COVID-19. (Image courtesy CDC)

Public Health says they were wrong over Regency outbreak, cites data error

Regency reported cases on Nov. 10, but Public Health didn’t register it due to a data error.

Update:

A data entry error led Seattle & King County Public Health to state that Regency North Bend did not report its cases for nearly week, after discovering coronavirus cases in early November. This is incorrect, said James Lewis, medical epidemiologist for Public Health.

Lewis said, on Dec. 11, that the initial report that Regency filed with Public Health on Nov. 10 — when it first found a positive test — was not entered correctly and did not show up while he was providing information for this story on Dec. 10.

Regency North Bend did in fact report the case to Public Health and the Washington State Department of Health on Nov. 10, and began immediately testing staff and residents.

The data entry error did however delay Public Health’s response, and they did not follow up with Regency until Nov. 17, Lewis said.

Regency North Bend Administrator Adam Dold said staff has “worked tirelessly” to help protect patients and residents. They also reported the positive case within an hour to Public Health, Dold said.

Dold issued the following statement on Dec. 11:

“As a licensed skilled nursing facility, Regency North Bend was required to conduct routine COVID-19 testing based on the King County positivity rate. In early November, that county rate was below 5% and the recommendation was that the facility conduct routine staff testing on a monthly basis. We fully complied with the direction we received from the county Health Department.

Weekly testing was not required at the time and the facility had sufficient resources to meet its obligations. The facility was proactive in conducting both routine testing and doing rapid testing if any resident or staff member presented any potential symptoms. On Nov. 10 a staff member complained of symptoms that could indicate COVID. The facility required that the person be immediately tested. The rapid test used tested positive and the staff member did not return to the facility. The facility immediately reported the positive case to Residential Care Services and to King County Health Department.

Following receipt of our initial report on the 10th, the Health department required a red cap form to be submitted, which was done on that same day and a representative from the health department called the Director of Nursing Services that night. The facility remained in close contact with the Health Department throughout the entire outbreak and worked closely with the DOH and RCS to ensure that all measures were being taken to contain the spread and protect both the residents and staff. We initiated testing protocols for all residents and staff, a process that continues in order to remain proactive in determining the spread of COVID among residents and staff.

The facility continues to work closely with residents, staff and family members to keep everyone informed and supported, and to ensure that appropriate care interventions and preventive measures were being taken at all times. As we are all aware, this virus is extremely contagious and has a devastating effect on the Nursing Home population. The facility staff worked tirelessly, in extremely difficult circumstances, to take care of their precious residents. The loss of some of our long term residents to this disease has been heartbreaking for all those that had tried so hard to protect them. Regency North Bend had kept the virus out of the facility successfully for 9 months through this pandemic.

Unfortunately, with the rise in community spread, our facility experienced this tragedy first hand.”

————-

The original story below appeared on Dec. 10 and contains significant errors provided to this paper by Seattle & King County Public Health. In a follow-up call on Dec. 11, Public Health said Regency had in fact contacted them on Nov. 10, the day they discovered they had cases.

Regency North Bend waited nearly a week to inform King County’s public health authority that the facility had positive COVID-19 cases, according to Seattle and King County Public Health.

On Nov. 11, staff at the rehabilitation and nursing center learned that there were coronavirus cases at the facility. But staff did not inform Seattle & King County Public Health immediately, the agency said.

It wasn’t until six days later, on Nov. 17, after Public Health analytics teams noticed a cluster of cases tied to the facility’s address, garnered during COVID-19 tests, that Regency North Bend alerted authorities to the outbreak.

In a written statement provided to this newspaper by Regency North Bend on Dec. 9, Administrator Adam Dold said they “immediately implemented treatment plans in coordination with their physicians to care for any identified positive residents using all appropriate treatment protocols to address this challenging and highly contagious disease.”

This reporter repeatedly requested additional comment from Regency North Bend on Dec. 10, with questions about when they reported the postive cases to Public Health. But no response was given.

On the Snoqualmie Valley Record Facebook page, Adam Dold, the administrator of the nusring home said “This is false. The reporting time was 46 (minutes). Not six days. It’s unfortunate that things like this get reported without actual facts.”

James Lewis, medical epidemiologist for Seattle & King County Public Health said his agency reached out to the facility on Nov. 17, and that they received a call from Regency North Bend on the same day. He doesn’t know who called first.

Long-term care facilities are supposed to report cases to Public Health as soon as possible. If results come in late in the day, some facilities choose to either report after hours, or the next business day. King County requires long-term care facilities to report outbreaks if one resident or staff member test positive, or if two or more staff or residents are experiencing COVID-like symptoms.

But Regency North Bend waited six days before contacting Public Health, Lewis said.

And it was another six days — on Nov. 23 — before Public Health was able to schedule a virtual meeting with staff at Regency North Bend.

Lewis said Public Health reached out numerous times, but due to illness among staff at Regency North Bend, they weren’t provided a contact to arrange a meeting with. By this time, 23 of the 44 residents had already tested positive for COVID-19, and roughly half of the staff as well. And Public Health launched an investigation into the outbreak.

On Nov. 23, Public Health conducted a virtual meeting between Regency North Bend staff and Public Health staff. Two days later, on Nov. 25, Public Health along with the Washington State Department of Health did an on-site inspection and issued recommendations, Lewis said.

By Dec. 1, four residents of the facility had died.

And by Dec. 10 the number of dead had doubled, to eight — nearly 20% of all residents. Lewis said 37 residents, and 31 staff, had tested positive, a slightly lower number than previously provided by Public Health.

It’s not clear how the outbreak started. Establishing chains of infection is difficult with COVID-19, Lewis said, but the investigation did not turn up any visitors to the facility that could have brought the virus into the facility.

“It almost certainly is due in some part to asymptomatic staff coming in to work,” he said.

Coronavirus cases have been increasing across King County since mid-September, according to the King County COVID-19 dashboard.

On Nov. 11 when the first positive cases were discovered by Regency North Bend, King County was operating under loosened restrictions on long-term care facilities, announced in late summer. This allowed for more group activities in these facilities, although it’s not known if Regency was holding any of these.

As cases continued to climb across the county and Washington state in November, Inslee announced further restrictions. On Nov. 25, Seattle & King County Public Health also issued a recommendation that all long-term care facilities move back to the more restrictive Phase 1 guidance.

And at the time Regency North Bend discovered its positive cases on Nov. 11, it was only required to test once a month, instead of weekly. Lewis said the facility was only testing their residents and staff monthly due to “resource constraints.” Public Health issued guidance on Nov. 18 directing long-term care facilities to begin testing weekly.

“Weekly testing, or even more frequent than weekly testing is a really good idea,” Lewis said.

Because more than half of residents tested positive for the coronavirus by Nov. 23, Lewis said those who were positive earlier in the outbreak were likely out of the window for developing severe complications. The last patients to test positive did so on Dec. 1, so the remainder of the COVID-positive residents should be exiting the risk window as well.

The outbreak conjures images of the LifeCare Center in Kirkland, which saw the first documented outbreak of coronavirus in the U.S. In total, 35 people connected to that much larger facility died. But being the first outbreak, it left public health and facility staff scrambling.

In the ensuing nine months, protocols have been developed for reporting coronavirus cases and outbreaks at long-term care facilities, which often have a high concentration of elderly patients, or those with underlying medical conditions that make them more vulnerable to severe complications from the virus.

It is unclear why Regency North Bend did not report the outbreak when it learned of positive cases connected to it. This report will be updated when more information becomes available.


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