Minutes into a conversation with her mother, Deana Walkowiak-Olson could not shake the sensation that something was terribly wrong at the large Duluth senior home where her 82-year-old mother lived.
Her mother, who has dementia, was normally upbeat on these daily calls. But on this afternoon in early April, she seemed disoriented and repeated the same phrase, “We have an active case in the building,” multiple times.
“My mind was racing, fearing it was the coronavirus,” Walkowiak-Olson said.
Several days passed before authorities at the assisted-living facility, St. Ann’s Residence, confirmed her worst fears. A deadly outbreak of the coronavirus had swept through this tight-knit senior community by Lake Superior with alarming speed, killing five people and sickening 20 other residents.
To avoid getting infected, about a quarter of the facility’s nurses and other staff stopped showing up for work to care for residents, some unable to walk and suffering from memory problems. For several harrowing days, the staffing shortage at St. Ann’s became so acute that county officials requested emergency help from the Minnesota National Guard, which was turned down.
More fatalities could occur as a half-dozen of St. Ann’s residents remain hospitalized, and dozens more have yet to be tested for the virus. “The stress has been incredible,” said Scott Johnson, executive director of St. Ann’s.
The cascading crisis at St. Ann’s offers a frightening preview of what may lie ahead for frail and elderly people across the state as the pandemic widens its reach.
Until now, Minnesota has not seen the sort of large-scale outbreaks that have ravaged long-term care facilities across the nation, claiming more than 3,000 lives. In New Jersey, 17 bodies were found last week piled up inside a nursing home where 68 had already died, and dozens more have died in major outbreaks at senior care communities near Boston, Seattle and in Montreal.
In Minnesota, the death toll in long-term care facilities has reached 82 people, which represents more than 70% of the deaths from the virus statewide.
Most alarming, dangerous clusters of cases like that at St. Ann’s are becoming more common. Statewide, 15 long-term care facilities across the state have 10 or more confirmed cases of COVID-19, the respiratory illness caused by the virus, and eight facilities have more than 20 cases, state health officials said last week.
Even before the virus arrived, nursing homes were considered dangerous incubators for pathogens. In Minnesota, they have long been chronically understaffed and prone to lapses in infection control. In recent years, the senior care industry has also pushed back against regulations that would establish minimum standards of care and protections for lightly regulated assisted-living facilities, which are home to more than 50,000 people statewide.
And like passengers on cruise ships, residents in these facilities often have nowhere to go when an infection spreads. Many are too frail and too sick to be cared for at home by family; and with most facilities on lockdown and not accepting residents, they cannot move to a safer location.
“They’re like sitting ducks,” said Toby Edelman, a senior attorney for the Center for Medicare Advocacy in Washington, D.C. “They live in close quarters and, when someone gets sick, it just spreads through these facilities like wildfire.”
Founded in 1888, St. Ann’s Residence is the kind of large complex that is particularly vulnerable to a deadly outbreak.
Many of its residents have chronic health problems and chose the facility because of its proximity to St. Mary’s Medical Center. Its central location in downtown Duluth and amenities made it a popular destination. Before the lockdown, families visiting their loved ones would bring children to see the large aviary of exotic birds in St. Ann’s lobby or to pick up fresh-baked cookies at its gift shop, say residents and relatives.
Staff at St. Ann’s were also known for going out of their way to make things fun. There are regular bingo games, concerts and large picnics in the facility’s courtyard, as well as rummage sales and holiday dances. Most residents gather in the facility’s spacious dining hall for meals.
The facility also prides itself on turning away no one based on ability to pay. Half of St. Ann’s residents are impoverished and rely on publicly funded health care. “The whole atmosphere is overwhelmingly positive and social. Everyone knows everyone,” said Carol Hall, whose 94-year-old mother lives at the facility.
But the combination of the frequent traffic, close living quarters and vibrant social scene likely played a role in the rapid spread of the virus at St. Ann’s, staffers acknowledged.
“The virus seems to want to attack communities with a lot of people and a lot of traffic. Look at the cruise boats,” said Johnson, the executive director at St. Ann’s. “Any volunteer could have walked in here and passed it on without knowing they had it.”
Even now, public health officials do not know how the coronavirus arrived at St. Ann’s. The first positive case of COVID-19 was detected April 3 in a resident who had been taken to St. Mary’s hospital after suffering an injury from a bad fall and was later tested for the coronavirus after showing mild, flu-like symptoms. The patient never returned to St. Ann’s, becoming the first of five residents to die from the virus.
Another resident, Arthur Richmond, 72, was taken to the hospital with high blood-sugar levels, but doctors tested him for the virus after noticing that he also had a fever. He tested positive and died four days later. “I never got to say goodbye, and neither did his grandkids,” said his son, Randy Richmond, a father of two. “I think these senior homes should be testing everyone.”
Such cases reflect the stealthy nature of the virus and how it can spread rapidly in senior care homes without being detected. Data from three recent studies in the United States show that as many as half of people with COVID-19 infections in care homes were asymptomatic, meaning they had no signs of the illness, at the time they were tested. The research also suggests that symptom-based screening, such as checking for high temperatures, are often ineffective at identifying cases.
St. Ann’s was caught unprepared for the turmoil that followed.
As more residents got sick, a number of the facility’s nursing staff did not show up for work for fear of catching the virus, while others quarantined at home after being exposed. The departures left the facility perilously understaffed over a crucial period when people were getting sicker and staff were needed to keep residents from wandering the halls and further spreading the illness, officials said.
“We were completely overwhelmed,” Johnson said.
Fearing the situation was spiraling out of control, an impromptu coalition of state, county and private agencies came together to provide emergency support. Essentia Health and St. Luke’s Hospital each provided about a dozen staff to help with care and screening of residents. They also donated masks and other protective gear. At one point, St. Louis County officials sought help from the medics at the Minnesota National Guard, but that request was denied.
Speaking by phone Thursday, Johnson expressed remorse for the anguish that residents and families have suffered, while sounding confident that a more serious crisis had been averted. The facility continues to test residents for the virus, he said, and a batch of recent tests came back negative. As of Friday, about 80 of the facility’s 150 residents had been tested.
“We’ve learned ... that it’s not just a sore throat. It’s not just a cough. It’s not just a headache,” he said. “Everyone needs to be symptom-free in the building to eliminate all the risk.”
On a bright afternoon last week, Walkowiak-Olson dropped by St. Ann’s to deliver cinnamon rolls and other food for her mother, Rose Crist, who remains in good condition but has not left her room in about a month. Because the facility is on lockdown, Walkowiak-Olson waved at her mother from the parking lot.
Both shed tears as they spoke. “I can’t believe I can’t come in and hug you,” she said, waving.
Early last week, Walkowiak-Olson asked that her mother be tested for the coronavirus. But that has yet to happen.
Staff writer Katie Galioto contributed to this report.