Sixteen percent of the residents at a Decatur nursing home have COVID-19, a spokeswoman confirmed Friday.

River City Center, a skilled nursing and rehabilitation facility, had 21 residents and five staff members who had tested positive for COVID-19 as of Friday, according to Lori Mayer, spokeswoman for River City's parent company Genesis Health Care. There are 131 residents at the facility on 14th Avenue Southeast in the medical district south of Decatur Morgan Hospital.

The numbers have risen quickly, based on data from the U.S. Centers for Medicare & Medicaid Services (CMS). As of May 31, River City had no confirmed COVID-19 residents and one employee who had tested positive. As of June 7, according to the most recent data available from CMS, it had three residents and three staff members who had tested positive.

Mayer said no residents or employees had died from COVID-19, and one of the 21 infected residents was hospitalized as of Friday.

The problem is not unique to River City Center. According to Alabama Department of Public Health data released Friday, 2,129 long-term care residents and 1,291 employees have tested positive for COVID-19 statewide. Long-term care includes both nursing homes and assisted living facilities. As of June 7, according to CMS data, 283 nursing home residents had died of COVID-19 in Alabama and 29,497 nursing home residents had died nationwide.

John Matson, spokesman for the Alabama Nursing Home Association, on Friday said 161 nursing homes across 63 counties have reported a COVID-19 positive resident or employee. There are 231 nursing homes in the state.

'Vulnerable population'

Judy Smith, administrator of the Alabama Department of Public Health Northern District, said nursing homes provide a particularly fertile ground for the spread of COVID-19.

“You’ve got congregate living of a highly vulnerable population. You have hygiene issues because their mobility is challenged,” she said. “This has been horrendous, because they are the most vulnerable population we have.”

According to ADPH data, people who were 65 or older accounted for 78% of the 812 COVID-19 deaths in the state as of Friday.

Assistant State Health Officer Dr. Karen Landers said ADPH assists nursing homes that are dealing with the virus.

“The Alabama Department of Public Health provides case investigation and contact tracing,” she said. “Testing of residents and employees will be performed, depending on the circumstances of the investigation. Nursing homes can test residents universally through commercial or clinical laboratories.”

As of June 7, according to CMS data, River City Center had less than a one-week supply of N95 masks.

A shortage of masks and other personal protective equipment (PPE) is an ongoing problem for nursing homes in the state, Matson said.

“The estimate is it takes 22 full sets of PPE to care for one COVID-positive individual for a 24-hour period,” Matson said. "PPE is still very hard to come by."

He said Alabama nursing homes are following Centers for Disease Control and Prevention guidelines to reduce how much PPE is used, both through cleaning and reuse of some PPE and in the way they handle residents with COVID-19.

He said staff entering an infected resident's room “try to provide multiple services at one time because that would limit the number of times you’d have to don and doff PPE. If I can go into your room and provide three services instead of one service, well now I’ve made one trip instead of three trips.”

That reduced staff contact with COVID-19 residents, however, adds to the psychological burden that began in mid-March when the state and the CMS ordered nursing homes to end all visitations except in end-of-life situations.

“Obviously that’s very difficult on nursing home residents because they’re used to seeing their family and friends and others there on a regular basis,” Matson said. “It’s also difficult on staff because we very much appreciate having the family and volunteers and others there because it does so much to add to the quality of life in the nursing home. We know this is also difficult on families because they’re separated from their loved ones.”

Richard Feiffer, chief medical officer at Genesis, said River City uses Zoom technology to allow families to have video conferencing calls with residents.

River City efforts

Feiffer said River City is being proactive in its efforts to prevent spread of the virus.

“At River City Center, we have been extremely stringent on visitation restrictions, use of personal protective equipment and many other precautions at our facilities,” he said in an email. “We’ve followed guidelines and protocols set by the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services, in some cases getting out in front of them.”

He said the size of Genesis, which owns 400 skilled nursing homes and assisted/senior living communities in 26 states, has allowed it to leverage better access to personal protective equipment, and “the company has been able to shift supply around from location to location as needed.”

Feiffer said River City is taking numerous steps to reduce the spread of the virus, including:

• Screening residents and patients for symptoms three times a day;

• Screening and taking temperatures of all staff upon building entry;

• Requiring all staff to wear personal protective equipment;

• Restricting visitation except for exceptional circumstances, such as end-of-life situations; and

• Cancellation of all outside medical appointments except for medically necessary, time-sensitive and lifesaving treatments, such as dialysis and chemotherapy.

In April, Gov. Kay Ivey instructed the Alabama National Guard to take on the task of sanitizing long-term care facilities. The Alabama National Guard has sanitized 188, Lt. Col. Tim Alexander, director of public affairs for the Guard, said Friday.

Mayer said River City Center is not among those facilities that the Alabama National Guard has sanitized.

"Nursing homes can request cleaning by the National Guard team through ADPH," Landers said. "There may be instances where ADPH specifically recommends such cleaning above what a facility is already providing."

ADPH does not release information on which nursing homes have COVID-19 cases, but Landers said the agency takes the cases seriously.

“Each case of COVID 19 in nursing homes or any other case is investigated and contact traced and has been since the beginning of the COVID-19 outbreak,” she said. “ADPH Bureau of Health Provider Standards has remained in contact with nursing homes and has resumed onsite infection control visits for all nursing homes in Alabama with a target date for completion by the end of July 2020.”

Matson said nursing homes have struggled with the virus since early in the pandemic.

"I think what we've learned is that nursing homes should have been a top priority from the beginning of all this," he said.

Because nursing homes were not given top priority in PPE and testing early on, they struggled to control spread of the virus. While testing availability has improved dramatically, he said nursing homes were having to wait five to 10 days for test results early on.

"We can't treat what we don't know," he said, so viral spread was inevitable.

‘Extremely disturbing’

While the daily count of new COVID-19 cases in the state is erratic, the seven-day average shows the number of new cases increasing. Two months ago the daily count of new cases averaged about 220. On Friday, ADPH reported 787 new cases. Over the past week, an average of about 750 new cases were reported per day. Morgan County averaged about 28 cases per day in the week ending Friday, with Limestone averaging 12 and Lawrence averaging fewer than two.

Hospitalizations are also up, both statewide and in Morgan County. Between Monday and Friday of last week, the number of COVID-19 patients at Decatur Morgan Hospital grew from 17 to 24.

Landers said the state is still early in its struggle with COVID-19.

“Statewide, our numbers have continued to climb, and this is an extremely disturbing trend to the Alabama Department of Public Health and to me personally as a public health physician,” she said Friday. “We really have limited options in terms of prevention, and we certainly have limited options in terms of treatment.”

She stressed that while prevention options are limited, they are relatively easy. They include social distancing, wearing masks in public and good hand hygiene.

“I’m deeply worried, statewide, about the ability of our health care system to respond to and handle these numbers,” Landers said. “With these rising numbers, if we do not get this under control, it’s going to overwhelm our health care system, which has been the worry that we’ve had the whole time.”

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