A fourth resident of Canterbury Rehabilitation & Healthcare has died of COVID-19, this time at the skilled nursing care center in western Henrico County.
Three previous deaths caused by the coronavirus disease occurred in local hospitals, but Dr. James Wright, chief medical officer at Canterbury, said the 75-year-old man died Thursday morning at the facility after the family requested that he not be transported to a hospital.
“The family opted for comfort care,” Wright said Thursday.
The center currently has 13 confirmed cases of COVID-19, in addition to the four who died this week from the disease. The facility is treating 11 confirmed cases at the center and two others have been hospitalized. Six health care workers at the facility also have been confirmed to have COVID-19.
More than 20 other residents are showing symptoms of the disease but have not been confirmed infected, Canterbury and public health officials said.
Wright said the center is awaiting test results from GENETWORx, a private lab in Glen Allen that expects to reduce the wait from 10 days to 48 hours.
“We’re expecting quite a bump in the number of confirmed cases,” he said.
Dr. Danny Avula, director of the Richmond and Henrico Health Districts, said Thursday, “The number has continued to climb unfortunately, despite the best efforts of the facility.”
A health department investigation traced the COVID-19 outbreak to a resident who had been admitted to a local hospital nearly two weeks ago with sepsis, an infection that the body has difficulty fighting.
Wright confirmed that a 48-year-old man was taken to a local hospital on March 13 with sepsis from a bladder infection. He was tested and confirmed with COVID at the hospital, even though the patient’s symptoms “did not present like a typical COVID patient,” the medical director said. The man is recovering from his illness.
In a letter to Canterbury on Wednesday, Avula said investigators deduced that the original source of the virus “may have been an ill visitor or staff member” in one unit of the facility, known as the Westham.
The health department team visited the facility March 19, after the first case was confirmed, and again this Wednesday. The team used hospital records to identify the initial “index” case, as well as a second patient who had been hospitalized.
“Although it is not possible to be certain, these paired illnesses, the absence of other hospitalizations or events prior, and the subsequent increase in illnesses and hospitalizations suggest that point of entry for the outbreak may have been an ill visitor or staff member on the Westham unit,” Avula wrote.
Wright previously had thought the initial case was a 55-year-old woman with chronic illness who had been admitted to a local hospital on March 14 with symptoms of COVID-19. One of her roommates had gone to a dental appointment outside the center and she, too, was confirmed with the disease.
“They all came down with the virus at the same time,” he said, adding both patients are recovering from the virus.
Avula outlined the investigation, its conclusions and two dozen recommendations in a five-page letter to Canterbury on Wednesday that credited the facility’s efforts to control the spread of infection, while promising help with concerns about insufficient protective medical supplies, hospital support and interaction with Henrico emergency medical services called to transport patients.
“We are also focusing on staffing concerns where staff may be working at other facilities; given severe staff shortages, asymptomatic exposed staff on quarantine may still work at Canterbury, following [Centers for Disease Control and Prevention] guidelines for such,” he wrote to Wright.
However, the health department is restricting Canterbury staff “from working any other medical, nursing home or high-risk facility during the course of this outbreak.”
Prior to the outbreak, Wright said some staff worked at other facilities, but that became harder after the COVID-19 cases at Canterbury became publicly known.
Avula also addressed concerns about the shortage of protective face masks and other gear for the center’s staff, which are required to use protective clothing in dealing with patients who have been confirmed with the disease or showing symptoms. However, he said in an interview Thursday that the center does not have adequate supplies of protective gear for staff who deal with patients who are not displaying any COVID symptoms but could be carrying the virus.
“The challenge is becoming there likely is an asymptomatic spread of the disease,” he said.
The health department also said it had heard concerns from the center about conflict with Henrico EMS crews over transport of ill patients to hospitals.
“We documented concerns regarding delays in response that may have adversely impacted patient outcomes, as well as regarding reported expectations for the facility to transport a resident to the front lobby for EMS responders,” Avula wrote.
The investigation found that most of the center’s beds “do not have wheels where a resident can easily and quickly be wheeled by staff to the front entrance,” he added. “Untrained transport of an ill patient may pose hazards to the patient as well as potential for additional exposures within the facility in the stand of suspected or confirmed COVID-19.”
Henrico Fire Chief Alec Oughton strongly disputed the finding. “We don’t require anybody to do anything,” he said. “We request it if it’s possible. If it’s not possible, we go in and get the patient.”
Oughton said his EMS crews have responded to 17 calls from the center in 10 days. “We’ve transported everyone we’ve been asked to transport,” he said.
Henrico County Manager John Vithoulkas said Thursday that the county had arranged for a private ambulance company to serve the facility full time. “Everybody has been working overtime on this,” Vithoulkas said.
County officials have participated in conference calls the past two days with Canterbury representatives, public health officials and the leaders of Richmond-area health systems that have assisted the center with needs ranging from staffing to palliative care for ill residents.
In a statement on Thursday, Canterbury Administrator Jeremiah Davis expressed the center’s gratitude “for the outpouring of support from our local, county and state healthcare departments, educational institutions and trade associations.”
“We are heartened by this united effort and hope it will serve as a teaching tool for others,” Davis said in a written statement.
Wright, the medical director, said staffing levels have improved because of the help the center has received, although he added, “We still need more staff.”
“Obviously, it’s a tragic story,” he said.