Younger Americans have been driving the recent coronavirus surge in Texas — but the virus is now also rapidly spreading in the state’s nursing homes, threatening elderly, frail residents who are most at risk of serious illness and death.
Across Texas, nearly 1,000 new infections of nursing home residents were reported in the week ending last Friday, July 10, NBC News found in an analysis of data from the Texas health department. That’s the highest weekly increase since mid-May, when the state began publishing the data, and it reflects record increases last week in the Houston, Dallas-Fort Worth and El Paso regions.
And that is most likely an undercount. Since last Friday, the state has reported more than 1,800 new cases among nursing home residents, in part because a data lag had prevented cases from being counted in the San Antonio area and the southernmost part of the state over the past two weeks, health officials said.
Deaths from the virus are also mounting: 1,173 nursing home residents have died in Texas so far, according to state data — including 224 deaths since July 1.
The rising numbers have alarmed nursing home advocates and family members of residents who worry that facilities may not be able to contain the virus as it spreads in the surrounding community. The greatest fear is that Texas — now one of the biggest coronavirus hot spots in the country — could see mass outbreaks in nursing homes like those that hit the Northeast earlier in the pandemic. More than 6,400 nursing home residents in New York have died from the virus, and more than 6,600 have died in New Jersey.
“We had an opportunity to avoid what we’re experiencing right now,” said Patty Ducayet, Texas’ long-term care ombudsman, an independent watchdog for the state’s nursing homes. “We got this chance to see what other states did, what awful things they were experiencing, so we might be ahead of the crisis. Now I’m bracing for more deaths to come and more cases.”
Deaths typically lag coronavirus infections by weeks, and Texas hit a daily record of overall deaths from the virus last week.
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The largest increase in COVID-19 infections in Texas nursing homes last week was in the Houston region, which had nearly 400 new cases — more than nine times the number of new cases reported in the region during the last week of May.
The western and north central parts of the state also saw sharp increases in infected nursing home residents in early July. The El Paso region had 109 new cases in the week ending last Friday, and the Dallas-Fort Worth region had 287, according to state data — both record increases.
The American Health Care Association, which represents long-term care facilities, warned that rising coronavirus cases — not just in Texas, but across the United States — could have a devastating impact on nursing home residents.
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“With the major spikes of COVID cases in many states across the country, we are very concerned this trend will lead to a dramatic increase in cases in long-term facilities,” the group wrote Tuesday in a letter to the National Governors Association. Nursing homes in Tampa, Florida, Phoenix and other hard-hit areas have also seen a recent rise in cases as the virus has spread in the Sun Belt, according to a Wall Street Journal analysis.
In Texas, Dr. Philip Huang, director of Dallas County Health and Human Services, attributes much of the recent increase to the state’s decision to reopen businesses weeks earlier.
While nursing homes in Texas have remained closed to visitors throughout the pandemic, staff members are constantly cycling between the facilities and the broader community, and some work at multiple facilities. Nursing home residents also may leave their facilities for dialysis or other medical treatment.
“Around Memorial Day, when the governor opened up all these things, they thought everything’s open, go back to normal — including workers in the nursing homes,” Huang said.
The Texas health department did not comment on the state’s reopening policies, but said the state is continuing to investigate all long-term care facilities with one or more positive cases and is working to identify facilities that are in need of testing. Amid the new surge of cases, the state has backtracked on reopening businesses, closing bars and limiting restaurant capacity.
Huang believes that public health officials and facilities are better equipped than they were earlier in the pandemic to detect the virus and ensure that residents receive the appropriate care, citing mobile testing units and a close partnership with the Dallas County’s public hospital system.
In the Houston area, Harris County has assembled a “strike team” to help nursing homes with testing and infection control. Last month, Harris County launched an investigation into Jacinto Nursing & Rehabilitation Center after 12 residents became infected and one died from the virus; the investigation is ongoing. (The facility did not immediately respond to a request for comment.)
However, nursing homes in Texas and across the country are still facing inadequate access to testing and other vital resources, according to industry groups, resident advocates and researchers. “Nursing homes and assisted living communities cannot stop the virus by ourselves — not without testing, personal protective equipment (PPE), staff support and funding,” the American Health Care Association said in its letter Tuesday.
The federal government has been sending shipments of PPE to nursing homes, but they have not included N-95 masks that are sorely needed by some facilities, the American Health Care Association added. And the federal stockpile itself is running thin, according to internal documents obtained by NBC News.
“We have by no means stopped these horrible rates of deaths in nursing homes,” said R. Tamara Konetzka, a public health professor and long-term care expert at the University of Chicago. “We’ve learned these things that now seem completely obvious, but they’re not completely implemented yet.”
In Texas, advocates are currently pushing for greater access to testing with quick turnaround times, which they say is critical given the spread of the virus through asymptomatic staff.
“Unless we get truly rapid response testing, we’re never going to really get a handle on the virus,” said George Linial, president and CEO of LeadingAge Texas, which represents nonprofit nursing homes. “They’d ideally test staff every day and get results in an hour or less. But right now, it’s waiting days and sometimes weeks for test results.”
Last week, Texas Gov. Greg Abbott, a Republican, launched an initiative to provide on-site coronavirus testing for nursing homes and assisted living facilities, with results available the same day, through a partnership with Omnicare and CVS Health. But the testing units will not be permanently installed in the facilities, according to a spokesperson for CVS Health.
And on Tuesday, the federal government announced that it would distribute rapid testing machines to nursing homes “in COVID-19 hotspot geographic areas,” beginning next week, but did not specify which facilities or states would get priority. The devices will be sent to 2,000 nursing homes across the country, according to the American Health Care Association.
The latest COVID-19 surge has distressed family members who have already spent four months separated from their loved ones. In mid-June, Abbott announced that he would soon open nursing homes to visitors, but those plans have since been stalled by the rise in cases.
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Cissy Sanders fears for her 70-year-old mother, who has dementia and lives at Riverside Nursing and Rehabilitation in Austin. In April, the facility had an outbreak that infected dozens of residents but spared her mother, she said.
“When I saw this surge starting to happen last month, I thought, ‘OK, here we go for Round Two,’” Sanders said. “The staff are going to go home, and it’s all going to happen again.”
The facility acknowledged it had COVID-19 cases among staff members and residents in April, but said that it could not comment further because of privacy laws, and that it had no current cases.
Sanders speaks to her mother through FaceTime, with the assistance of a staff member at the nursing home, and comes to the facility for a weekly window visit. It has been a struggle to understand her mother’s speech and body language from a distance, and she worries about the toll of prolonged isolation on her mother’s health. But her primary concern is still the virus itself.
“The biggest emotion that I have is just downright fear,” said Sanders, who has written letters and made calls pleading for health officials to provide more nursing home testing. “I refuse to be one of those family members who is talking to my mother over the phone while she’s in a hospital bed dying.”