60 infected, two dead after coronavirus outbreak at Orange County nursing home
This story was updated at 7:28 p.m. April 8, 2020.
At least 60 people at an Orange County nursing and rehab center — both patients and staff members — have tested positive for the coronavirus, Gov. Roy Cooper said Wednesday.
Seven of those patients are at Duke University Hospital, and two have died.
“These are shockingly large numbers,” Cooper said during a news conference.
Orange County had 81 cases of COVID-19 as of Wednesday evening.
The outbreak is at PruittHealth-Carolina Point, the Orange County Health Department said Wednesday night. It’s a significant increase from April 2, when the health department reported there were two positive cases there — a health care worker and a resident. That day, the county reported a total of 37 confirmed cases.
PruittHealth-Carolina Point, on Mt. Sinai Road near the Durham-Orange county line, is one of two long-term care facilities with coronavirus outbreaks in Orange County, the Health Department said in a release.
The other is at Signature HealthCARE at Chapel Hill, the release said. Three people who tested positive are being treated at UNC Hospitals, the release stated.
An outbreak is two or more cases. More test results are pending for both facilities.
The Health Department has worked with the facilities and other agencies to test staff and residents to determine who carries COVID-19, even if they are asymptomatic. Those who test positive are separated from other residents and staff, and the facilities immediately notified the Health Department about new or suspected cases, the release stated.
PruittHealth began operating at “Code Red status” and working with public health officials to implement an “enhanced infection prevention protocol” after receiving its first positive test results, according to a statement Wednesday night from PruittHealth’s communications team.
The center began monitoring staff levels and providing personal protective equipment, it said, while also installing an air scrubber system and isolation units. Meanwhile, staff worked with Duke University and UNC-Chapel Hill to test all of the residents, it said.
“This is unprecedented,” according to the statement. “Thanks to them, we were able to test 100 percent of the residents in just 48 hours. We are actively communicating with these residents’ families.
“We will continue to monitor the issue and its effects on our community as we follow the latest public health guidance. We ask for your prayers for the patients’ loved ones during this difficult time, and out of respect for them and the patients’ privacy, we cannot share any more details at this time.”
Orange County lawmakers issued a joint statement Wednesday night, confirming the cases were at PruittHealth-Carolina Point and reminding residents to follow the state’s stay-at-home order. The statement came from Democratic state Rep. Graig Meyer, state Sen. Valerie Foushee and state Rep. Verla Insko.
“First and foremost, we want to express our most sincere care for the residents and staff at PruittHealth’s Carolina Point facility,’ according to the statement. “We also understand how this must feel to their concerned families who are learning this news.”
Long-term care settings
Eighteen of North Carolina’s 21 outbreaks are at what’s called “congregant living facilities,” including nursing homes, jails and shelters, N.C. Department of Health and Human Services Secretary Dr. Mandy Cohen said during a news conference.
In addition to the Orange County outbreak, at least 30 people at Pinehurst Healthcare and Rehabilitation Center in Pinehurst had tested positive for the coronavirus Wednesday afternoon, according the Moore County Health Department.
Last month, Cooper issued an executive order banning visitors to long-term care facilities except for end-of-life situations. DHHS officials suggested staff wear protective gear but stopped short of making it mandatory.
“Now we need to go further,” Cohen said Wednesday.
The state will now require all nursing home staff members to wear masks, close communal areas, screen staffers daily and report all new or suspected cases to the state health department.
If infections are detected, those residents must be moved to a separate area of the facility so they can be cared for by separate staff members to ensure there is no interaction with residents who are not COVID-19 positive.
There are more than 3,500 cases of COVID-19, the illness caused by the coronavirus, according to a tally by The News & Observer. The state reported more than 3,400 cases earlier Wednesday morning.
There are cases in 92 of the state’s 100 counties.
Past issues at Pruitt Health-Carolina Point
A Medicare health inspection for Pruitt Health-Carolina Point rated the facility “much below average” in September 2019. The inspection record shows the facility had 13 health citations. The average citations for North Carolina care facilities was five, the record states, and the average citations for care facilities across the country was just over eight.
Short-stay residents got better care than long-term residents, it said.
The report noted multiple problems at the facility, including concern among residents that no menu or alternate foods were provided at meal time and the dining room was sometimes closed when they arrived for meals. The facility’s dietary manager told inspectors that the dining room was only closed on days when the staff received and put away stock.
The staff also failed to complete assessments for multiple patients as required, including two daily living assessments, which help staff understand a patient’s physical needs, the report said. Another patient’s catheter was not properly attached, kitchen staff failed to properly clean several appliances, and staff also failed to remove 10 medications that had expired from the facility’s storage room, it said.
Three reports from inspectors with the U.S. Department of Health and Human Services were attached to the record.
One, in March 2019, cited Pruitt Health for failing to prevent a resident with dementia from leaving the center unsupervised. The resident was found lying in a drainage ditch nearby with a temperature of 90.5 degrees and was taken to the hospital, the report said. A later investigation indicated a lock on the facility’s front doors may have been disabled.
The facility was cited again in June 2019 after a staff member stretched a resident’s fingers to get her to open her hand while the staff member was trying to help the resident get dressed. The resident’s finger was “swollen and purplish in color,” the report said. An X-ray later showed that the resident’s finger was fractured, it said.
The record reflects that the nursing assistant was suspended, but it does not say whether she was fired.
A third report in January 2020 cited Pruitt Health for failing to notify a medical provider when a “verbally aggressive” resident refused to take his medications. The resident, identified in a random sampling of three patients at the center, was not given his insulin, heart, blood pressure, antibiotic or antipsychotic medications, the report said. His vital signs remained normal, it said.
Pruitt Health was fined twice in the past three years, the record shows, for a total of $14,927.
Signature HealthCARE problems
A federal Medicare record shows Signature also received a “much below average” rating on its health inspection and for staffing. There have been two citations and 21 complaints in the last year, the record shows. Long-term residents received a “below average” quality of care, it said.
The most recent inspection was in May 2019, when Signature was cited for not providing required physical therapy to a patient, and for failing to label medications with the date they were opened.
The report also noted in June 2019 that heating and ventilation systems were not properly installed. The problem was corrected in time for a September inspection, the report said.
Signature’s staffing levels also indicated that there may have been too few registered nurses. The report notes that registered nurses working for the facility had roughly 15 minutes each day to spend with an average of 83.5 residents.
The state average for registered nurses was 36 minutes for roughly 85.2 residents, while the national average was 41 minutes per nurse for roughly 85.9 residents.
More orders to come
Cooper said he’ll be issuing another executive order, likely on Thursday, that would make social distancing and safety guidelines at stores “more uniform across the state.”
“We know that people have to go out and to get groceries and other essential items, and we want people to be as safe as possible when they go,” he said.
Harris Teeter, the Matthews-based grocer that’s owned by Kroger, announced Wednesday it would begin limiting the number of customers its stores at the same time to 50% of building code capacity. Store employees will monitor how many people are in the store. The restrictions were scheduled to begin at 5 p.m. Wednesday.
Cooper previously issued a stay-at-home order from March 30 to April 29 and closed schools through May 15. Gatherings of more than 10 people have been banned and those who go out in public must maintain social distancing of 6 feet.
The governor told reporters on Wednesday that it is “so critical that people abide by that order and only go out for work and essential reasons.” He said the data show that it’s working.
“We don’t know the answer yet whether the stay-at-home order will be extended into May and if it is, what it will look like,” Cooper said. He said he will consult public health experts, look at data and modeling and talk to business leaders.
“We know that we have to cushion the economic blow of this crisis,” Cooper said. “So we’ll look at all of those factors in the coming weeks,” he said, and what kind of interventions are needed in May and beyond.
Cooper’s statewide stay at home order followed some local orders, including Wake County and Durham, that started a few days earlier. Cooper said that residents should follow whichever order is more strict. Since then, some cities and counties have issued nightly curfews.
Cooper’s order went into effect the same day as orders in Virginia, which has a Democratic governor, and Maryland, which has a Republican governor. Governors of Florida, Georgia and South Carolina have been slower to put restrictions in place.
Staff writer Carli Brosseau contributed to this report.
This story was originally published April 8, 2020 at 3:18 PM with the headline "60 infected, two dead after coronavirus outbreak at Orange County nursing home."
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