Public health officials across the Washington region are scrambling to contain the coronavirus as it makes its way through long-term care facilities.

Thousands of residents and staff of such facilities in D.C., Maryland, and Virginia have contracted the coronavirus and hundreds have died of the disease.

Maryland is several weeks into an experiment sending out “strike teams” to facilities with such outbreaks. The teams are made up of doctors, nurses, and other public health experts. Elder care facilities are an especially thorny public health problem. Residents live close together, and in some cases need daily, in-person care from staff. Many residents have existing health conditions that can make their cases of COVID-19 especially severe.

So far, the “strike teams” have worked with close to 50 different facilities across the state, the majority of which are in the D.C. and Baltimore metropolitan areas with large populations and outbreaks. Maryland Gov. Larry Hogan announced the teams in early April.

Dr. Timothy Chizmar, the medical director of Maryland’s emergency services, is coordinating the strike teams. He says the original goal was to help facilities get ahead of outbreaks.

“We, the hospital systems, and the National Guard kind of jointly said, ‘We need to do something more proactive as opposed to just bringing the requisite number of ambulances when they’re called for,’” Chizmar says.

The teams can help with three different challenges facing facilities: National Guard medics can assess facility needs and triage sick patients, sending those who need more intensive care to the hospital, and stabilizing those who don’t; another group can work with local and state public health departments to increase testing; and doctors and nurses sent from area hospital systems and the federal Department of Health and Human Services’ medical aid teams can provide care to patients.

On Wednesday, Hogan announced that the state would supplement the strike teams with ‘bridge teams’ of nurses and aides to support facilities experiencing a crisis.

The hope, according Chizmar, is to reduce the number of patients from nursing homes winding up in the hospital as much as possible. In some cases hospitalization is unavoidable, but Chizmar says that the strike teams can shore up skilled nursing facilities’ ability to provide care like a fluid IV or extra oxygen. That could free up space in hospitals for patients who can’t receive that care in their own homes.

Strike teams are only deployed when facilities request them through their county health department. That’s happened several times in Montgomery County, according to Enrico Lachica, the clinical health administrator for the county’s health care facilities program.

On March 20, before the strike teams were announced, Montgomery County started assigning a county nurse to facilities with a case of the coronavirus. The nurses help facilities figure out how to tailor infection control guidance from the Centers for Disease Control and Prevention, and other public health authorities, to their specific physical layout. They also act as a liaison between the facility and state epidemiologists as they monitor the outbreak.

“[The nurses] contact the facilities each day to kind of get a sense of if there’s been any changes as far as symptomatic residents, or there have been any positive test results that have come in,” Lachica says. “And then they help the facilities to identify which residents need to be moved to specific units.”

Some outbreaks in Maryland and elsewhere in the region have already resulted in climbing death tolls. At Pleasant View Nursing Home in Mount Airy, almost 30 people have died, and at Canterbury Rehabilitation and Healthcare Center outside of Richmond, the disease killed more than 40.

“The death rate in these facilities, and the lack of PPE and testing for employees and residents of these facilities, is a national disaster,” said Hank Greenberg, the state director of AARP Maryland in an emailed statement.

‘It Really Comes Down To Testing Capacity’

Virginia Gov. Ralph Northam announced the formation of a similar task force dedicated to responding to outbreaks in the state’s long-term care facilities in early April.

The task force is focused on improving testing capacity; shoring up protective gear for care staff; addressing staffing shortages; and making public county-level (though not facility-level) data on outbreaks.

Dr. Laurie Forlano is leading the Virginia task force. She says the group’s most encouraging progress so far has been on the testing front. Public health testing criteria in Virginia currently says that symptomatic individuals living in or about to move into congregate settings can be tested for the virus.

That wouldn’t account for people who are carrying the virus but are not exhibiting symptoms. But Forlano said the task force has put together a team to carry out more extensive testing in facilities experiencing outbreaks.

“We go in and test as many people as possible at one point in time,” she explained. “And that can help get information around the prevalence of a disease in a population.”

Efforts to increase testing are also under way in Maryland. On Wednesday, Maryland Gov. Larry Hogan issued a new executive order, mandating universal testing of residents and staff in long-term care facilities and group homes.

Lachica of Montgomery County thinks widespread testing could be the difference between one case ballooning into a major facility-wide outbreak or staying relatively contained.

“We believe it really comes down to testing capacity,” he said.

Advocates applauded the move, but lamented the lost time.

“We would have like to have had more testing earlier,” AARP Maryland’s Greenberg said. “Testing now is imperative as we move forward.”

D.C. has not set up a dedicated task force for long-term care settings (14 of the 19 facilities in the District have outbreaks).

“Staff from DC Health have contacted long term care providers to inquire about their screening, training of staff and infection control practices as it pertains to the ongoing care of residents,” a spokeswoman for DC Health wrote in an email.

‘A Perfect Storm’ 

Additional resources may have come too late for some facilities, like the Pleasant View Nursing Home, which reported its first few cases of the virus in late March, and the Canterbury Rehabilitation and Healthcare Center.

And even with dedicated teams and task forces, public health officials admit they face a major battle trying to reduce cases in long-term care facilities.

“It’s often a perfect storm, so to speak. These are very vulnerable individuals that are living in these facilities. They often have existing health health conditions. They are obviously of advanced age and they’re all living in a congregate setting. And that combination of things sets one up for disease transmission,” Virginia’s Forlano said.

Timothy Chizmar, the medical director of Maryland’s emergency services, agrees.

“It’s a matter of when, not if, a facility has to deal with it,” he said.

When that day comes, long-term care providers often face staff shortages as workers get sick, too.

Forlano said finding people to fill in those gaps is a major challenge. Her group is connecting facilities who need more staff help to Virginia’s Medical Reserve Corps, but the need is still significant.

“The staffing to me is the hardest nut to crack,” she said.

Montgomery County’s Lachica said the availability of personal protective equipment has hampered response efforts. Ideally, he said, the public health department would like nursing home staff to act as though every resident they treat has COVID-19 and wear a mask, gloves and gown to protect themselves from possible infection.

But that’s not possible right now, Lachica said.

“There simply isn’t enough [equipment] for them to do that,” he said.

Montgomery County has sent nearly 250 shipments of protective gear to long-term care centers so far. There are 303 such facilities in the county.