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Monroe Health Center’s physician assistant Erica Dowdy performs a COVID test in the temporary drive-in carport for patients to be safely seen for testing.

UNION — Monroe County had been weathering the COVID-19 storm well, with a total of only 20 positive cases and no deaths since the pandemic began.

But that changed on Aug. 18, when three positive cases were detected at the Springfield Center, a skilled-nursing facility in Lindside, and despite the immediate response by the center, the Monroe County Health Department and state agencies, the statistics show the grim reality of what happens once the virus enters a congregate setting with a vulnerable population.

On Aug. 18, the Monroe County Health Department posted this message on social media:

“Monroe County Health Department confirms an outbreak of COVID 19 at a local Long Term Care Facility; one resident and two staff members have tested positive. We are working closely with the facility to identify additional cases and conduct contact tracing. Health and safety measures have already been implemented by the facility.”

The facility was Springfield, which also is a rehab center.

Those first positive tests prompted immediate action by Stonerise Healthcare, the Charleston-based owner of Springfield, with same-day testing of all residents and staff. The results started coming in within 48 hours, and the center had 45 active cases with 18 employees and 27 residents on Aug. 20, only two days later.

As testing continued, the number of positive cases reached its peak on Aug. 30, at 72 confirmed cases, with 67 still active among 43 residents and 29 employees. Three remained hospitalized, and, sadly, five had died.

How the virus got into the center in the first place, especially with so many safety protocols in place, remains a mystery as does the rapid spread once it entered the facility.

For Larry Pack, CEO of Stonerise, which also has several other long-term care facilities around the state, seeing those numbers dropping during the past week has been a “blessing.”

“We currently (as of Friday) have 17 positive cases with residents at the center and 13 positive employees,” he said, adding that all are quarantined and will remain that way until they test negative.

The center now has a total of 42 residents and 100 employees,

“We are significantly down from the peak of the outbreak,” Pack said. “We are very thankful.”

Since long-term care facilities were on the radar from the beginning of the pandemic because of their vulnerable residents, and deadly outbreaks had been occurring around the state and nation, everyone involved was watching closely, following protocol, preparing for the worst but hoping and praying for the best.

Pack said Stonerise was prepared and ready to be on site quickly if a positive case was found.

Pack said when he learned of the positive tests, the center’s priority was to give the positive residents the proper care, including quarantine from other residents, contacting the families of all residents that a positive case was found and “immediately” trying to determine the extent of the outbreak by testing and bringing in the needed help, including the Monroe County Health Department.

Not only that, Stonerise already had a team with people who had experience handling an outbreak on hand and ready to go to Monroe County.

The National Guard, state DHHR and the Bureau of Health were also all notified.

“We run to the fire, as the Governor (Jim Justice) likes to say,” he said of the rapid response. “It really goes pretty fast, things move quickly.”

Pack said everybody has a role and the center focuses on the residents while the health department concentrates on the employees.

“They do the contact tracing,” he said, which includes trying to determine where it may have spread in the community, in Monroe County. “They help us on the communications to the community. We work hand-in-hand and arm-in-arm … We are focused on taking care of our patients and doing everything we can to take care of them. They (health department) focus on stopping the spread in Monroe County.”

Jim Nelson, CEO of the Monroe County Health Department, said the team there was also ready for such an event.

“Everything and everybody” were in place to take action quickly, he said, trying to protect the residents, working with employees who could unknowingly spread the virus in the community and setting up testing sites in the county.

But with a lag time in testing results, that two-day delay hampers the process, he added, especially with so many people who are positive showing no symptoms at all.

“Once we realized the employees had it as well, we are in the middle of, ‘Who have you been in contact with’?” he said, as contact tracing must start immediately with a positive test as well as segregating the positive cases from the community.

Offering mass testing events for everyone in the county was also set up.

Nelson said when it started the department quickly reached out to Richard Miller, the county’s’ 911 emergency center’s director.

“He too immediately put things together and pulled resources so everyone would have the needed supplies without question,” Nelson said, and volunteers were lined up to do things like coordinate traffic.

All of the groundwork was well under way by the health department before the state had time to respond, he said. “They (state agencies and the National Guard) did throw resources at us and they did bring manpower down.”

“For us, the process was really recognizing their employees there (at Springfield),” he said. “We are looking at the outbreak in the facility but we are also looking at the overreaching aspect of an employee and show who they have come in contact with.”

“But with the two or three-day delay, you are already behind,” he said.

Although the decline in new positive cases was expected as contract tracing was implemented effectively, the threat remains.

“I don’t think we are out of the woods yet,” Nelson said. “When you are asking about contact tracing, those first levels of people on contact tracing (direct contact with a positive), those are the most probable to be positive and they are contacted to come in for testing. That’s going to be your spike.”

In the second level of contact tracing, more positives will most likely be found as well, he said, because it’s a matter of people in the first level who did not know they were positive coming in contact with family members or people at church or others.

“Now, what you are starting to see is the deeper levels,” he said. “We have pretty much identified everybody (who may have had contact) and we are still seeing a few who we may have missed through contact tracing because somebody forgot to mention them or they were asymptomatic and chose not to be tested.”

These are the “handful” of cases that may continue to surface, he said.

Nelson said the community may not always understand how hard health department employees work and how they put themselves in danger.

“Look at the protective gear they have to work in,” he said, pointing to people who work outside at the department’s drive-in testing, which is offered every day in all weather. “This will be on-going. This thing is not over yet and we don’t know the duration.”

Pack said the employees at the center, health care workers and first-responders who deal with this virus are all “heroes.”

In fact, Stonerise has given its employees raises and bonuses for the hard and risky work they do.

Pack and Nelson both said the virus got into the center because it’s in the area, and as the number of positive cases grows and people travel more, the more difficult it is to keep it out.

“It’s nothing more than a virus in the community,” Pack said. “Our caregivers live in the community.”

Other external people also visit the center for needed services.

But the comparison to other viruses, like the flu, has many limitations.

Even with the protective protocol in place, the virus found a way in and how that happened and how it spread once it was in remains a mystery, Pack said. “We are very proud of our infection control process. It’s difficult to see us doing more than what we are already doing.”

This virus is new, so the experts are still learning, trying to understand the details of how it spreads and why it is so often asymptomatic in people, which makes the possibility of spread more likely.

That is one of the reasons testing continues, he said, with another round of testing last week.

“We are testing employees twice a week since the outbreak and residents once a week,” he said, and that will continue until the center is COVID free.

Since no visitation is allowed, he said iPads are used to allow residents to speak with their families remotely.

“We have wonderful families,” he said. “They understand what we are doing and why we are doing it.”

Pack said the community has been supportive of the center from day one, bringing food and helping any way they can.

“The community and cooperation (with the health department and other agencies) is the key,” he said. “We have been blessed to have both of this and to be in Monroe County.”

On Friday, the Lindside and Peterstown Methodist churches announced more than $2,100 has been raised to work with Linda Fox (owner of Hometown Restaurant in Peterstown) to provide food to the center until the end of the month.

But Pack also knows the coronavirus will be around for awhile and, as Nelson said, the danger will persist.

“At the end of the day, this virus has no vaccine and will be around until we do have a vaccine,” he said, and that could mean additional outbreaks not only here but around the state and country.

That risk, as well as outbreaks at facilities like Princeton Health Care Center which has seen 21 resident deaths, prompted Justice to say recently that diligence by everyone continues to be necessary.

“The overwhelming majority (of deaths) have come from out of the nursing home community,” he said. “The elderly are the most vulnerable. I urge all West Virginias to realize the impact of the virus…“

 As of Saturday, according to the DHHR, Monroe County has reached a cumulative total of 133 positive cases, almost seven times the number before Aug. 18.

— Contact Charles Boothe at cboothe@bdtonline.com

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