In April the data became clear to state officials: Long-term care facilities, such as nursing homes, needed heightened help and attention to stave off the novel coronavirus.

Over the last month, more than 110 deaths and 1,000 cases have been linked to care facilities. The residents and staff of these facilities make up 23 percent of Oklahoma’s known COVID-19 cases and 45 percent of reported deaths, according to data from the state health department. 

Deputy Secretary of Health and Mental Health Carter Kimble said although long-term care facilities had always been part of the state’s response to the pandemic, the state didn’t designate a team to focus solely on that area until mid-April. State leaders initially focused on preparing for a possible COVID-19 patient surge, Kimble said, and put resources into securing enough ventilators and hospital beds for the sickest patients.

“To a certain extent, shame on us for not having connected the dots on this earlier,” said Kimble, who is leading the state’s COVID-19 response for long-term care facilities.

As Oklahoma starts to reopen businesses and ease social distancing measures, the state has heightened efforts to prevent the spread of COVID-19 in eldercare facilities. State leaders and some nursing home advocates say efforts so far have been successful. Out of more than 600 long-term care facilities in the state, the virus has been found in over 60.

However, one advocate who has been sounding the alarm on COVID-19 in nursing homes since March, said the state’s elevated response has come too late.

Nursing homes and other care facilities across the U.S. have been hit particularly hard by the coronavirus, and older adults and those with underlying health conditions are at higher risk for complications and death.

After advocates and facility operators called for expanded testing and for the state to send personal protective equipment to long-term care facilities, Gov. Kevin Stitt last month said he would become “laser focused” on fighting the virus in the facilities and formed a task force last month.

Nursing home operators told The Frontier they struggled to secure personal protective equipment and were paying 1,000 percent markups for gloves and masks.

Boxes of personal protection equipment (PPE) and medical supplies in Oklahoma City, Okla. on Tuesday, April 7, 2020 in a warehouse where the State of Oklahoma has amassed a stockpile for its COVID-19 response. [Chris Landsberger/The Oklahoman]

In recent weeks the governor and the task force have sent protective equipment to all 308 nursing homes in the state, issued more protocols for the equipment’s use and deployed the National Guard to disinfect nursing homes, Stitt’s office said in an emailed statement Thursday.

Kimble said until recently, the state did not have enough personal protective equipment to actively send to nursing homes.

As of Wednesday, the Oklahoma National Guard had disinfected more than 26 nursing homes, said Brig. Gen. Tommy Mancino, Oklahoma Army National Guard assistant adjutant general, at a news conference.

Stitt has promised to test all nursing home staff and residents by the end of the month.

Secretary of Health Jerome Loughridge on Wednesday said 12,250 specimens out of about 31,500 total residents and staff at nursing homes in the state had been tested so far.

“We began with testing all staff and that is step number one. Then it will progress to where our objective is to test all nursing home residents. That is not a quick process.”

Loughridge said having access to saliva tests is going to make the process smoother.

“The reason that matters so much in our long term care facility if you can imagine the current swab, it can be rather invasive,” Loughridge said. “It’s very difficult for folks who may be suffering from dementia. It is a harsh process. The saliva test is a much more tenable way.”

Saliva testing will increase as the state gets more test tubes to perform the test in, which are faster to get tested than the cups.

Wes Bledsoe, founder of A Perfect Cause, an advocacy organization for nursing home residents, started trying to sound the alarm on preventing the spread of COVID-19 in Oklahoma facilities in mid-March.

“This state was not prepared,” said Bledsoe, who has been an advocate in Oklahoma for more than 20 years. The state should have expected nursing homes to need their own heightened response, he said.

“Where else in America do you have that kind of contact under one roof with people who don’t know if they are infected or not, and they have no proper PPE?” Bledsoe said.

Though the state doesn’t yet have a plan in place for repeated testing in care facilities, Bledsoe said regular testing in eldercare facilities is vital.

“And we know testing hasn’t been completed yet so how many more will there be?” he said

Steven Buck, president and executive director of Care Providers Oklahoma, said he was encouraged by the state’s new efforts. The organization represents the interests of residents and workers in long-term care facilities.

“The challenge for the state was real, and I understand … why the front end response was very heavily towards addressing a potential hospital surge,” he said.

He added: ”I appreciate the receptivity and I hope that it gains momentum.”

Buck agreed that continued testing is an important piece of keeping the disease out of facilities.

“We are encouraging our members to make sure that they work to have follow-up testing protocol so that we can truly do surveillance,” he said.

Calls for reopening
Though Stitt said at a news conference Wednesday that the state was on track to continue to phase two of the tiered plan to reopen the state on May 15, visitation to long-term care facilities will remain limited.

Gov. Kevin Stitt inside the state Capitol. BEN FELDER/The Frontier

A state lawmaker this week called for the state to ease visitation restrictions as early as June 1.

Though the governor’s executive order limiting visitation expires after May 30, the state hasn’t set a date for facilities to reopen, Kimble said.

“It is on our radar, it is something that’s going to have to be measured,” he said. “Right now, the data is not there for us.”

The virus has entered care facilities in two main ways: Through staff who may not know they are sick and by residents coming in from other care settings.

As shuttered businesses start to reopen, Kimble said, the task force will keep an eye on infection rates in facility staff. The state is considering incentivizing those employees to shelter in place, he said.

Kimberly Green, chief operating officer at the Diakonos Group, agreed that reopening the state has added a level of danger to nursing home residents. The group operates several skilled nursing and rehabilitation facilities in the state.

“Furthermore, the conditions in our community matter a great deal,” she said in a statement. “If we continue to see community spread, and if social distancing measures are not adhered to, opening our nursing homes will put our residents at a very high risk. In fact, the reopening of the state outside of our nursing homes has already added a level of danger to our residents because our staff is more likely to contract COVID.”

Staff writer Ben Felder contributed to this report.