The emotion is raw. The human toll is immeasurable.
Nearly 12 months to the day since the first case of coronavirus in a Colorado nursing home showed up at North Shore Health & Rehab Facility, few involved with the yearlong battle say they’ll ever be the same.
Three outbreaks, 204 cases, 19 dead.
The early days of the outbreak at the 200-bed Loveland nursing home were chaotic and frustrating as the deadly and highly contagious virus spread into Colorado and Larimer County. Guidelines changed daily, sometimes hourly.
Personal protective equipment was scarce.
The staff was scared.
Residents isolated in their rooms, and human hugs were replaced by FaceTime.
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Terrified families saw loved ones through closed windows — hands pressed against the glass — until temperatures and wildfire smoke abated, making outdoor visits possible. Still, no touching was allowed.
North Shore found itself on the front pages of newspapers and on TV as they became the epicenter of long-term care outbreaks in the state.
Days turned to weeks, then months. When one outbreak subsided, another took its place.
The coronavirus hardly spared a long-term care facility. More than 172,000 of the U.S. COVID-19 deaths have been tied to nursing homes, including 41% of deaths in Colorado, according to the New York Times.
In Larimer County, 124 of the 224 COVID-related deaths — 55% — have occurred in nursing homes, assisted living centers or rehab centers.
The road has been long; the burden, heavy.
The onus of being first fell hard on North Shore. They learned — sometimes by trial and error — alongside public health agencies.
“We never thought we’d be first,” said medical director Dr. Rebecca Jackson. “You can’t expect to be excluded from it. I learned over the last year COVID really knows no bounds. It doesn’t care what your 5-star rating is.”
Physicians naturally want to go in and fix something, Jackson said in a telephone interview. But treatments, especially at the beginning, were minimal. “There was not much we could do.
“The lack of control, the sense of helplessness was really challenging,” Jackson said. No one — not nurses, administrators or doctors — had answers for how best to treat this new virus. “As we’ve gone along we … have more tools to treat people. It’s truly a gift to have that more solidified.”
From the first positive case, Columbine Health System, North Shore’s owner, decided to be transparent and went public with the outbreak.
Today the center is outbreak free. Most residents and all employees have been vaccinated, and life is starting to return to normal. Residents are starting to see their families again, albeit 6 feet apart.
“It was super overwhelming,” said Chandler Wittkop, an RN in her first year of nursing. “Every day, CDC was calling and changing things multiple times a day. We didn’t know what we were supposed to be doing.”
In early days of North Shore outbreak, guidance changed daily
COVID-19 showed up at North Shore’s door 10 days after a Kirkland, Washington, nursing home saw the virus explode among its residents.
Jackson remembers the call from North Shore staff citing concerns the virus was in the building. “We got confirmation, then I think we worked 18 days straight, 12 to 15 hours a day,” she said. “We were only 10 days behind Kirkland. The ability to even plan wasn’t there. It was really hard.
“As a country we were grossly underprepared; there was no guidance,” she said. “It was a wild experience. I never could have imagined what it would mean for us.”
Columbine established an emergency operations center; discussions happened across all departments; personal protective equipment became a precious commodity. “It was a moving target every single day,” Jackson said. “It was such a whirlwind to even think back to those days.”
Guidance from the Centers for Disease Control and Prevention and the National Institutes of Health changed daily, sometimes hourly.
“It was frustrating,” Jackson said. “We’d work so hard to get something in place, then it would change.” Some days the guidance “would literally be updated as we were having the conversation as to what guidance to use.”
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Because North Shore was the first long-term care facility in Colorado to see the disease, it had health officials’ undivided attention. CDC, state and local health officials visited and consulted constantly.
The speed was “incredibly hard” for the staff, Jackson said. “Everyone was tired and scared. They didn’t know what they were dealing with, but they came to work and cared for those residents and showed compassion for them and their families.”
Jackson’s medical team worked at North Shore during the first outbreak. When she went to relieve them, “that moment of seeing what a COVID unit was like and how awful it was for the patient. That was eye-opening. That’s stuff I will never forget until the end of my days.”
Staff continued to do their jobs while dealing with their own fears, said Wittkop, who worked at North Shore as a nurse’s assistant before graduating nursing school. “We were getting all this information from the CDC but I didn’t know if I could get it and give it to someone. It was very stressful coming into an environment with so many unknowns and no one having answers.”
The first outbreak was the worst, Wittkop said. “Eventually we were on the news with drones flying over the building, news crews in the parking lot. Being on the front line was scary with no end in sight — no vaccine plan, no treatment.
“Definitely, the worst part was watching (residents) try to fight it,” Wittkop said, her voice wracked with emotion. “Some couldn’t and didn’t make it.”
Yvonne Myers, Columbine’s director of health services, was on vacation in Arizona when she got the call a resident had tested positive.
In constant communication with nursing home staff, Myers got home, put down her suitcases and went to the emergency operations center. “When I got there, people were like, ‘Can you believe we’re first?’ ” she said.
“I was positive about being first,” she said. Myers told the staff, “We will learn about it first and make it right for everyone else. We have to own that space. That would be our role.”
PPE was hard to come by, more expensive
Like most health care providers, personal protective equipment ran short in the early days of the pandemic.
“We were never out of PPE, but we did have to be very creative,” Myers said.
They scoured local hardware stores for N95 masks and goggles. They bought ThermalStrike devices to decontaminate masks in paper bags and boxes to extend their use, per CDC recommendations, and purchased washable gowns.
“As we had never purchased N95s and goggles, we were not in the queue to receive these from our vendors,” Myers said. Hewlett Packard and Ford Motor Company donated face shields. Columbine purchased what it could from its suppliers and got donations from the federal government.
“This made for quite a variety of PPE for staff to use,” Myers said. “Community members and church sewing groups, lifted up for COVID support, donated cloth masks for our residents to use. So many of these were made, we could provide each resident with two to three masks each. One church made cloth head coverings for our infusion nurses.”
With desperately limited supplies, the cost of personal protective equipment skyrocketed.
Masks that once cost about 5 cents each went to 40 cents; gowns went from 30 cents to $2.50. Prices have modulated from those early days but are still higher than pre-pandemic days, Myers said. Masks now cost 10 to 15 cents, gowns and N95 masks about $1, and face shields can be had for $2 each.
“We did not ever have to purchase N95s and face shields before so this is a brand new supply cost for us,” Myers said.
Clinton Dell walked into his new job as North Shore’s administrator three weeks into the pandemic after managing Columbine’s medical supply division in charge of gathering personal protective equipment from vendors.
“We were one of thousands trying to yell the loudest to get our needs met,” he said. “Suppliers only had so much.”
Much of the equipment was being produced in China, which had its own horrific outbreak. “As they shutdown production in China, it put the U.S. in a really bad place with lack of PPE. Suppliers had to decide who got what and how much and had to keep their own stockpiles high enough to provide for the future.”
Dell said he was driving around to local hardware stores every day looking for masks. “It was a mad scramble from all health care across the U.S. to obtain enough PPE.”
The danger of false positives and false negatives
As one outbreak subsided and infection numbers dropped, North Shore collectively breathed easier. They thought they might be through the worst.
From the start, efforts focused on getting their arms around it and getting through it, Dell said. “No one knew when would it end.” By summer it wasn’t as bad as the beginning; outdoor family visits were allowed, numbers were down.
The darkest days came “when we started going into winter months; when people started to realize the worst was ahead of us and COVID was here to stay,” Dell said. “When we lost that nearsighted hope of an end and realized this was almost the new norm, that was a really tough time.”
As North Shore saw a second wave and a staff shortage caused by positive cases, it moved patients to other Columbine facilities for care.
“To see it come back and so bad was disheartening,” Dell said. “To a degree it felt like our efforts had been for naught. As we were learning more about it and how to stop the spread, it felt like we were getting ahold of it, figuring it out.”
Then it exploded, with 114 cases and seven deaths in November.
“It kind of humbled you a little bit and let you know COVID was still here and in charge,” Dell said. “We weren’t done with it yet. Each time we’d get over an outbreak and would think we were past the worst of it, it would come back with a vengeance.”
In January, North Shore saw a dramatic rise in cases, from 38 to 110 in a matter of days. Management struggled to figure out what went wrong. They hadn’t changed health and safety protocol and began to wonder if something was amiss with the state-mandated Curative tests they were using and for which the state was paying.
A high percentage of false negative tests could explain how the virus took hold of so many of North Shore’s staff within a short window of time.
“It didn’t make sense we could have a worse outbreak than in March (2020),” Jackson said. “We were able to contain it during the first outbreak when we knew nothing about it. I felt like I was going crazy.
It’s not that management didn’t believe COVID-19 was present, “but it didn’t make sense it was as big as it was,” she said.
False positives were as big a problem as false negatives. “We need to trust our tests,” Myers said. “If we have a lot of false negatives, we could have asymptomatic people working who are spreading the virus.”
False positives would mean residents got moved to a COVID-19 wing where they would definitely be exposed, and false positives among staff would mean they were quarantined and not working for no reason.
By late January, after Columbine’s management raised issues with the test results and the FDA issued warnings about faulty results, the Colorado Department of Public Health and Environment ordered nursing homes and other facilities to stop using the test.
Testing went back to using Colorado State University’s testing lab, which the state agreed to pay for.
Families place ‘blind trust’ in facilities
Phyllis DeNovellis’ father, Bob, was among those transferred to Columbine West amid North Shore’s staffing shortage. DeNovellis said it’s been tough on the family to not have contact with her father and to trust the facility was doing the right thing.
“As family members we were not in there any more to do any kind of observation,” she said. “We had to go on blind trust. We truly don’t know what’s going on behind closed doors.”
She says her father’s cognition has declined with little socialization during the pandemic.
“We don’t know how long he will be with us, and we’ve had a full year taken away from us,” DeNovellis said.
Although she’s been critical of North Shore at times, she gives them high marks for communicating with the families of residents.
Resident Roberta Ewing, 84, said she never felt afraid because the staff didn’t appear afraid, but being confined to her room was a “little claustrophobic.”
She said she always “kept the rules” and didn’t leave her room even though she missed seeing her friends in the facility. She had a cell phone to talk with family, and there were times she wanted to see them in person. “But I won’t say there was any length of time I was lonely.”
Ewing tested positive for COVID-19 in a test that later turned out to be negative.
She said when the pandemic hit, North Shore was very open. “They told me nursing homes were protecting their residents by shutting the doors to anyone coming in and that we were liable to be confined to our rooms for our own safety.”
Geriatric care always “walks closely with death,” and care providers have a constant conversation about what people want at the end of their days so they can help honor their wishes, Jackson said.
“It was so hard simply because they couldn’t be with their families,” said Jackson, who often sat with residents as they passed. “Often at the end of life they have chaplains, support staff and are surrounded by people who love them. We didn’t have that during those time periods, and it was tremendously difficult.”
Wittkop, who tested positive for COVID-19, said it “blows my mind this happened. The world should have been more prepared. So many people passed from respiratory failure after having COVID. It was hard watching treatments not working and someone going from completely healthy to dying.
“That’s been really hard, especially when I’ve been here 4½ years and have watched people progress and live their lives, then having the virus come in and take them out.”
As vaccine arrives, the lessons remain
It’s still too early to know when COVID-19 will become just a horrible memory, but North Shore’s management and staff say lessons learned during the pandemic will be long-lasting.
It’s changed them personally and professionally.
Jackson said she is just starting to work through the personal toll on herself and her family. Like many health care workers, she changes her clothes and showers before she greets or hugs her two kids.
And the exhaustion is just starting to hit now that there’s some quiet time.
“I think I’ve been in fight or flight mode for the last year,” she said. “Last month I began really staring to process all of the things that happened. Definitely, every time there was an outbreak, I thought, ‘Oh my, I can’t take a moment more.’
“I think I’m feeling it more now because I have time to think about it and come down from everything in the last year,” Jackson said.
If there’s a long-lasting impact on the facility itself, Myers said it would be improvements in infection control. “I’m the queen of infection control,” she said. The proof may be that in the height of flu season, there’s been no flu among residents or staff due to the infection control measures they’ve been taking, such as masks, gowns, hand sanitizer, gloves and hand washing.
Wittkop said she considered leaving nursing. “For a couple months, it was a struggle to come to work. Feeling like you’re not making a difference is hard on a person,” she said.
“We were trying our hardest but nothing was changing. Once the vaccine was introduced, morale has changed. Everyone is a lot happier and there’s some kind of hope out there.”
Pat Ferrier is a senior reporter covering business, health care and growth issues in Northern Colorado. Contact her at firstname.lastname@example.org. Please support her work and that of other Coloradoan journalists by purchasing a subscription today.