Nursing homes across Maine are banning or screening visitors, stocking up on scarce supplies and redoubling disinfection of their facilities as they prepare to protect patients from the coronavirus, a disease that has hit elderly, sick patients especially hard.

Several nursing homes have stopped allowing visitors in an attempt to protect elderly patients, a population that is particularly vulnerable to coronavirus, while others are considering implementing more serious restrictions on visits. Nursing home administrators say they are on high alert and are participating in daily calls with state health officials as they monitor the quickly evolving situation.

One particular concern for state health officials and nursing home administrators is a potential shortage of protective gear and other medical supplies for staff as the virus continues to spread.

Gov. Janet Mills and the Maine Center for Disease Control and Prevention announced Thursday the state’s first presumptive case of COVID-19, the disease caused by the coronavirus, which had sickened more than 125,000 people in 118 countries and killed more than 4,600 worldwide as of Thursday, the World Health Organization said.

In the U.S., the federal CDC reported 1,215 confirmed cases and 36 deaths in 42 states plus the District of Columbia as of Thursday.

The infected individual is a woman in her 50s who is quarantined at her home in Androcoggin County.

The highest number of coronavirus cases and deaths in the United States is in Washington, where a cluster of coronavirus fatalities linked to a nursing home account for about two-thirds of all deaths nationwide. The death toll attributed to coronavirus in Washington is 29, including 18 residents of a single nursing home in Kirkland.

In Maine, about 10,000 people live in nursing home or assisted living facilities, the Maine Health Care Association said.

Starting Thursday morning, no visitors were allowed at St. Mary’s d’Youville Pavilion in Lewiston, one of the largest nursing homes in the state, with 210 patients in its long-term care and rehabilitation units. It is the first time St. Mary’s d’Youville has closed the facility to visitors, though restrictions have been put in place during past influenza outbreaks, said Philip Hickey, president of St. Mary’s d’Youville Pavilion and a Covenant Health Systems vice president.

Employees and vendors are asked a series of questions about their risk of exposure to coronavirus and have their temperatures taken before they can enter the building. Anyone with a temperature higher than 100.4 is turned away.

“We are really being proactive to protect our residents and staff in the building,” Hickey said Thursday morning, hours after the new restrictions went into place.

The Barron Center, a nursing home and rehabilitation center operated by the city of Portland, will begin restricting visitors and screening staff before each shift starting Friday morning, city spokeswoman Jessica Grondin said. The center will make exceptions for end-of-life patients, she said, but their visitors will be screened and only allowed in the patient’s room.

Nursing homes are especially at risk during an epidemic because older residents often have weakened immune systems and underlying health issues that make them vulnerable to infection. Residents live in close proximity, travel back and forth between hospitals where they could be exposed to diseases like coronavirus, and are treated by staff members who circulate among sick patients.

The U.S. Centers for Disease Control and Prevention has advised that people older than 80 with major illnesses have the greatest risk and should take extra precautions. The CDC also recommends that long-term care facilities have employees dedicated to caring for COVID-19 positive patients and to assess the respiratory health of new residents.

Brian Sheets uses disinfecting spray to clean surfaces Thursday at The Cedars in Portland. The Cedars increased sanitizing of high-touch areas in response to the outbreak of coronavirus.  Derek Davis/Staff Photographer

Dr. Nirav Shah, director of the Maine CDC, said his office and the Maine Department of Health and Human Services have provided written guidance to long-term care homes and other health care facilities on dealing with coronavirus. On Tuesday, Maine’s state epidemiologist and the DHHS staffer who monitors the spread of infections at facilities briefed representatives of the long-term care industry.

“Everything we can do right now we are doing as far as infection control and limiting contact that might spread the virus further,” said Rick Erb, president and CEO of the Maine Health Care Association, which represents 200 nursing and assisted-living facilities across the state.

Among the recommendations to nursing homes and long-term care facilities is to funnel any visitors through a single checkpoint where they will be checked for signs or symptoms of infection. Staff should also be required to check in before their shift starts to ensure they are not potentially bringing the virus into the facility.

Shah said the Maine CDC also is urging nursing homes to begin developing plans for how they would limit visitation if the virus begins circulating in the community.

“These are all steps that we ask facilities to begin looking at in preparation for possible community transmission, which is not occurring in Maine but, based on the experience of other states, is a possibility,” Shah said. “This is all a part of our continuing effort to maximize the window of opportunity that we have here in Maine. … This effort to work with health care facilities, to give them concrete, specific and granular guidance is part of our effort to maximize the window of opportunity that we have in Maine before cases arrive. Everyone has a role to play there: the public, health care facilities and all of us.

Shah said there is no statewide policy on nursing home visitation, but that DHHS or the Maine CDC could issue mandatory policies if local conditions exist where coronavirus is circulating in the community.

“Right now it is a facility-by-facility decision,” Shah said. “Our guidance document right now asks groups to start preparing to limit visitation, to start preparing to have visitors come into a certain checkpoint. It’s possible that some facilities would want to go ahead and effectuate these guidelines right now. We would support that.”

Nadine Grosso, vice president of the Maine Health Care Association, said the organization is hearing from members who are considering further restricting visitors, especially in light of the announcement of the state’s first presumptive-positive coronavirus case. For some facilities, that could mean stopping all visitors, while others may allow families to be with patients only in end-of-life care, she said.

“Each home will implement a policy that will work for them,” Grosso said.

Visitors, employees and anyone else entering nursing homes are being asked questions about respiratory symptoms, recent travel and whether they’ve been in close contact with anyone who has been tested for coronavirus.

Erb said infection control is “not a new issue” for nursing homes, which regularly have increased monitoring and cleaning during outbreaks of influenza. Of the 75 outbreaks of influenza in Maine this season, 43 were reported at long-term care facilities, the Maine CDC said.

At The Cedars in Portland, screening began on Wednesday. The Cedars – which includes skilled nursing for 102 patients, 61 independent-living apartments and 30 assisted–living apartments – has also canceled community events with more than 20 people, increased sanitizing of high-touch areas and will consider limiting visitors if needed, said Katharine O’Neill, director of housing and communications at The Cedars.

“We’re taking it a day at a time,” she said.

Erb said he is anticipating there will be a shortage of medical supplies available to nursing homes as the pandemic continues and that some are already hard to come by. Staff at The Cedars stocked up on face masks and hand-sanitizer, but have been told by distributors it could be months before those supplies are available again.

Asked about potential shortages of protective equipment, Shah said Maine’s primary concern is about the so-called “N95” face masks that are designed to protect the wearer from inhaling viruses and other airborne matter. Those are different from the general surgical masks – more commonly found in pharmacies – that aim to prevent the wearer from coughing or sneezing on others.

Shah said supplies of N95 masks are “in flux” so he couldn’t comment on whether there was a shortage at that moment, but said they are working with hospitals, EMS providers and other groups to monitor the issue.

“We are simultaneously asking residents not to go out and horde or stockpile even the standard surgical masks that are available at pharmacies,” Shah said. “Those masks, too, are a valuable resource … and we want to preserve them for the health care community, for doctors, nurses and ambulance drivers when they need them.”

Hickey, from St. Mary’s d’Youville Pavilion, said no one screened so far has had a fever or been turned away. The response from employees, residents and family members to the new measures has been overwhelmingly positive, he said. The facility will provide technology to help residents communicate with family members who are no longer allowed to visit.

“They understand we are trying to protect our residents and staff,” he said.

Staff Writer Kevin Miller contributed to this report.

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