Experts: Nursing home cases a sign of how infectious coronavirus is as resident awaiting test results dies

UPDATED information about a death and 9 presumptive positive COVID-19 cases at Koester Pavilion in Troy.

Local health officials are looking for anyone who potentially had contact with the first three local people infected with coronavirus and said there is no indication that the Miami County skilled nursing center where two of them lived did anything wrong.

On Thursday afternoon Vicky Knisley-Henry, spokeswoman for Miami County Public Health, and Emma Smales, spokeswoman for the Clark County Combined Health District, both said it appears Koester Pavilion followed all guidelines in protecting against COVID-19, the disease caused by the novel coronavirus that is sweeping the globe.

On Friday the Miami County Coroner announced that one of the Koester residents awaiting the results of his coronavirus test had died.

Earl Bolinger, 93, was a resident of the Koester Pavilion nursing home in Troy, where two earlier cases of COVID-19 were discovered and where additional residents and staff are now presumed positive or awaiting testing. He is the father of a resident who had earlier tested positive and Miami County Coroner Dr. William Ginn said Bolinger’s death is being treated as a coronavirus death.

Thursday evening Miami County health officials had announced there were “nine additional presumptive positive COVID-19 cases in Miami County,” all residents of Koester. The news release did not make clear whether those nine were part of the 17 people who were originally quarantined because of contact with the two patients whose positive tests were announced on Wednesday.

The news release also said there are three additional residents and two staff members from Koester who were hospitalized. All of them, plus five additional staff members, are awaiting results of their COVID-19 tests.

“These positive cases are not unexpected given that public health officials have anticipated that COVID-19 will spread through community contact in our region, state, and nation. Patients at UVMC who are ‘presumptive positive’ for COVID-19 continue to be kept in isolation,” said Ben Sutherly, system director of communications for Premier Health, which owns the facility in Troy.

In earlier comments Sutherly said skilled nursing and short-term rehabilitation facility in Troy took “proactive steps to protect residents,” including restricting visitors on March 6 and then on March 12 instituted far-ranging restrictions in accordance with state and federal guidelines.

On Thursday night Sutherly added, “Other precautions taken at the hospital include securing additional personal protective equipment, taking additional measures to ensure patients with symptoms consistent with COVID-19 are separated from other patients, and tightening visitor restrictions. We also have postponed elective surgeries, made changes in our nutrition services, and have set up internal hotlines to support our physicians and employees.”

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“Koester Pavilion employees are taking several precautions as they care for their residents, including monitoring themselves for symptoms upon leaving and returning home, and upon arriving at and leaving the skilled nursing facility,” Sutherly said. “
Our clinical and support teams have trained extensively for this eventuality and are well-prepared to treat patients with COVID-19 while ensuring the safety of our patients and staff.”

Koester is continuing “to restrict all visitors and non-essential services, screen anyone who enters facility including temperature, follow Centers for Disease Control and Ohio Department of Health guidelines in their entirety, monitor and treat every resident for signs and symptoms, and address based on our protocol,” said India Chrisman-Williams, regional vice president of operations for AdCare Health Systems, which manages the facility.

The cases illustrate the difficulty nursing homes have in protecting residents against highly infectious diseases like COVID-19, said Dr. Glen Solomon, chairman of the department of internal medicine at Wright State University’s Boonshoft School of Medicine.

“Even if you do everything perfectly, you can’t keep the virus out of these environments,” Solomon said “This is not a marker of quality of care. This is a marker of how bad and how widespread this virus is in this community.”

Even with restrictions on who can go inside a nursing home it is possible for a staff member or someone else who must be inside the home to carry the virus and show no symptoms.

“The reality is you can’t 100 percent prevent the spread of a virus like this. Careful hand hygiene and keeping surfaces clean is the best we can do,” Solomon said. “We all want to point fingers. We all want someone to blame but with this one all you can do is blame the virus.”

Statewide there are 119 confirmed cases of coronavirus, with 33 patients hospitalized, according to the state health department. Nationwide there are 10,442, with 150 deaths, according to the CDC.

The Warren County Health District announced a confirmed positive COVID-19 case in Warren County on Thursday.

“The patient is a male in his 40s. He is currently in isolation at home. Out of respect for the patient’s privacy, no additional identifying information will be released,” according to a news release.

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“Warren County Health District will monitor the patient during his isolation. We will be in daily contact with him and as needed with our partners at the Ohio Department of Health. We are taking every precaution to stop the spread of this virus,” the release says.

On Wednesday officials announced that two Koester residents tested positive for the virus and were hospitalized. One, a man in his 70s from Bethel Twp. in Clark County, was transferred to the Dayton Veterans Affairs Medical Center, where he was placed in isolation for another condition before showing symptoms. The other is a Miami County woman in her 60s who now is hospitalized at the Upper Valley Medical Center.

On Thursday afternoon Knisley-Henry said ten other Koester residents, six staff members and a visitor are in quarantine, including three who are hospitalized but it is not clear which of them, if any, are included in the news release the health district sent out Thursday evening. 

Health officials in both counties are looking for others who may have been in contact with any them.

The Koester cases are the first confirmed coronavirus cases at an Ohio long-term care facility and the news “underscores the difficulty of preventing the spread of the virus,” said Pete Van Runkle, executive director of the Ohio Health Care Association.

He said the group is working with its members to make sure steps are taken to fight the spread of coronavirus in facilities serving seniors and those with intellectual and developmental disabilities, as well as persons delivering home care or hospice services.

“The facilities are aggressively screening staff and other essential personnel entering the building for any indication of exposure,” Van Runkle said. “Staff is also constantly screening patients, and isolating anyone who is found to be symptomatic. Personal protective equipment, such as masks, gowns and gloves are used whenever caring for someone believed to be infected.”

On Thursday Montgomery County officials announced they are struggling with a shortage of that protective equipment and will be issuing new guidelines for EMS crews that will include limiting when protective gear is used, re-using some protective gear and seeking to get non-traditional protective gear from community partners.

“This is a huge change of practice,” said Dave Gerstner, of the Regional Medical Response System and Dayton Fire Department EMS.

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“The choice is not if we are going to run out, but when we are going to run out,” said Gerstner, speaking on Thursday at the daily briefing held by Public Health - Dayton & Montgomery County.

Montgomery County’s first positive case of COVID-19 was announced on Wednesday by Kettering Health Network, which has tested 73 patients for coronavirus. Thirty-one of those tests were negative and 41 are pending.

Dr. Jeffrey Weinstein, an infectious disease specialist for the health network, said the one positive test was a Montgomery County man who was admitted to Kettering Medical Center on Saturday and released on Sunday. His test didn’t come back until Wednesday.

The man stayed in a private room for one night and was discharged with instructions to self-isolate, hospital officials said. Weinstein said hospital staff spoke with the man and he is doing well.

Weinstein said the health department will try to track who might have come into contact with the man before he went to the hospital. To protect patient privacy, Weinstein wouldn’t say more about the man.

Weinstein said any patient who comes to Kettering Health Network hospitals and is suspected of possibly having coronavirus is put in isolation.

“Even before the test results come back, we treat them as though they are positive,” Weinstein said.

Drive-up testing for the coronavirus began in Dayton on Tuesday for people who have a doctor's note saying a test is needed. The site, a collaboration between Premier Health and the University of Dayton, is at the UD Arena parking lot, 1801 Edwin C. Moses Blvd., and is open from 10 a.m. to 6 p.m. daily. Health professionals will collect a specimen using a nasal swab that will be sent to a Quest Diagnostics lab for testing. Most patients were initially tested for flu and if they tested negative went on to more extensive testing that included the COVID-19 test.

As of Thursday 864 people were tested, including 810 who were tested for COVID-19 and 54 people who tested positive for influenza, said Sharon Howard, director of site communications for Premier Health.

People will only be tested if they have a doctor’s order, which is based on symptoms that include cough, fever and shortness of breath; direct contact with an infected person or travel to a country that has an outbreak. Howard said 110 people were turned away from the drive-through site because they did not have a doctor’s order.

Dr. Joseph Allen, regional medical director for Premier Health, said officials are talking about further limiting who can get tested due to declining supplies in the test kits.

Solomon said COVID-19 is notable because no one has immunity to it and “it causes a more severe infection with pneumonia and respiratory symptoms” compared to some other viruses that people typically get. He said there is no medicine to treat COVID-19 but its symptoms can be treated with things like ventilators.

Both Allen and Solomon believe that the dramatic steps taken by Ohio — closing schools, restaurants and bars, postponing the primary election and other measures to encourage social distancing — is going to blunt the impact of the virus.

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“It’s flat out going to save lives,” Solomon said. “We’re going to see a lower infection rate because we are keeping people away from each other.”

If the number of COVID-19 cases can be kept under control it will keep the hospitals and other medical facilities from being overwhelmed during a period when they are already dealing with a severe influenza season and the usual late winter ills. And with all the social distancing, hand washing and sanitizing going on, Solomon and Allen said there should be a drop in the spread of other communicable illnesses.

“If we do everything right it’s going to look like we overreacted,” Allen said.

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