LTC Outbreaks

More than half of the Commonwealth's 486 COVID-19 outbreaks originated in long-term care facilities, such as skilled nursing and assisted living facilities, and nearly 96 percent of all deaths from COVID outbreaks have occurred in long-term care centers since the pandemic began.

"To date, there have been [254] long-term case facility outbreaks in Virginia," said Dr. Laurie Forlano, deputy commissioner for population health and director at the Virginia Department of Health's Office of Epidemiology. "Long-term care centers represent over 40 percent of all [coronavirus] deaths in Virginia."

Other sources suggest long-term care centers could account for more than 60 percent of COVID deaths statewide.

A staggering 1,135 COVID deaths have come from long-term care facilities, according to the Virginia Department of Health (VDH). This is compared to just 50 total deaths from all other outbreaks, including those originating in social congregations, correctional facilities, healthcare settings and education settings.

"With a pandemic such as this, the info, science and data changes incredibly rapidly," Forlano said. "It's very normal for guidance to change and evolve over time as we learn more."

The VDH published its first guide to nursing home reopening mid-June.

"Prior, we had published a lengthier guidance document that goes into more detail about infection detection and control," Forlano said. "The reopening guide includes information about testing and recommendations about repeat testing. They are largely informed by the CDC and centers for Medicare and Medicaid services."

The public has expressed concerns about numbers that "don't add up" when it comes to the COVID-19 pandemic, especially when it comes to the number of cases reported at the state level. The reason for this, Forlano explains, is that the state health department uses two databases to track epidemiological numbers. The Virginia Electronic Disease Surveillance System operates on an individual basis, case-by-case. The Virginia Outbreak Surveillance System tracks outbreak data.

"VDH pulls from both databases," Forlano said. "We use an algorithm, because the numbers aren't always matching – it's a little complicated. We always take the higher number."

From the Coronavirus Aid, Relief and Economic Security (CARES) Act, over $246 million will go toward long-term care in Virginia.

"A new funding package will support facilities in their efforts to combat COVID-19," Forlano said. "The money goes towards testing, supplies and point prevalence surveys. Most goes to nursing homes, and $56 million goes to continued testing support."

The Virginia Department of Medical Assistance Services (DMAS) will administer the funds.

Last month, Gov. Ralph Northam released the names of the long-term care centers with COVID-19 outbreaks, after maintaining for several months that state law grants these facilities the same health privacy rights as individuals.

"Due to the widespread nature of this pandemic, it is now unlikely that releasing facility information would compromise anonymity or discourage facilities from participating in a public health investigation," Northam said.

Release of this information is what allowed the VDH and DMAS to target certain homes for additional funding, testing and surveying, Forlano said.

Another goal of the VDH is to increase test availability to asymptomatic residents of long-term care facilities, said Dr. Danny Avula, Director of Richmond City and Henrico County Health Districts.

"This is a disease that spreads at high rates in an elderly, vulnerable population," Avula said during a June press conference. "What we're seeing in congregate care facilities is that asymptomatic spread is an even more significant part of transmission than we realized."

In the meantime, COVID rates in Virginia's long-term care centers will continue to rise until they receive the money and testing capacity they need. Forlano says keeping staffing numbers up is also an issue at this time.

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