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Coronavirus in Texas

Coronavirus outbreak at Texas City nursing home follows cluster of patients at San Antonio facility

Officials in both regions are tracking the movements of nursing home staffers, many of whom work at multiple facilities.

A test tube with 2019-nCoV on the label on January 29, 2020.

A second large group of Texas nursing home patients and staff have tested positive for the new coronavirus.

Eighty-three residents and staff at The Resort in Texas City tested positive for the virus, Galveston County Health District officials announced Friday. That came less than a day after San Antonio officials announced that 67 out of 84 patients at the Southeast Nursing and Rehabilitation Center had been infected.

One of the San Antonio patients has died. A few of the Texas City patients who tested positive have been hospitalized, said Dr. Philip Keiser of the Galveston County Local Health Authority at a press conference Friday. Keiser declined to disclose how many of the 83 people who have tested positive are residents and how many are staff.

Keiser believes the cause of the Texas City cluster is that workers contracted the coronavirus and then went into work. San Antonio area officials are now also scrambling to track down Southeast staffers who worked at other facilities.

"One of the things that we're learning about this virus is that there are a lot more asymptomatic cases out there than anybody ever dreamed of," Keiser said. "I just view it as bad luck on their part."

Multiple other long-term care facilities in Galveston County are also reporting confirmed cases, but these are in the low single digits, Keiser said. However, many of the workers at these facilities work part-time at multiple facilities.

Keiser is issuing an order that, among other things, will mandate that those working at a facility that has reported a confirmed COVID-19 case will be prohibited from working at multiple facilities.

"We’re trying to get to everyone," Keiser said. "We’re also planning on looking at the facilities that have cases and discussing the possibility of doing widespread testing."

The latest group of residents testing positive comes on the heels of 13 people previously receiving such results, spurring widespread testing of 146 residents and staff at The Resort. Some residents refused testing or were unable to receive tests, but Keiser said these people are being treated as if they tested positive. About a dozen results are still pending, he added.

"It's shocking," Keiser said. "And we're very worried."

The first reported positive case came less than a week ago, on March 28. The Galveston County Health District has been in contact with local hospitals to notify them of estimates of how many cases might require hospitalization.

Residents who have tested positive at The Resort will be quarantined in a separate hallway from everyone else. Keiser also affirmed guidelines from Centers for Disease Control and Prevention to wear masks in public.

Keiser is issuing an order that will require all long-term care facilities — including nursing homes and assisted living centers — confirmed cases of COVID-19 to notify family members and put a sign on the front door to notify the public. Residents at these facilities can only be taken outside for emergency medical care or to receive dialysis, Keiser said. The order models one issued in Dallas County that took effect two days ago.

Another cluster of people testing positive emerged Thursday at the San Antonio nursing home, when the vast majority of Southeast Nursing and Rehabilitation Center residents tested positive for the coronavirus, according to city officials.

"In case anyone in San Antonio needed a wake-up call about the seriousness of COVID-19 to our community, this is it," San Antonio Mayor Ron Nirenberg said during a news conference Friday morning. "COVID-19 is alarmingly contagious and very insidious."

He added that San Antonio and Bexar County emergency response officials were "launching a multi-agency, multilayered, aggressive response" to the outbreak at the Southeast Nursing and Rehabilitation Center, with an urgent focus on its staff.

The nursing home has 60 staffers, and eight have already tested positive and are in self-isolation at home, Nirenberg said. The city is moving to contact and test the remaining staffers.

"Of the eight staff members who are COVID-positive, we know that two of them worked in other facilities," said San Antonio Fire Chief Charles Hood. "And the staff members who have not yet been tested — we know that they have worked in at least seven facilities in this city. That number is going to grow as we interview more staff members."

Of those 52 remaining workers, Nirenberg said seven were tested Thursday, 17 are set to be tested today and the city is trying to reach 28 others. The city has dispatched teams to the seven facilities that Hood referenced to test patients and staff at each place who show symptoms.

To crack down on the potential spread of the virus by such staffers, Nirenberg said he was amending his public health emergency order to "prohibit nursing-home staff from working in multiple facilities."

Hood said the city did not become aware that workers at Southeast Nursing and Rehabilitation Center shuttled between other facilities until his department started receiving an increase in calls from the location related to the coronavirus.

"There is a lack of uniformity with regulations related to nursing homes nationwide, and what we have determined is that — actually, though this process — that we have … people working in multiple facilities," Nirenberg said. "When we discover that, we want to cut that loophole off immediately. But in terms of guidance for orders that prevent this kind of thing, there’s nothing nationally that we’ve been able to be guided by, so we’re gonna create hose safety valves here."

San Antonio-area officials are also monitoring 17 patients who have not tested positive. Of those 17, 11 tested negative and are being kept in a separate part of the building and not sharing staff with the infected residents, Nirenberg said. The remaining six tests are pending or inconclusive.

The San Antonio Express-News reported Wednesday that the nursing home has a troubled history, including a citation last year for failing to maintain an infection control program.

"We have been undergoing … obviously a contact investigation," Nirenberg said Thursday, referring to the practice of identifying and following up with those who have come in contact with infected people. "Right now we’ve obviously learned about previous inspections and violations, so I’m confident that those conversations and research will continue."

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