SANDWICH – If there’s one piece of advice Willow Crest Nursing Pavilion administrator Zach Ruddle has for other nursing homes, it’s to keep an eye on the future.
“This virus has forever changed how we care for our residents,” Ruddle said. “Every nursing home needs to be vigilant and take all the precautionary measures outlined by local, state and federal health authorities.”
The Sandwich long-term care facility at 515 N. Main St. is the site of the largest ongoing COVID-19 outbreak in the county, with 26 cases of the viral respiratory disease reported in employees and 41 in residents since entering outbreak mode July 1. It's unknown how many of the people at Willow Crest have recovered, because health departments don't report where recoveries are linked.
As of Tuesday, 14 of those residents have lost their lives from complications of the virus, the most recent on Monday, accounting for the most deaths of any long-term care facility in the county, followed by DeKalb's Pine Acres Rehab and Nursing Center's 82 cases and 12 deaths.
In total, deaths of residents at long-term care facilities account for 27 of the county’s 41 COVID-19 deaths.
Inside the outbreak
Emails obtained through the Freedom of Information Act show the facility’s correspondence with DeKalb County Health Department officials after the virus breached the facility, which for months had successfully kept it out.
Ruddle said the facility tried to mitigate the risk of the virus with visitor restrictions, temperature checks and screening tools for staff on top of local, state and federal guidelines. Among his frustrations, he said slow response rates on COVID-19 testing results may have played a role in the virus’ arrival.
“The hardest thing to screen is a COVID-positive staff member who doesn’t exhibit symptoms,” Ruddle said. “These asymptomatic staffers look and act healthy, but they can still spread the virus. That’s how we suspect the virus was brought into our building.”
On June 24, one week before reporting the facility’s first case, Ruddle emailed Stacia Runge, health department coordinator of communicable disease and Kathryn Kovac, clinical team leader at the county health department to say that “all tests from Monday (June 22) came back negative!”
Documents show Ruddle and the health department also used a shared spreadsheet, a symptom log updated by Ruddle frequently to track the arrival of symptoms in residents and employee. Additional information from this log was not available.
While the health department first reported Willow Crest's COVID-19 outbreak July 1, documents show Ruddle was made aware of the first case two days earlier. The health department discontinued daily COVID-19 reporting on weekends and holidays in July.
On June 29, Ruddle informed Kovac and Runge that a resident sent to Northwestern Medicine Kishwaukee Hospital tested positive. He said Willow Crest on that same day completed 115 COVID-19 tests, with the rest scheduled for the next day.
On July 1, the health department reported 10 cases; seven in residents and three in staff.
Measures to mitigate spread
After multiple cases had been reported, documents show Kovac shared with Ruddle a summary July 1 of a phone call, which laid out recommended and already completed steps taken to mitigate further spread.
Included was that all Willow Crest staff, and those who had tested positive, along with their families, were aware of the ongoing cases, and the directive was given to share that information with the remainder of the Willow Crest community, including residents and their families who hadn’t tested positive.
Positive employees and residents were placed in isolation, and contact tracing through the health department was underway, documents show. Negative residents who had positive roommates were moved into single rooms, and the facility laid out a plan to place residents with the disease behind barrier doors on the first level.
The county and Willow Crest also had to track down six residents who had been discharged or transferred since June 1 – four sent home and two who went to other long-term care facilities.
One of those transfers was out of state, although the names of the facilities they transferred to were not mentioned. All six who moved or were discharged were in the process of being notified of possible COVID-19 exposure, according to the email.
Documents show Kovac and Ruddle “discussed notification of funeral homes in the event a positive resident expires.”
Testing and PPE
The first death at Willow Crest was reported by the health department July 6, although documents show Ruddle told health officials July 2.
On July 7, Runge reported receiving results from the facility’s second round of testing, conducted June 30. There were five more positive cases, with two in residents.
By Aug. 28, an email from nurse Michelle Bergeson at the county health department indicated that staff at the facility had begun using rapid testing. She referred Ruddle to an Illinois Department of Public Health webinar from Aug. 7 for information about rapid testing machines.
Ruddle said rapid testing is in use now at the facility whenever there is a suspected case of COVID-19.
“This test isn’t perfect, but it gives us the information we need to immediately quarantine an individual while we await a separate reading from our lab,” Ruddle said. “We feel it has significantly improved our numbers and decreased the spread of this virus. We only wish we had it sooner.”
Emails also show efforts to collect more personal protective equipment in mid-July.
Willow Crest’s Maria Sanchez requested 50 KN95 masks, 100 surgical masks, 200 pairs each of medium and large gloves, and 75 large coveralls, documents show.
Melissa Edwards, health department spokeswoman, said the gloves were in short supply and referred Sanchez to another agency July 14. By Aug. 5, an exchange indicated that all requested supplies had been located.
Another exchange indicated another supply drop on Sept. 2, including 200 extra-large gloves, 100 KN95 masks and 200 surgical masks.
Lack of state, federal support
Three months later, with the outbreak still ongoing, Ruddle said it’s been an uphill battle at the federal and state level for proper support to fight the contagious disease, with support for some of the country’s most vulnerable sorely lacking.
“It took much too long to get the recognition and the support we needed at the beginning of this fight, particularly with respect to PPE and test acquisition,” Ruddle said. “That state and federal guidelines seemed to change every other day also posed a challenge.”
But Ruddle said he appreciated the support and guidance from the DeKalb County Health Department.
“We didn’t have a case until the end of June and the county provided the assistance it could, given the challenges in acquiring testing and the lengthy delays in getting those test results back,” Ruddle said. “Those issues have been prevalent across the country since March, and unfortunately we’re still dealing with them.”
Ruddle said one of the toughest parts is keeping seniors from their loved ones to keep both residents and staff safe.
“One of the most difficult parts has been dealing with the limitations that impact day-to-day life at Willow Crest,” Ruddle said. “Masks make it difficult to see the smiles on the faces of our residents and staff. Visitor restrictions mean families can’t see their loved ones. The bright spot has been the diligent care provided by our hardworking staff. They’ve given everything in the most difficult of environments. I couldn’t be prouder of them.”