to work when they should have been in isolation. She also questions procedures that she said allowed staff to go back and forth to work in areas of the home with and without COVID-19.
She ended up with a fever that reached as high as 102.9 and lasted for 10 days.
“I went to the ER three times before I finally called 911 and was rushed to Concord Hospital and stayed for seven days,” Alvarez said.
“I still have ringing in my ears and am very, very dizzy and have an awful brain fog.
It’s devastating. I’ve had 36 symptoms, everything from losing my sense of taste and smell to hallucinations, memory loss.”
Alvarez, a former competitive swimmer, said she recently left New Hampshire to stay with her parents in the Palm Springs, California, area.
Rosemary Simino, the home’s administrator, did not respond directly to these claims.
A total of 77 residents and 52 staff members ended up testing positive for the virus at the Meredith nursing home, according to state statistics. Simino said 11 have died.
“We follow CDC, CMS (Centers for Medicare and Medicaid Services) and State of New Hampshire DHHS Public Health Guidelines for Long Term Care Facilities.
“In accordance with CMS procedures for Long Term Care Facilities, Golden View had two CMS focused infection control surveys, one in June and one during our outbreak in December.
“On both surveys, Golden View was found to be in full compliance with infection control regulations, CMS and CDC recommended practices for COVID-19. Golden View remains a CMS 5-star facility out of a possible 5 stars which is much above average and has earned a CMS 5-star rating in staffing and quality resident care. Our record speaks for itself.”
Margaret LaBrecque, commandant of the New Hampshire Veterans Home in Tilton, said things are now looking up at her facility, which reported its first deaths from the disease in November.
A total of 36 people died of the disease at the home, and the outbreak was beginning to ease off by the time the first vaccinations were given last month.
Sarah Stanley, a spokesman for the home, said the death toll reached 37, which is the second highest of any outbreak in the state, behind only the Hillsborough County Nursing Home, which registered 39 deaths before its outbreak ended in July.
LaBrecque said the veterans home did a good job of keeping the virus outside of the facility until community spread of the disease increased late in the year. The theory is that a staff member contracted the disease outside of work, was asymptomatic and brought it inside the facility.
Once it got in, the virus went through the home like wildfire. In the end, 93 residents and 102 staff members tested positive for COVID-19.
The National Guard and the U.S. Veterans Affairs Department helped with staffing shortages.
After the disease afflicted most of the residents and a high percentage of the staff, it finally began to ease off. There were 135 residents and 280 staff members when the outbreak began.
There were no positive results in the last round of testing and this outbreak is also now classified as closed.
LaBrecque said many of the staff members at the home are related to one another. While the close-knit nature of the staff is usually a positive, it may have hastened the spread of the disease in this case, she said.
An infection control team from Veterans Affairs did not find any serious deficiencies in infection control practices, but found a lack of fit-testing for N-95 respirators, a shortage of some cleaning supplies and lags in turnaround time for COVID-19 tests.
LaBrecque said the exact reasons why the home had such a bad outbreak is hard to pinpoint.
“We can guess all day on different things,” she said. “There are many contributing factors and until we dig into it and pull it apart it’s hard to say, other than the fact that our population is, on average, 86 to 90 years old and there are very, very many with co-morbidities. Our guys and gals are sick. That's why they come to us.”
Other long-term care facilities have managed to avoid outbreaks.
Gretchen Gandini, a spokeswoman for the Taylor Community in Laconia, said positive tests have been limited to two residents in independent living, who have since recovered. There was one positive test result for a resident of the community’s nursing facility.
“This resident was asymptomatic and two subsequent tests were negative. We (and DHHS) suspect that that case was a false positive.”
There have been six positive test results among staff members, all of whom have since recovered.
She credited staff and residents with working effectively to avoid problems.
“The two most critical factors have been the buy-in from our staff and the buy-in from our residents to follow the strict safety protocols that have been put in place,” she said. “It’s been a true team effort from the leadership team on down.
“From day one we’ve emphasized that we are all in this together and that we need to follow safety protocols with fidelity both at work and when our team is at home.”
These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.
On the Web:
Nursing home best practices: www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html