Ventilation at long-term care facilities with COVID-19 scrutinized

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Dr. Benjamin Chan speaks at Tuesday’s news conference in Concord with Gov. Chris Sununu behind him. Photo/Paula Tracy

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CONCORD, NH – An investigation has begun into ventilation systems at long-term care facilities that have suffered outbreaks of COVID-19, officials said at Gov. Chris Sununu’s news conference Tuesday.

Lori Shibinette, the state director of the Department of Health and Human Services, said as concerns for possible spread of COVID-19 through the air increase, the state hopes to look at whether there are similarities in the HVAC systems at the long-term care facilities which have had more than three cases of the coronavirus constituting an “outbreak.”

The two-week study began on Monday and it may lead to suggestions for changing those HVAC systems and others, she said.
If so, there could be federal funds spent to help fix the problems, Shibinette said.

There have been 28 long-term care facilities that have suffered more than three cases of the coronavirus and now there are four, she said. All of their HVAC systems will be analyzed.

She announced that the state has closed out a “significant” outbreak at the Hillsborough County Nursing Home but added a new facility in Bedford to the list, Ridgewood Genesis with nine people including seven staff testing positive.

The state’s epidemiologist, Dr. Benjamin Chan, said the nation continues to experience a surge of the virus, overall with approximately 1 million new infections reported every couple of weeks.

While New Hampshire and New England have not seen the large surges, he conceded that the state’s numbers continue to creep up. “Our numbers have increased a small amount and we are watching this carefully,” Chan said.

On Tuesday, he announced 59 new people testing positive for COVID-19 totaling 6,500 since the beginning of the outbreak. One new hospitalization was reported for a total of 690 cases and there were no new deaths to report Tuesday.

However, 409 people have died in New Hampshire from the respiratory virus, a majority of which were elderly who lived in long-term care facilities.

A majority of the cases and the outbreaks have occurred in the southern part of the state with more than 70 percent in Hillsborough and Rockingham counties. But the state is still seeing a low overall positivity rate among those being tested, remaining at between 1 and 1.5 percent of the overall number of tested.

Another factor, hospitalizations remain stable and low and we are not reaching surge capacity, Chan said.

Contact tracing is one tool used to interrupt transmission, but Chan asked everyone to do their part by washing their hands frequently, staying six feet from people in public and wearing cloth face coverings and “we need people to stay at home if they are sick and get tested,” Chan said.

Education Support

For those who have financial barriers to school, Sununu announced additional assistance on Tuesday.

He said he would allocate $8 million from the federal CARES Act to help with the UNIQUE scholarship program for college students. It will be expanded temporarily due to pandemic to allow up to 3,000 students to get an increase in college funds.

“We know COVID-19 has caused financial hardships and those families are trying to make their next steps. We want to make sure that the state is doing everything it can to stand up and help them,” he said.

Another announcement was targeted at helping minorities access K-12 education. He noted minority business owners sent him a letter acknowledging they have been disproportionately impacted by the virus in ways that not only impact health but education.

To help he announced $1.5 million in additional funds for 800 scholarships to private elementary, middle, and high school students from the governor’s emergency relief fund.

Money Left

The state received $1.25 billion from the CARES Act and the governor said approximately $250 million in unallocated funds still exists.
That does not include money that may be in funds that have been unspent, he said, and it doesn’t include a hoped-for reallocation from the federal government.

“We now know a second surge is probably coming and we want to make sure we can provide for that,” Sununu said.

He said funds were created but “we never knew how many would apply and there is quite a list of funds. If for some reason they are not spent, they can lapse back. We should have a better idea by the fall,” on what is unspent.

Sununu noted one area he expects will not reach the fund total is broadband expansion.

He said he expects an announcement next week but he said he does not believe all $50 million will be spent.

“So there is an example of a fund that might lapse. We are not going to waste money,” he said.

What comes out of Washington next is also important, he said. The rumor is there may be more flexibility for what CARES Act funds could be used for.

“It could be a blessing,” Sununu said adding “it would have been nice to set the rules of the game in the beginning.”

He said there will be definitely some money to move around and there may be new rounds of existing funds.

New Hampshire was one of the only states in the country to offer a Main Street Relief fund and more than $340 million went out to help bail out small businesses from the CARES Act, Sununu said.

Another $25 million went to the self-employed in the first round of SELF fund allocations and more may be sent out this week. The third piece for businesses, the GAP Fund, for those who didn’t meet qualifications for those other funds, has about $30 million to be allocated by the state Business Finance Authority.

“Will we have more GAP funds? I hope so,” Sununu said because there is more need. “I also think as we go through the fall, as the dust settles, some might find they are not doing as well as they thought.”

He noted hotel and restaurant and retail franchises have suffered under their corporate parents in particular.

“I am shocked they are not getting more help from their parent companies. I feel terrible for some,” Sununu said, noting the programs they have set up have not focused on helping franchises.

“They should be investing in their franchises,” he said.

But he said there may be an option to do that down the road.

“We really have to see how big the surge is when it comes,” Sununu said, but he did not preclude the concept of helping them down the road.

HVAC Systems

Shibinette said there are emergent signs to suggest the virus could be airborne for some time and that respiratory droplets could travel through the air farther and longer than first thought.

“We are trying to stay ahead of these issues,” Shibinette said. A great tool to mitigate those risks going forward is to better understand ventilation systems – or HVAC- and the part they may or may not play.

Shibinette said they will take the information learned from HVAC systems in long-term care facilities where there have been outbreaks and apply it to other facilities. She did not indicate whether that information might also be used in schools, which will open soon.

“Our knowledge of the virus has just evolved,” Shibinette said when asked why this was not done earlier. She noted the surprise to find asymptomatic transmission spread earlier in these facilities. That led to more testing of staff and residents which is ongoing.

In the last few weeks, she said, there has been probably more discussion about how long droplets are suspended in the air.
Surface transmission is not as big an issue now as it was first considered, she noted.

“In some facilities, we saw some high attack rates,” Shibinette said. “We don’t know what is contributing to COVID-19 within these facilities so we are looking at anything we can,” she said. “We are leaving no stone unturned.”

Hillsborough County Nursing home saw 158 residents in its 300-bed facility test positive to COVID-19 on June 14 and 21 died.
In March, two residents tested positive and within two days, the number of residents testing positive soared to 34.

On Tuesday, Hillsborough County Nursing Home was taken off the list of outbreaks in cases having gone at least 14 days without a new case.
Sununu said the overall number of cases in the state are going up and down with every passing day, noting that on Monday, there were only 7 cases reported and 59 on Tuesday.

Part of that has to do with batches of cases being reported at the same time along with sentinel testing. He told the public not to be concerned or too relieved from day-to-day.

“We are doing a deep dive on our numbers,” Sununu said, noting that the new cases are averaging about 30 a day, “I think over time we will see waves and troughs.”

He noted that there are about 650 active cases in the state but they are concentrated in about 17 or 18 communities. He said in the entire state, few communities have more than five cases.

Mask and Vaccine

It is not anticipated there would be any mandatory vaccine required in the state once one becomes available, Sununu said, and he again said no to a statewide mandatory mask order.

Sununu said the number of people wearing masks in the past two weeks has skyrocketed and a number of businesses have begun to require them. He gave examples of states with mandatory mask ordinances that are still seeing increased cases including California, Washington, and Oregon.

“It is not an end-all, be-all,” Sununu said, and he noted it is not enforceable.

He also said he thinks people are not washing their hands as much as they used to and during the press conference, he challenged the public to wash their hands at least four times before they go to bed on Tuesday.

Veteran Support

A recent study by the Woodruff Foundation on the impact of the pandemic on veterans included reports of isolation and bad outcomes for those with preexisting conditions.

About $7 million was announced last month to help with veteran homelessness, mental health support, and Tuesday, the state was opening up the application process for the organizations that support veterans, allowing for $3 million to become available for employment support, transportation, and other programs often offered by Legions and VFW Posts.

The application process will run through Aug. 10 and details are at goferr.nh.gov.
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About this Author

Paula Tracy

Veteran reporter Paula Tracy writes for InDepthNH.org