29 Deaths Later, Mary Wade Recovers

An asymptomatic healthcare worker. A bathroom shared by seniors. And wavering national public health guidance in the early weeks of the pandemic.

Mary Wade Home administrators and New Haven’s top health official pointed to those three factors as the likely reasons for why the Fair Haven nursing home has suffered the most fatal Covid-19 outbreak so far of any elderly care facility in the city.

According to the latest weekly Covid-19 nursing home impact report put out by the state Department of Public Health and the federal Centers for Medicare and Medicaid Services, as of July 28, Mary Wade Home has seen a cumulative total of 61 Covid-19 cases and 29 related fatalities among residents in its 94-bed facility.

That’s double the number of fatalities of the next hardest hit local nursing home, Advanced Center for Nursing & Rehabilitation in the Hill, which has seen 14 Covid-related deaths and 106 confirmed cases among residents in its 226-bed facility.

RegalCare in Fair Haven Heights has had seven Covid-related fatalities and 51 confirmed cases among residents in its 150-bed facility. And Yale’s Grimes Health Center in Dwight has had three Covid-related deaths and 57 confirmed cases among residents in its 114-bed facility.

In interviews with the Independent Tuesday afternoon, Mary Wade Home Executive Director Stan DeCosta, Mary Wade Home CEO David Hunter, and city Health Director Maritza Bond all stressed that the Fair Haven nursing home has successfully implemented mass testing — in partnership with Fair Haven Community Health Care — and other infection control protocols over the past three-plus months to protect its residents from the novel coronavirus.

The state and federal impact reports show that Mary Wade has had only six new Covid-19 cases and one new related fatality among residents since the last week of May.

DeCosta said, and the state data bear out, that Mary Wade has not reported a single new positive case in well over a month.

“Teams from Connecticut DPH and National Guard have inspected Mary Wade six times so far as part of focused infection control surveys between April and July,” state DPH spokesperson Av Harris told the Independent by email. ​“Our teams focused on infection control practices, staffing levels and training, and availability and use of personal protective equipment (PPE) among other things. Throughout each of these visits, DPH inspection teams saw no findings of non-compliance with state or federal regulations.”

Bond added that the local health department currently checks in with Mary Wade’s infection control staff twice a week.

She, DeCosta, and Hunter credited regular point prevalence surveys (PPS)—that is, mass testing of all of the facility’s residents over the course of a single day — as turning the tide in early May in the nursing home’s attempts to stem the spread of the virus.

“Overall, Mary Wade was responsive and proactive in ensuring the overall safety of their residents,” Bond said. She commended the nursing home for doing ​“an exemplary job in meeting the residents they serve.”

And yet, the state data show that the historic Fair Haven nursing home — which consists of adjacent residential and skilled nursing facilities at 118 Clinton Ave. and is in the process of building a new 84-unit building nearby — has seen by far the largest number of Covid-related deaths of any nursing home in the city. It’s also among the top 25 in the state in terms of related deaths among residents.

In reflecting back on the early days of the pandemic in late March and early April, DeCosta and Hunter described a dangerous and confusing time when the national government provided little guidance on the efficacy of mask-wearing, cohorting, and mass testing of asymptomatic individuals as key to stopping the spread.

“Before there were clear and comprehensive recommendations and understanding from the CDC, it was already spreading,” DeCosta said about the federal Centers for Disease Control and Prevention’s stumbling response to the pandemic.

“I believe the overriding factor in the COVID experience was the inability to manage the virus and its spread since people were asymptomatic,” Hunter added by email. ​“Unfortunately, in March and April, we did not have testing [or] appropriate levels of PPE.”

Harris and Bond said that Mary Wade Home is not the only nursing home in the state — or the country, for that matter — to have seen a devastating stretch of infections and deaths early on in the pandemic. The spread of the virus in such facilities proved all the more lethal as the elderly and immuno-compromised suffer disproportionately adverse health effects from Covid-19.

“Rates of infection in nursing homes are generally related to rates of disease transmission in the communities in which they were located,” Harris wrote. ​“Many Nursing Homes in impacted communities saw high rates of infection in the early Spring.”

The July 28 state report shows that a total of 8,777 Connecticut nursing home residents have tested positive for the virus and 2,849 have died from Covid-19 since the start of the pandemic.

When asked what he believes will be the most important tool for protecting elderly residents at Mary Wade in the coming weeks and months as Connecticut braces for a potential resurgence of the virus this fall, DeCosta said one word: ​“Testing.”

The nursing home needs funding and support and access to frequent, reliable Covid-19 testing that can have results turned around quickly, he said. That will be the most effective means of identifying who has the virus and who needs to quarantine and isolate.

“It’s the asymptomatic healthcare worker that will bring the infection into the nursing home,” DeCosta predicted. Testing is the best way to ensure the virus is stopped at the door.

Asymptomatic Worker; Shared Bathrooms; Mass Testing

DeCosta’s concern about an asymptomatic healthcare worker serving as a potential vector for the virus was not just a matter of speculation on the future.

He said that that is exactly how Mary Wade administrators currently believe entered the Fair Haven nursing home in the first place back in March.

DeCosta said Mary Wade Home stopped all visitations, communal dining, and group activities on March 9. The facility didn’t see its first documented, verified case of Covid-19 among residents until April 2.

“The transmission of Covid most likely came from an asymptomatic healthcare worker,” he said. ​“And we found a large number of our cases were asymptomatic.”

After the facility did its first point prevalence testing on May 6 with the help of Fair Haven Community Health Care, he said, 35 asymptomatic residents and 15 asymptomatic employees all tested as positive for Covid-19.

As for how the virus spread once it had entered Mary Wade, Bond said the culprit was likely a shared bathroom in the Fair Haven nursing home’s residential facility.

“They initially experienced a large number of exposures of COVID-19 in their Boardman residential facility,” she wrote. ​“This was likely linked to a shared, communal bathroom setting in the facility. This was before there were clear and comprehensive recommendations and understanding from the CDC of the infectivity, incubation, and infectious period of COVID individuals.”

DeCosta said that the Boardman residence does indeed have communal bathrooms, and that many of the residents were sharing bathrooms early in the pandemic.

He said that ​“cohorting” residents — or separating those who have tested positive for the virus, even if they are asymptomatic, from those who have not tested positive — proved to be an effective means of stopping the spread.

He said that guidance about cohorting only came in early April, at roughly the same time that the CDC started recommending the use of face masks as a means of preventing the spread of infections.

Mary Wade wasn’t able to do its first comprehensive point prevalence testing until early May. Cohorting is difficult to accomplish without an accurate understanding of who has the virus and who doesn’t, DeCosta said.

In the intervening months, the facility has managed to keep its number of infections — and related fatalities — at a near standstill. Bond and Harris said that state and local health officials held conference calls with Mary Wade administrators in April and May about the latest CDC infection control guidance and about strategies for cohorting residents who were positive.

“When done effectively, mass testing of residents and subsequent cohorting can slow the spread of COVID-19 among nursing home residents. This likely accounts for the drop in cases seen in May and June,” said Harris.

A surprise visit by state inspectors at the end of May found no deficiencies in the local nursing home’s infection control program, according to a May 20 state report.

DeCosta said that Mary Wade has been so successful at stemming the spread of the disease that it’s lost the ability to tap into state funding for testing.

“They placed us on a pause,” he said. ​“The state is no longer financially supporting” testing at the site because Mary Wade has gone more than two weeks without reporting any new positive cases. He said that two-week threshold of no new cases currently determines whether or not a nursing home facility can get funding for testing.

He said Mary Wade Home’s latest set of comprehensive tests of residents facility-wide were done on July 22.

“Once we began testing, we were and continue to be successful in controlling the spread,” Hunter said. ​“So testing is only part of the treatment to control the virus, proper PPE and appropriate use of PPE is also key. This continues to be the key to managing COVID.”

In a press release put out by Mary Wade in response to the Independent’s questions about what caused such a fatal outbreak early on and what the nursing home has done since then to protect residents, Hunter said the Fair Haven nursing home is well prepared now — and going forward — to keep its residents and staff safe.

“What we have learned is that if the virus is in the community, that it will eventually make its way to Mary Wade,” he’s quoted as saying in the release.

“That is why we continue to be extremely cautious, adhere strictly to the recommended guidelines and policies and stay vigilant. We are committed to protecting and caring for our residents and staff and, based on what we’ve learned in the last few months, we stand ready to meet the challenges ahead.”