With confirmed cases of the new coronavirus found in over 80 nursing homes across the state, Maryland Gov. Larry Hogan issued an emergency order Sunday aimed at curbing the spread of the illness in such facilities, many of which have been ravaged by similar outbreaks across the country.
Per the order, “symptomatic” residents now qualify for expedited COVID-19 tests, administered either by the state or other public laboratories. The state is giving priority in testing to such residents, as well as health care workers, patients in hospitals and first responders believed to have the disease.
Among the other measures included in the order, nursing home staff who interact with residents will be required to wear personal protective equipment, and homes must create separate areas with designated staff to care for positive and suspected cases of the disease.
“As we have been saying for several weeks, older Marylanders and those with underlying health conditions are more vulnerable and at a significantly higher risk of contracting, getting more severely ill, and dying from this disease,” Hogan wrote in a news release.
“Of major concern is that we currently have cases or clusters of cases at 81 nursing homes and long-term care facilities across the state. Our highest priority is keeping Marylanders safe, and we will use every tool at our disposal to protect the most vulnerable among us.”
The death toll from the disease in Maryland reached 67, the state announced Sunday. Confirmed cases of coronavirus increased to at least 3,609. Almost 25,000 people have tested negative for COVID-19 in the state and 936 have been hospitalized.
The 14 deaths added Sunday to the state’s total included a Baltimore woman in her 30s; two Baltimore County men, one in his 50s and the other in his 70s, and two Carroll County women, one in her 60s and the other over 80.
A national shortage of testing kits has created gaps of knowledge required to understand the virus’ nature, severity and extent of exposure, medical experts and researchers say. With tests in limited supply, potential carriers of the coronavirus without symptoms often do not qualify for swabs.
That creates the possibility of intermixing vulnerable people — such as nursing home residents — with staff members who may have been exposed to the virus without knowing it.
The order for nursing homes to expedite testing through the Maryland State Public Health Laboratory comes after The Baltimore Sun reported a Carroll County nursing home that’s an epicenter of the disease had not been able to test staff amid the national shortage of tests. Hogan has said a staff member who did not have symptoms likely brought the virus to the Pleasant View Nursing & Rehabilitation in Mount Airy, where 10 people have died and dozens are sick.
County health department officials announced the 10th COVID-19-related fatality of a Pleasant View resident Sunday, shortly after the governor issued the order. They also announced that three additional Pleasant View staff members have tested positive, bringing the total to 27.
On Friday, Frances Phillips, deputy director for public health services for the state health department, said there was now “clear evidence” that asymptomatic staff have been inadvertently helping the spread of coronavirus in nursing homes. At that point, she said the state lab was reserving testing capacity for nursing home staff and residents and instructed nursing homes to use the state lab so they would get the fastest results.
Hogan’s order Sunday made it mandatory for nursing homes to use the state lab.
“This includes using either a test kit provided by the Maryland State Lab or sending their test specimens if using the nursing home’s own test kit to the Maryland State Lab for COVID-19 testing of residents and staff,” the health department told nursing homes Sunday.
Also in the order, nursing home staff who interact with residents will be required to use face masks, appropriate eye protection, gloves and a gown.
According to Mike Ricci, the governor’s communications director, a process is in place for nursing homes to obtain personal protective equipment from state and local health departments.
Facilities must now also designate personnel to care for known and suspected residents with COVID-19 in a separate room that serves as an observation area. Newly admitted and readmitted residents will stay in this area for 14 days and be monitored for symptoms of the virus.
An additional observation area will be designated to care for residents who have been designated to have or suspected to have COVID-19.
Under the new order, the state health department can assist acute care hospitals in discharging and finding placements for patients who require nursing-home level care.
Nursing home residents admitted or seen at a hospital for COVID-19 must be allowed to go back to the nursing homes from which they came, so long as the facilities adhere to federal recommendations for transmission-based precautions. Residents can be sent to short-term placements, if necessary.
“Every effort” must be made to transfer former residents back to their original nursing homes as soon as possible, according to the order.
Mary-Claire Roghmann, professor of epidemiology and public health and medicine, associate dean for physician scientist training at the University of Maryland School of Medicine and associate hospital epidemiologist and physician at the VA Maryland Health Care System, said though she was not intimately familiar with the governor’s latest order, each of the mandates could significantly slow the spread of the virus in these facilities.
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But, she said, shortages in critical supplies such as personal protective gear and testing kits could render the governor’s orders less effective than desired.
“Nursing homes are going to be absolutely critical to helping us recover from this epidemic,” she said. “My hope is, in the future, we’ll be able to test all our staff to see if they’ll be able to determine if they’ve been be exposed, so they’ll have less anxiety about caring for people.”
Roghmann also said not every nursing home in the state has the space to assign a designed observation unit, but staffs should consider moving residents to different rooms and floors when necessary. Establishing distinct cohorts within facilities for COVID-19 patients and for those who test negative for the disease will be essential, she added.
“You typically don’t move patients without a very good reason, and this is a very good reason,” she said. “We’re going to have to think about how we separate nursing homes to make it possible to care for each group.”
Some nursing home spokespersons and staff said Sunday that they had previously instituted some of the protocols mandated by the governor’s order — such as the use of masks and gloves by workers.
Dan Dunne, spokesman for Erickson Living, said his company had “followed and stayed ahead of guidelines issued by the CDC and local health departments,” but appreciated the measures outlined in Hogan’s order.
Statewide, more than 3,600 residents have tested positive for the disease and nearly 70 have died. Worldwide, over 1.2 million people are known to have the disease, with the U.S. suffering the largest recorded outbreak so far.