After the first positive coronavirus test at a Virginia nursing home in mid-March, its administrator said, the staff restricted visitors, conducted temperature checks at the end of every worker’s shift and isolated residents who had tested positive into separate areas.
Even so, there suddenly was another case. Within two weeks, dozens of others inside were falling ill.
Now, about a month after the first case, at least 46 residents are dead at the nursing home, the Canterbury Rehabilitation & Healthcare Center in Richmond — more than a quarter of the facility’s population and one of the highest known death tolls in the United States.
The facility’s medical director, Dr. Jim Wright, said he had asked the state health department how to test a suspected case before the outbreak began. But even as the situation grew dire, it took almost two weeks for all the facility’s residents to be tested for the coronavirus.
“You can’t fight what you can’t see,” Dr. Wright said.
Virginia had only about 300 test kits available in mid-March, said Dr. Danny Avula, the Richmond health director, and to get one at the time, residents of long-term care facilities first needed to test negative for the flu and other respiratory viruses.
“We could have limited the spread in Canterbury had we been able to test more,” he said.
The lack of widespread testing and the difficulty in retaining staff members were additional challenges for the nursing home, where residents, who are older and therefore more vulnerable to the coronavirus, live in close quarters.
The New York Times has tracked hundreds of clusters of coronavirus cases across the country, and the 10 deadliest have been in nursing homes and long-term care centers. More than 21,000 residents and staff members at nursing homes and other long-term-care facilities have contracted the virus, and more than 3,800 have died.
Some involved in the crisis at Canterbury described a nightmarish scenario in which the casualty count climbed as health workers and family members tried to determine whether sick residents should go to hospitals or receive palliative end-of-life care inside the home. More than half of the Canterbury residents who died from the virus did so at the facility.
The nursing home’s first positive test came on March 18, Dr. Wright said, and within days the number of symptomatic patients was climbing fast. One resident who had been sent to a hospital with a bladder infection later tested positive for the virus. Around the same time, another resident developed a high fever and respiratory symptoms.
Still, it took precious time for those in charge to act.
Canterbury requested the Henrico County Health Department’s assistance in testing all residents and employees on March 26. Around that time, a Richmond laboratory gained the ability to start testing, and by March 30, everyone at the facility was finally tested.
The results were frightening.
More than 60 of the 160-some residents tested positive. About 50 of them had no symptoms, though some developed symptoms later.
“We were shocked,” Dr. Wright said. “We thought we had it relatively contained until the results started coming in. And that revealed to us how far behind we were.”
The number of calls to the county fire department about problems at Canterbury also started to climb. Dispatchers asked the facility’s staff members to bring patients into the front lobby, where a paramedic in protective clothing could assess the situation. Some residents were taken to nearby hospitals, which were coming under stress themselves.
Canterbury has acknowledged that it was understaffed as the crisis was intensifying. Jeremiah Davis, the facility’s administrator, said in a statement that Canterbury had temporarily doubled nursing staff wages and had tried to hire employees through third-party staffing agencies.
“Notably, nearly a dozen Canterbury employees recovered from Covid-19 have returned to work and are caring exclusively for Covid-19 positive residents,” Mr. Davis said.
Margo Turnage, whose 77-year-old father, Frank Bonarrigo, has lived in Canterbury for about three years, said she had been impressed with the facility’s willingness to help her frequently FaceTime with her father.
She said he had tested positive for the virus but was currently asymptomatic. She said she worried that the staff members would be blamed for the outbreak even though they have been putting themselves at risk on the front lines.
“The staff are putting in so many hours,” she said. “Their friends, who they have been working with for years, are dying on them. It’s heartbreaking.”
In late March, the facility made a plea for more nurses, offering a bonus and an elevated pay rate. The job posting, which is still active, encouraged applicants to contact a recruiter for “immediate consideration.”
“DOUBLE-TIME PAY RATE and $2500 sign on bonus,” the post read. “All Shifts available.”
Vanessa Swales and Robert Gebeloff contributed reporting.
