A8 eZ sU the washington post.monday, april 6 , 2020
“You could see t he doubt in her
eyes,” he said. “Like, ‘What am I
in the middle of ?’ ”Death, veiled in uncertainty
Hogan announced the out-
break that Saturday night.
Tracy Shavell had her fears
confirmed as she read the news
reports. Her father, Gary Holm-
berg, had been taken from Pleas-
ant View to Carroll Hospital the
day before with a suspected case
of pneumonia. When she asked
staff at the nursing home if there
were covid-19 cases at the facility,
they told her only t hat there were
no cases in Building A, where her
father was living.
Holmberg, a 77-year-old for-
mer D.C. firefighter who had
dementia, had moved into the
facility in february, his daughter
said. She lived nearby in freder-
ick and visited frequently, and
sometimes thought there were
not enough staff members on the
weekends.
In the hospital, Holmberg’s
condition quickly grew worse. By
the time his son, robert Holm-
berg, arrived from his h ome in St.
mary’s County around 1 a.m.
march 28, their father was gasp-
ing for air.
“It was the worst thing I’ve
seen,” robert Holmberg said, his
voice breaking.
Gary Holmberg died march 29
at 9:30 a.m. Shavell said staff at
Pleasant View told her his covid-
19 test came back negative, but
the hospital said the cause of
death was pneumonia and possi-
ble covid-19. The family is await-
ing test results from the hospital
and an autopsy. “He was not
supposed to go this way,” Shavell
said.
The next morning, s tate health
officials asked Singer whether
the nursing home could wait
until Tuesday for help. Singer
said his answer was emphatic:
No.
The maryland National Guard
arrived that night. Their doctors
determined which patients need-
ed to be immediately taken to
hospitals, and the maryland In-
stitute for Emergency medical
Services Systems figured out
transportation and routed them
among 14 different hospitals.
meanwhile, officials said 11 more
nursing home residents had test-
ed positive — raising the tally to
77 out of the 95 people who lived
there.
Hewitt’s ambulance again was
summoned, along with seven
others from Butler medical
Transport.
The situation at the nursing
home was wildly different from
two nights earlier, Hewitt said.
There were triage tags on pa-
tients noting who was sick andation,” Phillips said.
The county gave gowns,
gloves, face shields and masks to
the nursing home, and Carroll
Hospital sent one of its own
nurse practitioners march 28,
along with oximeters to measure
oxygen saturation in the blood,
said Sharon mcClernan, vice
president for clinical integration
at L ifeBridge Health. She said the
12 intensive-care beds in the
hospital were filled by the end of
the day.
meanwhile, the state was
struggling t o set up a triage team,
Singer said. With beds full at
Carroll Hospital, patients were
being sent elsewhere, and those
hospitals were complaining
about the i nflux of patients. Sing-
er’s staff members were on the
verge of tears.
“We were drowning,” said
Wantz, t he president of the board
of commissioners. “Every single
day, we said, ‘We need help, we
need help, we need help.’ ”
medic ron Hewitt said he got a
call march 28 that the nursing
home had “essentially blown up.”
When he drove up the long
driveway, he saw dozens of flash-
ing lights from other ambulanc-
es. There was a stillness once he
came through the door.
Hewitt and his partner were
escorted into a room and told the
name o f their patient, whom they
transported to frederick memo-
rial Hospital. The masked nurs-
ing home aide who was assisting
them started to cough at one
point. Hewitt said he and the
woman made eye contact.
“It’s just a cough,” s he said.
Hewitt, who was wearing pro-
tective gear of his own, w as not so
sure.In his absence, three nurses
were in charge.
“The nurses were attempting
to do as much as they could, but
they were under no physician’s
directions,” Wantz said. “from
day one, there was no medical
director.”
Singer declined to discuss Vel-
lanki, saying it was for the state
health department to determine
whether regulations were violat-
ed. fran Phillips, m aryland’s d ep-
uty secretary for public health,
said the doctor’s conduct is “defi-
nitely something to investigate,
for another day.”
When contacted by a reporter,
Vellanki hung up the phone,
saying he needed to see a patient.
He could not be reached by a
reporter after multiple attempts.searching for backup
Singer spent that Saturday in
the county health department
offices with his staff, calling po-
tential medical volunteers listed
in a state database, which has
swelled by more than
5,000 names since the outbreak
started. They made between 800
and 900 calls for help, Singer
said, but few were willing to
come, saying the situation ap-
peared to be too dangerous.
Phillips said the s tate has since
hired a network of health-care
workers — including nursing a nd
medical students and EmTs li-
censed in other states — to bol-
ster workers at hard-hit facilities
like Pleasant View.
But those resources, intended
to prepare for the surge officials
say is coming, were not available
when Pleasant View was grap-
pling with its response.
“It was an unprecedented situ-the coronavirus pandemic
who needed to be hospitalized.
“It went from, ‘We’re really not
sure what we’re doing,’ to com-
plete organized chaos,” he said.
“You could tell the military went
in there and did their thing.”
on Tuesday, Carroll County
family medicine physician Dan-
iel Aukerman arrived. He w as the
only physician the health depart-
ment could find who was willing
to treat patients at the facility.
Before going to Pleasant View, he
sat down with his wife and chil-
dren and discussed the risks and
the ramifications, but also the
potential for him to h elp vulnera-
ble patients.
“We talked about that no one is
willing to step up,” he said. “Ev-
eryone seems to be running from
this thing instead of confronting
it.”
Aukerman got to the nursing
home at 7 a.m. and did not leave
until after 8 p.m. He has been
back every day since, writing
medical orders and providing
oxygen support for covid-19 pa-
tients who remain at the facility.
He said those who remain there
have either tested negative or are
positive and have signed do-not-
resuscitate orders.
When Aukerman is not at
Pleasant View, he is at his home
in Westminster, md., separate
from his family to ensure that if
he is infected with coronavirus,
he does not spread it to them.unanswered questions
The situation at Pleasant View
has stabilized, Singer said. But
some of the biggest questions are
still unanswered — including
how the virus entered the facility
and spread so rampantly.
Hogan has said it is possible an
asymptomatic employee was a
carrier, but Singer said it is not
yet clear how the disease spread
and that the county health de-
partment is just beginning con-
tact tracing.
on friday, the state health
department ordered all staff
members at nursing homes and
assisted-living facilities across
maryland to wear protective
equipment when they interact
with patients. The same day,
leaders at more than 30 senior
living facilities sent Hogan a
letter warning that they are not
ready for the projected surge in
cases.
They a sked for immediate test-
ing of all nursing home residents
and staff, requested the state set
up isolation centers to treat pa-
tients who test positive and
asked the county and state to
provide protective gear.
Phillips said that because test-
ing and personal protective gear
are limited, the state prioritizes
testing of symptomatic patients
and health-care workers and
works with local health depart-
ments to get supplies to long-
term care facilities.
Hogan issued an emergency
order Sunday making it manda-
tory for staff at nursing homes
and assisted-living facilities to
wear face masks, gloves and
gowns. The order also requires
nursing homes to designate spe-
cific staff members and space to
treat coronavirus patients. Viola-
tors could face up to a year in jail
and a fine of up to $5,000.
Nursing homes are particular-
ly susceptible to epidemics be-
cause they serve an immunocom-
promised population that inter-
acts in close quarters. Yet for
years, regulatory bodies at the
state and federal level have failed
to emphasize infection-control
measures at nursing homes, said
Lona mody, a professor of epide-
miology at the University of
michigan. In part, she said, such
measures can seem out of place,
because unlike hospitals, a nurs-
ing home is a place of long-term
residence.
“Imagine k nowing a person for
10 years, maybe even seeing them
as family, and having to gown up
every time you see them,” mody
said. “It’s not intuitive.”
At Pleasant View, 27 employ-
ees had tested positive and 34
had tested negative as of Sunday.
Singer said he is focused on
ensuring that patients who re-
main in the facility get the care
they need and that the county is
prepared for the surge officials
say is coming.
on Wednesday, he learned
that three residents at a retire-
ment community in the county
had tested positive for the coro-
navirus. By Sunday, that commu-
nity — Carroll Lutheran Village
— had 10 more cases.
A woman in her 90s from
Carroll Lutheran Village died
Saturday, along with four more
Pleasant View residents over the
weekend: a man in his 80s, a man
in his 60s and two women in
their 80s.
[email protected]
[email protected]
[email protected]searching for backup, to no avail.
A paramedic who responded to a
911 call found the halls eerily
quiet, with staff members
masked and not talking, and
ragged coughing audible from
behind closed doors.
The crisis at Pleasant View is
an East Coast version of the
tragedy at Life Care Center of
Kirkland in Kirkland, Wash.,
where scores of elderly patients
were sickened by covid-19 and 40
died. It foreshadows challenges
other nursing homes face across
the country and in the greater
Washington area as the pandem-
ic bears down. As of Sunday,
residents and staff at 81 mary-
land nursing homes and assist-
ed-living facilities had tested
positive for covid-19, Gov. Larry
Hogan (r) said. Health-care
workers are dangerously low on
gloves, masks and other protec-
tive equipment. At one facility
outside richmond, 133 people
had tested positive, and 17 had
died.
In the predawn hours of last
Sunday m orning, Singer was a ble
to secure 14 oxygen tanks from
the Carroll County emergency
medical services department.
Just over 36 hours later, the
maryland National Guard ar-
rived with doctors and supplies.
But the fast-spreading virus
had already overwhelmed the
nursing home’s staff and filled
nearby hospitals to capacity, ac-
cording to interviews with
18 people directly involved in the
crisis. By friday, 99 residents and
staff had tested positive. forty-
two people were hospitalized,
and six were dead. four more
people would die over the week-
end.
“I was screaming at my boss,
saying I needed more resources,”
Singer said. “maybe I should
have screamed louder.”
The outbreak
mount Airy is a bedroom com-
munity of 10,000 residents that
sits on the border of Carroll and
frederick counties, 45 miles
north of the District of Columbia.
most days, said mayor Pat rock-
inberg, it looks like something
out of a Hallmark movie — a
quiet town, where the most
pressing emergencies are water
main breaks or roving cows
blocking traffic.
The nursing home sits atop a
hill, a family-owned facility that
has operated for more than four
decades. residents live four to a
room, and 76 percent have de-
mentia, according to the mary-
land Health Care Commission.
The facility received a one-star
rating for staffing from medi-
care, which bases its rating on
nurses per patient and offers
from one to five stars.
When the mayor heard on
march 27 that two Pleasant View
residents had tested positive for
the coronavirus, he was con-
cerned, but not alarmed. At the
time, there were just nine cases
in Carroll County.
“We thought we were doing
fine,” s aid Leslie Simmons, presi-
dent of Carroll Hospital, who
made the 2 a.m. phone call to
Singer last Sunday. She has
worked at the hospital for nearly
20 years and is the executive vice
president of its parent company,
LifeBridge Health. “one minute
you are fine, and the next minute
you are not.”
Singer, a military veteran who
has been the county’s top public
health official since 2015, visited
Pleasant View after he was told
about the first two cases. Don-
ning a gown, mask and gloves, he
toured the facility.
Generally, he was satisfied.
Employees were being screened
when they got to work to see if
they had elevated temperatures
or respiratory symptoms and
were wearing protective gear
while working with all patients.
Patients with symptoms were
isolated. few were visibly ill.
Things changed the next day,
march 28.
Stephen Wantz, president of
the Carroll County Board of Com-
missioners, said he felt his stom-
ach churn when he heard the
numbers: 64 new cases, meaning
nearly two-thirds of the elderly
residents were ill. In his 30 years
as a firefighter in Baltimore, he
had run toward burning build-
ings. But he said he never felt as
much dread as he did at that
moment.
Wantz and a second county
official said no one could locate
the nursing home’s medical di-
rector, Nandakumar Vellanki,
even as officials repeatedly at-
tempted to call him. When they
reached him, Wantz added, Vel-
lanki told officials he had been
self-quarantining because he was
concerned he had been exposed
to the infected patients.
nursing home from A
‘We were drowning’: A look at Maryland’s worst outbreak
Photos by Katherine Frey/the Washington PostToP: Tracy shavell and
robert holmberg pose
Friday with photographs
of their father, gary
holmberg, above right,
who died march 29 after
being taken from
Pleasant View nursing
home to Carroll
hospital. ABoVe LeFT:
stephen Wantz,
president of the Carroll
County Board of
Commissioners, stands
at the closed
government offices in
Westminster, md., on
Friday. BeLoW:
Pleasant View nursing
home in mount Airy,
md., where there is a
coronavirus outbreak.