NC governor tightens coronavirus rules. Orange County nursing home reports 3rd death.

N.C. Gov. Roy Cooper tightened rules for skilled nursing homes this week as more COVID-19 outbreaks in long-term care settings, including the first in Wake County, surfaced across the state.

Skilled nursing facilities must close common areas, require employees to wear face masks, and test residents and employees daily when Cooper’s new executive order takes effect at 5 p.m. Monday. The state already has restricted visitation at nursing homes, except for family members with a dying loved one.

The rules do not apply to continuing care retirement communities, adult homes and assisted-living centers, but they are being encouraged to also follow them.

“We know that transmission of a virus in a nursing home or skilled nursing facility can pass very quickly among the residents, and we need to take a lot of preventive measures to try to prevent the virus from being introduced into these types of settings,” Cooper said.

The N.C. Department of Health and Human Services as of Friday afternoon had reported over 3,900 coronavirus cases and 74 deaths across the state.

There were 23 outbreaks reported in nursing homes as of Friday, including one in Durham County and two in Orange County. Another four outbreaks were reported in residential care facilities, which are not included in the executive order. The state defines an outbreak as two or more positive test results.

One of the latest outbreaks was reported soon after the governor’s announcement in Chatham County, where The Laurels of Chatham, a 140-bed skilled nursing and rehabilitation center, had four people test positive for COVID-19.

Then Thursday night, Wake County announced its first outbreak in a long-term care setting after two nurses and two patients tested positive at Wellington Rehabilitation and Healthcare in Knightdale.

The new rules follow Cooper’s announcing Wednesday that an Orange County nursing home had at least 60 coronavirus cases and two deaths. By Friday, the count there had risen to 86 cases and three deaths.

Orange County officials said Thursday’s announcement of the then-two deaths caught them by surprise. Efforts to get more information about that and related reporting issues from state and local officials left several questions unanswered.

Reporting confusion

Kristin Prelipp, a spokeswoman for the Orange County Health Department, said the county learned about the then-60 COVID-19 cases at PruittHealth-Carolina Point on Wednesday but only learned of the two deaths there when Cooper announced them at a news conference.

“The reason that we didn’t know about (the deaths) is because they were reported to Durham County,” Prelipp said. “The state is the one who alerts the counties that one of their residents has passed or that one of their residents is positive for COVID-19.”

The confusion stems in part from Carolina Point’s location on the Durham-Orange county line, Prelipp said. While Orange County Environmental Health inspects the facility, Durham County works with its nurses, she said.

In addition, each COVID-19 case is reported to the patient’s home county, so if a Durham resident living in an Orange County nursing home is infected or dies, the state reports the case in Durham County, she said.

But, if the two initial deaths were reported to Durham County, that’s not reflected on the state’s website, which as of Friday afternoon showed one death each in Durham and Orange counties. The Durham County death was reported Saturday, and the family of the woman who died told The News & Observer she was not a resident at Carolina Point.

The Department of Health and Human Services did not return emails and phone calls from The News & Observer seeking clarification.

Alecia Smith, a spokeswoman for the Durham County Health Department, said by email Thursday night that her department is working with Orange County and the state “to understand how residence will be determined in the event of COVID-19 deaths of individuals residing in long-term care facilities.”

Without state clarification, it also remained unclear Friday whether the confusion in Orange and Durham counties may be happening elsewhere and whether deaths being reported for one county on the state’s website actually have happened in another county.

Prelipp directed questions about how reporting infections and deaths might affect a county’s ability to track infections to the state Department of Health and Human Services.

Meanwhile, Quintana Stewart, the Orange County health director, said Friday that a third resident at Carolina Point died April 8. The resident was in his or her 70s. The two other residents there died earlier this month, she said, one on April 3, another on April 4.

Nine Carolina Point patients were hospitalized as of Friday, two more than Wednesday.

As of Friday morning, Orange County had 104 coronavirus cases.

Durham County had 259 cases, according to the state’s website.

Orange County outbreak

COVID-19 may have taken root at Carolina Point in mid-March, according to information provided by a company spokesperson and Orange County Health Department news releases.

That’s when the county’s Communicable Diseases team — the county’s health director, medical director and other medical professionals — responded to a request from the facility. A “strike team” from UNC Health Care and Duke University Medical Care then worked with staff to isolate potentially infected patients, teach employees recommended practices and make sure masks, gloves and other protective equipment were being used.

Stewart noted those contacts in an April 2 news release about Carolina Point’s first confirmed case.

“We have been in daily communications with the facility since it became concerned about a resident with respiratory symptoms over two weeks ago,” Stewart said. “Together, we have been monitoring symptomatic residents and testing suspected close contacts as needed.”

When asked whether that meant Orange County knew of potential infections at Carolina Point at least two weeks before the first positive test, Prelipp said she would reach out to the Communicable Diseases team to get an answer.

The state determined who got tested, Prelipp noted, and those guidelines, in the beginning, strictly limited testing.

When the two positive cases were confirmed April 1, the UNC and Duke team returned to Carolina Point, and the company placed the facility under a Code Red order. All residents were tested, a company spokesperson said in an email, although neither Prelipp nor PruittHealth’s spokesperson could confirm exactly when that testing took place.

PruittHealth has notified the residents’ families, the company spokesperson said.

Daughter waits for test results

Durham resident Teala Spitzbarth learned from the news that someone at her father’s nursing home had tested positive for the coronavirus.

She worried about never being able to see him again, she said Thursday.

“Then I had to make a decision. I am just going to pray,” Spitzbarth said. “I am just staying in touch with family and friends, and we are trying to help.”

Her father, 79, has been at PruittHealth-Carolina Point since September, said Spitzbarth, 56. He has been tested for the virus, but she doesn’t know the result yet.

She and her 15-year-old son, Josiah Moore, started making face masks as part of a local church team and recently delivered 150 masks to Carolina Point.

She doesn’t have any concerns about how PruittHealth has handled the situation or with how staff has communicated with her, she said. She sensed that the numbers had jumped significantly when her father was moved to different rooms, away from where residents who had tested positive were being housed.

“I feel like they are doing the best that they can do,” she said.

Nursing homes affected statewide

Both Carolina Point and Signature HealthCARE in Chapel Hill, where another outbreak of initially three cases was reported Wednesday, have been rated as “much below average” by the U.S. Department of Health and Human Services. By Friday, confirmed cases as Signature HeathCARE had risen to 31, with two hospitalizations, Stewart said.

Inspections show problems at both facilities, including one incident last year in which a resident was found in a drainage ditch near Carolina Point early on a cold morning.

Prelipp said Carolina Point was receptive from the beginning to the Communicable Diseases team’s recommendations, telling Stewart that it already had implemented a recommendation “or they were working on it or it was in progress.”

She referred specific questions about what happened at Carolina Point and the residents and staff who were infected to the Communicable Diseases team. The leader of that team has not yet responded to a request through Prelipp for an interview.

It is common knowledge that long-term care facilities would face a higher risk from the virus, Prelipp said. Everyone in a facility can be tested once there are two infected people, she noted.

“It’s an added complication that this is a disease that presents as respiratory accompanied by fever, and you’ve got people in long-term care facilities with many health complications, and we‘re still in flu season, we really still are at this point, pollen season, you name it,” she said. “It’s just so complicated.”

Staff writers Steve Wiseman and Brian Murphy contributed to this story.

This story was originally published April 10, 2020 at 5:30 AM with the headline "NC governor tightens coronavirus rules. Orange County nursing home reports 3rd death.."