Staff members at the Seattle-area nursing home overrun by COVID-19 spread the coronavirus to other facilities where they worked, an investigation led by the U.S. Centers for Disease Control and Prevention has found.
The report published Wednesday said that as of March 9, the CDC confirmed 129 COVID-19 cases among people linked to Life Care Center of Kirkland. These comprise 81 residents, 34 staff members and 14 visitors.
Separately Wednesday, public health officials reported five more deaths associated with the facility, bringing the total number who have died to 35 — more than half of Washington state's known total of 66.
"Limitations in effective infection control and prevention and staff members working in multiple facilities contributed to intra- and interfacility spread," the CDC report said.
The report urged other such facilities nationally to immediately work to prevent coronavirus outbreaks.
"Long-term care facilities should take proactive steps to protect the health of residents and preserve the health care workforce by identifying and excluding potentially infected staff members and visitors, ensuring early recognition of potentially infected patients, and implementing appropriate infection control measures," it said.
Of the deaths linked to the nursing home, one was a visitor and the rest were patients.
The advanced age of many long-term care facility residents, their underlying health conditions and their proximity to one another put them at risk for sickness and death, the report said.
Life Care residents infected by the virus ranged from 54 to 100 years old, with a median age of 81.
"Substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to COVID-19," the report said.
Infected Life Care workers ranged from 22 to 79 years old.
A spokesman for the nursing home said Wednesday that managers welcomed the CDC report, because it could alert other facilities and lead to new guidelines.
"For us this is all positive, even if there are things they found that we could have done better," said Timothy Killian, a crisis communications specialist, on behalf of Life Care.
He said that two or three days after the outbreak was discovered, staff members were banned from working at other facilities.
"As soon as we had an idea that this was something that shouldn't be done, we stopped," he said.
Killian said that "it's a relatively common practice" for nurses to work in multiple long-term care facilities.
Dr. Michael Wasserman, president of the California Assn. of Long Term Care Medicine, said that low wages in nursing homes and assisted-living centers force many staffers to work in multiple facilities. Certified nursing assistants often make no more than minimum wage, and nurses typically receive less than they do in hospitals.
In addition, a sense of duty and financial stress may tempt employees to come to work sick, endangering elderly residents who have underlying health conditions.
"This is only the beginning, and there are going to be more Kirklands," said Wasserman, a geriatrician and former chief executive officer of Rockport Healthcare Services, a California chain of more than 70 nursing homes.
"You're taking a lethal virus, and if it gets into the nursing-home setting, where the staff are not trained to address it, this is what you get. The majority of nursing homes in this country are not prepared."
The Kirkland nursing home is a branch of Life Care Centers of America, a company with more than 200 skilled nursing, rehabilitation, Alzheimer's and senior living campuses in 28 states. With more than $3 billion in annual revenue, the privately held company based in Cleveland, Tenn., has about 40,000 employees.
On March 12, the company posted a statement on its website that said the safety of its residents was a top priority and that each employee's temperature was being taken upon arrival at work.
"If they have a fever over 100.4, we send them home and ask they visit their personal physician," the statement said. It said the policy met guidelines of the CDC and the Centers for Medicare & Medicaid Services.
On Wednesday, an updated policy on the website said that all visitors, nonessential healthcare personnel and vendors had been restricted from entering the chain's facilities.
The CDC investigation into the Kirkland facility found that infected healthcare workers had a broad range of occupations: doctor, nurse, nursing assistant, physical therapist, occupational therapist assistant, environmental care worker, health information officer and case manager.
The CDC conducted the investigation with the Seattle & King County Public Health agency and EvergreenHealth, the medical center that treated most of the patients hospitalized from the nursing home.
According to the report, an outbreak of respiratory illnesses began in mid-February. But tests of several residents were negative.
COVID-19 was discovered Feb. 28 in a 73-year-old with underlying health conditions. She had been hospitalized four days prior due to worsening respiratory symptoms.
Once the outbreak was discovered, investigators emailed about 100 long-term care facilities in King County to check for other clusters of the disease and visited nursing homes with suspected outbreaks to conduct emergency tests for the virus, the report said.
"As of March 9, at least eight other King County skilled nursing and assisted living facilities had reported one or more confirmed COVID-19 cases," the report said.
Several conditions probably made these facilities vulnerable, the investigation found.
Staff members worked in more than one facility. Staffers worked while symptomatic. Workers weren't familiar with standard precautions concerning droplets from patients, surface contacts and eye protection. Facilities had inadequate supplies of personal protective equipment and other items such as alcohol-based hand sanitizer. And supplies of test kits were limited.
"The findings in this report suggest that once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members and visitors," the report said.
The report said that since the outbreak was discovered, authorities in Washington state announced new requirements for long-term care facilities, including health screening for staff members and visitors, whose presence has been limited.