HEALTH

Maricopa County passes 1,000 COVID-19 deaths in long-term care facilities

Anne Ryman
Arizona Republic
Pennington Gardens in Chandler is one of nearly 400 long-term care facilities in Maricopa County that has reported cases of COVID-19 since the pandemic began. About one if five long-term care facilities in the state's most populous county have reported at least one or more cases of COVID-19.

Maricopa County marked another grim milestone on Thursday, reporting more than 1,000 COVID-19 deaths among residents of long-term care facilities since the start of the coronavirus pandemic.

The county reports that 1,004 long-term care residents and eight staffers have died. 

The rising death toll comes as COVID-19 hospitalizations are on the decline in the state and as nursing homes and assisted-living facilities have been given the green light to reopen to visitors after being close to outsiders for more than five months. 

Early on, long-term care residents made up 15% of COVID-19 cases and by June nearly 70% of all COVID-19 deaths. Since Arizona's stay-at-home expired at end of May, county officials said long-term care residents have accounted for 2% of all coronavirus cases. They currently make up 33% of all COVID-19 deaths

Maricopa County officials say the most challenging time for long-term care facilities was early in the pandemic when the virus was still a new threat and residents were accounting for a disproportionate share of the COVID-19 cases. 

Dr. Sarah Scott, medical epidemiologist for Maricopa County Department of Public Health, said the county made long-term care facilities a priority early on, providing help with personal protective equipment, testing and information on how to isolate residents. 

Since March, the county has hosted weekly webinars, where long-term care officials can get information and ask questions. 

Scott said these measures — along with state and federal direction that up until this week restricted nearly all visitors — helped keep coronavirus infections "as low as possible."

"I know it felt very strict," she said of the visitor restrictions. "And understandably so, and it was really done to isolate and physically distance our most vulnerable population."

COVID-19 deaths in Maricopa County are shown in this graph. The dark blue bars represent deaths in long-term care facilities. The gray bars are deaths elsewhere. The information is shown by date of death  so the more recent information will likely change as more deaths are identified by date.

How prevalent is the virus?

Long-term care is an umbrella term for care facilities. In Maricopa County's COVID-19 statistics it includes about 1,800 facilities in three main categories: skilled nursing homes, assisted living and hospice. 

Just how common is the coronavirus?

About one in five of these facilities has reported at least one or more cases of COVID-19. 

More than half the facilities that have reported cases have been able to go 28 days  — the equivalent of roughly two coronavirus incubation periods — with no reoccurring cases, Dr. Scott said.

County officials said some long-term care facilities have dealt with more than one outbreak, but they did not have numbers on how many.

The county has declined to name the facilities with coronavirus cases, citing state privacy concerning infectious diseases. 

But several of the largest and most well-known senior communities have confirmed outbreaks, including Glencroft Center for Modern Aging in Glendale, Friendship Village in Tempe and Beatitudes Campus in Phoenix.

July and August appear to have been the most deadly months for reported deaths, with more than 250 deaths reported in each of those months. But some of the deaths may have occurred earlier because it can take several weeks for a death to be confirmed as related to COVID-19. 

The deadliest days for deaths in long-term care facilities so far are July 4 with 21 deaths and July 23 with 17 deaths, though this could changes as more deaths related to COVID-19 are categorized by date of death. 

In Maricopa County alone, 3,726 residents and 2,092 staffers have been infected as of Thursday. 

Managers of long-term care facilities said staff are doing the best they can given the difficulties the pandemic has created. 

"All of us have figured out a way to live in this sort of state of high alert," said Donna Taylor, chief operating officer of LifeStream Complete Senior Living in the West Valley. LifeStream has four nonprofit senior communities in Youngtown, Surprise, Glendale and Phoenix with 600 residents and 400 employees. 

Taylor said there is consensus that the coronavirus is going to be here for a while so "let's figure out a way to live with it." 

Since the start of the pandemic, LifeStream has identified 16 COVID-19 cases among residents and 40 cases among staffers. 

"Sadly, we have lost three of our residents to COVID- related deaths," she said. "All had other significant health conditions, but we still felt their losses deeply."

DAILY COVID-19 UPDATE:  Arizona reports higher number of new COVID-19 cases, at nearly 1,100, and 65 new known deaths

More than 70,600 deaths across U.S.

Long-term care facilities around the country have been hard hit by COVID-19, the respiratory disease caused by the new coronavirus.

More than 70,600 deaths have been reported in U.S. long-term care facilities as of mid-August, according to the nonprofit Kaiser Family Foundation, accounting for about 43% of all COVID-related deaths nationwide. 

The threat is especially acute in nursing homes, where residents often share rooms and are cared for by the same staff, putting them at higher risk of contracting the highly infectious virus than the general population. Many patients are over 65 and have chronic medical conditions, making them vulnerable to complications if they become infected. 

Early on, long-term care facilities struggled to obtain enough COVID-19 tests for residents and staff. Rather than prioritizing tests for long-term care residents and staff, the Centers for Disease Control and Prevention gave priority to those with symptoms. This made infections difficult to control because of the prevalence in asymptomatic residents and staff, known as the so-called "silent spreaders."

A state-led "surge" testing of all residents and staff in the state's nearly 150 skilled nursing homes began in May but took longer than planned

Even when testing became more available, a backlog of tests in Arizona resulted in long turnaround times of up to 14 days. This meant asymptomatic staff could be on the job and working, without knowing they had the virus, for several days. 

Long-term care managers say testing turnaround times have improved in recent weeks. But they said it's still not possible to get all test results back within 48 hours — which is what is now required in Maricopa County for visitors who want to schedule time to see loved ones. 

Taylor, the COO of LifeStream Complete Senior Living, predicts long-term care facilities will see an uptick in cases as visitors return and more people come into the buildings. But allowing visitors is absolutely the right thing to do, she said.

"The risk of not welcoming our families back is just unacceptable," she said. 

For more than five months, families have had to stay in touch with loved ones through telephone or video chats, as nearly all visits have been prohibited to protect residents. 

Taylor said she is seeing more depression among residents. Patients with dementia are talking less and not eating as much. More residents are complaining of being in pain. 

"They are just lonely," she said. "Our staff does its best to fill the gap, but they miss their family."

In-person visits recently got approval to resume after the Arizona Department of Health Services in late August approved guidelines to resume visits. One way to assure a visit is to test negative for COVID-19 within 48 hours of the visit. 

Reach the reporter at anne.ryman@arizonarepublic.com or 602-444-8072. Follow her on Twitter @anneryman.

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