Rapid spread of COVID-19 in residential facilities and the case for early testing, quarantine

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Paper hearts are visible in the window at Hanover Hill Health Care Center in Manchester. Photo/Jeffrey Hastings.

MANCHESTER, NH – The city’s health department was unaware that the state Department of Health and Human Services was publicly releasing data detailing the 18 deaths at Hanover Hill Health Care Center until learning about it in the media.

“That’s data we didn’t have,” said Phil Alexakos, public health administrator for the Manchester Health Department, noting it was the first time that the state had released data publicly specifying the number of deaths at individual nursing homes related to COVID-19.

“Once this illness gets into a long-term care facility it spreads extremely rapidly and obviously has devastating consequences.  Our hearts go out to the families of the loved ones who have passed.”

Alexakos said early on in the pandemic public health officials realized how the disease affects different groups of people, particularly elderly residents of a nursing facility.  In February, Life Care Center in Kirkland, Washington, recorded its first death from COVID-19.  By April 2, 37 residents of the long-term care facility had died.

As reported during the May 6 televised press conference with Gov. Chris Sununu, 19 people died Tuesday from COVID-19 and all were residents of long-term care facilities, according to New Hampshire Department of Health and Human Services Commissioner Lori Shibinette. As of Wednesday in New Hampshire, 111 people had succumbed to COVID-19; all but 24 were residents of long-term care facilities.

When someone tests positive for the virus, Manchester and Nashua’s health departments conduct their own investigations while the state health officials cover all other communities.

However, when there is an outbreak or cluster – more than three cases at one facility – the state sends in a team that looks at infection control and initiates worker/resident testing.

Alexakos said the team works to isolate those diagnosed with the disease; separates those who potentially were exposed and closely monitors them; those not exposed are moved to a completely separate area so as not to impact them at all.

Those with close contact are monitored for 14 days with the hope “they don’t develop the disease. But once the virus gets into a long-term care facility what we are seeing not only in New Hampshire but in other states is that it is severe and tragic and a very difficult virus that is extremely infectious.”

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Testing of clients and staff from New Horizons in mid-April. Photo/Jeffrey Hastings

City’s early testing at shelter makes a difference 

Another population that is particularly vulnerable to the disease is the homeless.

Early in the pandemic, a Boston shelter reported that 37 percent of its residents had tested positive for the virus.

So far Manchester has not seen that kind of spread.

Alexakos said since last summer the health department had been working on addressing the growing number of homeless in the city.

FIT/New Horizons spent the better part of the fall and winter working with faith-based partners to open up a surge facility at Hope Tabernacle Church on Cedar Street.

“It really was an exercise in fatality prevention, to be honest,” Alexakos said.

But then the pandemic landed and they pivoted to focus on how to keep the homeless safe.

The city health department, together with the fire department and Catholic Medical Center Healthcare for the Homeless clinic, last month tested 50 staff members of the FIT/New Horizons shelter and 110 residents for the virus.  Fire Chief Dan Goonan said two residents contracted the infection.

Alexakos said they looked at sleeping arrangements and those who were in the infection zone – within six feet of the individual who became infected – were placed in quarantine for 14 days.  None of them contracted the disease, he said.

“There was one other positive in that mass testing group and 14 folks were part of that cohort and none of those tested positive,” he said.  “They eventually went through their quarantine.”

The early testing and quarantine appears to have made the difference.

As of Tuesday, 568 people have tested positive for COVID-19 in the city, a number that has resulted in city public health nurses making between 300 and 500 telephone calls a day trying to reach every individual who came into contact with an infected individual.

The process is called contact tracing, an effort to limit the spread of the disease in the city and elsewhere.

Once contacted, the individual is placed in quarantine for 14 days with a nurse making a daily telephone check.   

That is only one of the jobs the city’s 60-member health department has taken on during this ongoing crisis.

   

About this Author

Pat Grossmith

Pat Grossmith is a freelance reporter.