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US Covid-19 ravaged a nursing home and prison in a rural Kansas city spared by earlier surges. Its presence did little to change the community's habits

16:15  28 november  2020
16:15  28 november  2020 Source:   cnn.com

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Rural communities also have strengths, assets, and protective factors that public health can use to This might mean making changes to the physical environment such as adding physical barriers Additional infrastructure issues affecting a rural community ’ s ability to respond to COVID - 19 include

Covid - 19 , the disease caused by the coronavirus, is known to be particularly lethal to adults in their 60 s and older who have underlying health conditions. And it can spread more easily through congregate facilities, where many people live in a confined environment and workers move from room to room.

When Covid-19 cases began climbing in the fall within Norton County, Kansas, the administrator of a local nursing home used the facility's Facebook page to send residents reminders.

a building that has a sign on the side of a road: Of the 61 Andbe Home residents who tested positive since October, a total of 21 residents have died. © KHGI Of the 61 Andbe Home residents who tested positive since October, a total of 21 residents have died.

An early September post on the Andbe Home's page urged visitors to "PLEASE PLEASE follow the guidelines," including maintaining a distance of six feet and wearing a mask at all times, "not just in front of us."

Three weeks later, while the county's number of infections crept upward, the home went into lockdown.

"It is our responsibility to protect our residents and I feel with an increase in active cases we need to take this unfortunate step," Megan Mapes, the administrator, wrote on October 2.

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Covid - 19 , the disease caused by the coronavirus, is known to be particularly lethal to older adults with underlying health conditions, and can spread more easily through congregate facilities, where many people live in a confined environment and workers move from room to room.

Covid - 19 is ravaging nursing homes . In a May letter reviewed by CNN, a Camden County official told the state health department that the county had been "diligently assessing the facilities and educating the staff on infection control measures" and had "very serious concerns" about Avista and

Five days later, the home announced its first positive resident. By mid-October, Andbe Home had a "full COVID outbreak," Mapes said on Facebook.

a group of stuffed animals © Alberto Mier/CNN

Every single one of the 61 residents in the home tested positive for the virus. At least 21 have since died of Covid-19, according to Mapes.

"When we started to see some of our people passing away from this, I mean, that really hit us hard," says Reva Benien, a lifelong Norton resident. "People that we grew up with, that were family friends or church members."

In a nearby prison facility, another crisis at the same time: The virus, likely seeping into the facility through a staff member, according to a corrections department spokesman, was spreading like wildfire, infecting hundreds of inmates in just a matter of weeks.

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Main article: COVID - 19 pandemic in Alaska. On March 19, Governor Newsom announced a statewide stay at home order with all residents except those On March 23, the cities of Denver and Boulder issued a stay-at- home order effective March 24 through April 10 at the earliest , and Pitkin

While Cuomo did indeed direct that COVID - 19 patients be sent to nursing homes to help ease the The New York Times report outlined the hurdles that restricted patient intake in early April At the same time, according to the Times, the number of non- COVID - 19 patients in New York City hospitals

Some say part of understanding what went wrong lies in better understanding the surrounding community's response to Covid-19 since the start of the pandemic, when for long, Norton remained virtually untouched by the virus.

"I think early on people just thought, 'Well, we're either going to get it or we're not going to get it,' or 'I'm not ever going to wear a mask,'" Benien said.

a man standing in front of a store: Jeff Johnston, right, with his father, grew up in Norton and now lives in California. © Courtesy Jeff Johnston Jeff Johnston, right, with his father, grew up in Norton and now lives in California.

As the nation now grapples with the devastating fall Covid-19 surge, Norton County has become emblematic of the pandemic's deadly grip on Midwestern rural communities that were spared by earlier surges. But it also offers a glimpse into the diverse opinions that persist around the virus and the patchwork of safety measures used to curb its spread.

a man wearing glasses and smiling at the camera: Redeemer Lutheran Church Pastor Timm O. Meyer says, © Timm O. Meyer Redeemer Lutheran Church Pastor Timm O. Meyer says, "You would think, 'Well everybody's going to stay home.' They don't."

'Norton normal'

For Norton County, home to less than 6,000 people -- a community of ranchers and farmers, as the locals say -- the coronavirus was nothing but a nuisance for months after the pandemic's start.

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The latest estimates show that Covid - 19 is nowhere near as lethal as early models claimed, yet the mainstream media have been mum on the Among the points Horowitz makes in his commentary is that the overall CFR is actually pulled up by all the deaths in US nursing homes , which a number of

As cases first surged across the country in March, Kansas Gov. Laura Kelly, a Democrat, joined other state leaders in shuttering schools and issuing a statewide stay-at-home order.

But in Norton County, it wasn't until about a month later, April 30, that health officials reported the first case of the virus in a resident. Days later, they reported the second. A month later, and after all restrictions previously imposed by the state had already been lifted, a third case.

Over the summer, as the virus again ran rampant across the country, crippling hospital systems and claiming hundreds of American lives daily, active Covid-19 cases in Norton County only reached the double digits briefly in mid-July.

Residents settled into to a lifestyle resembling the normalcy that is now, for many other Americans, just a memory.

"We didn't overreact," says Pastor Timm O. Meyer, of the Redeemer Lutheran Church. "We went on like pretty much as normal with just a few adaptations. That's what I call the 'Norton normal.'"

In most places -- with the exception of a local hospital, a clinic and a pharmacy, Meyer says -- masks weren't required. When the governor issued an executive order in early July requiring masks in public places, the county opted out of a mandate.

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A day before the order went into effect, Norton's police chief announced on Facebook officers would not be enforcing it.

"It has come to our attention that some are concerned that we are not enforcing laws to protect our community," the July 2 Facebook post said. "The Governor's order is NOT a law. It has not been passed by our state legislature and therefore, not a criminal law that we can, nor will, enforce."

Meyer says it's the freedom to do the right thing, not being forced to, that was key for Nortoners.

"Out here, people are independent and if you give them a choice, they're going to do the right thing, they are concerned about others," Meyer says.

It's that choice that he says both residents and travelers -- especially from cities or states with mask mandates -- enjoyed over the summer months. Some, he says, have described Norton as an "oasis."

"An oasis in the desert, where we can do what we want... because this is still America and we still have our freedoms and we don't like to give them up much," he says.

Cases climbed in the fall, but little changed

Then came the fall.

Infection numbers first began climbing in September and, by mid-October, more than two dozen active cases were reported in the community. That's when health officials announced the Andbe Home outbreak.

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"That really made people go, 'Wow, I guess this stuff is real and it's serious,'" Meyer said. "But it didn't, I don't think it changed people's patterns."

"You would think, 'Well everybody's going to stay home,'" he added. "They don't. They still go out to work and they come back and they still go out to eat."

The nursing home outbreak landed the small community in national headlines, but many felt the cases were contained in the two facilities -- the home and the prison. There was still no "big fear" of the virus, 72-year-old resident Cindy McMullen said.

"There's probably a little more fear since we had such a big outbreak," she says. "They're a little bit more fearful than they were three months ago. But I don't think anybody's in a panic."

For the governor, the nursing home deaths were a "stark reminder," that the virus "poses a real threat to all Kansans and it doesn't stop at county lines," she said in an October news conference.

"Cases in communities like Norton are higher because of outbreaks in jails and nursing homes, but there is also wider community spread," she had said. "Outbreaks are not isolated incidents."

Community spread is "the top predicator" of Covid-19 outbreaks in nursing homes, the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) wrote to CNN in an email.

"The virus' ability to spread through asymptomatic and pre-symptomatic carriers makes it extremely difficult to prevent it from getting into our facilities when there is high spread in the surrounding community,"AHCA/NCAL wrote.

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"Rural areas are seeing higher COVID rates and, unfortunately, many individuals in these communities are not following CDC guidance on wearing masks and practicing social distancing," it said.

In facilities, some failed to wear masks

An October report from the Centers for Medicare & Medicaid Services (CMS) alleged failures by the Andbe Home which placed "residents in immediate jeopardy." The report said staff members didn't wear masks at all times and at least one was seen with their mask "pulled down around their chin." Infected residents were found to be living with Covid-19 negative roommates with "only a curtain between them," the report alleged, and communal dining did not stop until two days after the facility's first positive antigen tests in residents.

Some of the findings echoed a similar report released by CMS five months earlier. State investigators in May had found the home failed "to have staff wear face coverings while in the facility, failed to develop COVID-19 policies and procedures, and failed to educate staff on how to prevent the development and transmission of COVID-19."

A May 15 Facebook post from the nursing home said staff weren't wearing masks to conserve "our limited supply in case we would have cases in house."

"This meets the requirements as directed by our state governing agent," the post read. "We love our residents and are doing the best we can to take care of them."

Of the 61 residents who tested positive since October, a total of 21 residents have died. Forty have recovered while one resident remained hospitalized for a non-Covid-19 related reason, Mapes told CNN on November 23.

"Every time I look at the numbers of those who we have lost... I am struck by the fact that each represents an individual person, with a life and a history, and connections to other people," Mapes wrote to CNN earlier in November. "Please know what a sad time this has been for our staff, and that we have mourned every life lost."

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Throughout the pandemic, Mapes had said in an initial email, "We have strived to be in compliance with guidelines issued by CMS, the CDC and the state."

Following the outbreak, Mapes said the home was assigned temporary new management and that new measures, including a strict no in-person visitation policy, were in place.

"After our recent inspection we knew we needed to make significant improvements, and that's exactly what we have done now with the assistance of clinical experts on our temporary management team," Mapes wrote. "We have re-educated all of our staff on clinical best practices -- and we are all committed to doing the right thing and providing the best possible care for our residents going forward."

This is an "insidious virus," she added.

"Nursing homes all over the country are experiencing outbreaks due to the spread in the surrounding community and a lack of resources," Mapes said. "What we now know is that prioritizing nursing homes in emergency situations is key, and we need to focus on a collaborative, not punitive, approach to help nursing homes respond to the pandemic."

In a November 23 Facebook post, Mapes said staff had "fully embraced" CDC infection control protocols and she was informed by state officials that the previous infection control concern "has been corrected."

In Norton Correctional Facility, it was most likely staff who brought in the virus before numbers began exploding, according to Randy Bowman, the executive director of public affairs for the Kansas Department of Corrections.

"It always originates in the community somewhere so our staff ... whatever they're doing in the community, they're the ones that are bringing it in," he said.

More than 670 inmates and at least 90 staff members have tested positive since the outbreak began in September, according to Bowman. Positive inmates are taken to another prison facility to be closer to hospitals, Bowman said, adding none have died of the virus.

And while Bowman says there are required mask protocols for both staff and inmates, he added, "I think what we're seeing is fatigue."

"People are not always compliant with that but those protocols have been in place."

Some say it's political

Local and state officials across the US say the politicization of both the virus and face masks has gotten in the way of helping curb the spread.

Jeff Johnston, McMullen's brother, agrees. Johnston grew up in Norton and now lives in Sacramento County, California, where "you wouldn't dream of being out in public without a mask on." He says he is still in touch with Norton residents, including childhood friends who live there.

"If you were to admit that you thought wearing a mask was a good thing, you would be a suspected Democrat," he says of his hometown.

The county is a heavily Republican one, where Trump received nearly 83% of the more than 2,300 votes cast in the presidential election.

"If you ever tried to say, I believe in science, so I think we need to treat this like a communicable disease .. and whether I like Trump or not, I think we should be wearing masks, you would be ostracized," Johnston added. "You either fit in or you're heavily branded the unusual person."

His sister doesn't think so.

"I don't feel like it's Democrat or Republican wearing a mask. I don't think that has anything to do with it at all," she says, adding she believes President Donald Trump "did as good as anybody with warning the people once he realized how serious of an issue it was."

McMullen sometimes opts to just keep her distance instead, for reasons of convenience.

"It's hard for me to breathe through those masks and I wear glasses, so then they fog up," she told CNN earlier in November. "I wear them where I absolutely have to, but if I don't have to, I just try to keep my distance. I haven't worried about it."

Benien, who spent the majority of her professional life working as a nurse, says she's still baffled at the resistance against masks.

"Nobody likes to wear a mask. As a nurse, I didn't say I'm not going to wear a mask when I go take care of that patient, because they have an infection or they have a compromised immune system. For whatever reason, I was wearing a mask," she says.

For her, wearing one to protect herself and others remains a priority.

"Once a nurse, always a nurse," she says.

Governor urges to 'hunker down'

The county's number of active community cases are now at the highest levels they've ever been. And across Kansas, the governor has sounded the alarm on a concerning spike of cases.

On November 18, Kelly announced a new statewide face-covering protocol applying to local municipalities that previously opted out.

Less than a week later, Norton County's board of commissioners passed a resolution to adopt the governor's orders until December 31, rescinding a previous resolution prohibiting a mask mandate in the county. No enforcement details are listed in the county's resolution.

The state now holds the country's fifth highest seven-day positivity rate and on Thursday it reported record high hospitalization numbers, according to the COVID Tracking Project.

"Ninety-two percent of our state's 105 counties have moderate or high levels of community transmission," the governor said November 25. "I know we all want this to be over, we all want to turn to some semblance of normal but we cannot return... until this virus is under control, until we flatten the curve, until a vaccine is available, widely distributed and vaccination rates are significant."

"Until then, I encourage Kansans to hunker down."

Many Norton residents seemed to have traditional Thanksgiving plans, Benien said, something she worries will in a few weeks translate to more cases.

"If there's one hope I have for our community, because we are a supportive and loving community in a lot of ways and we just need to be kind to each other, you know, wear the mask, follow the protocols so that we can get through this and have it behind us."

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Rebekah Jones, a former state Department of Health employee, said agents knocked on her door around 8:30 a.m. Monday and took her "hardware and tech.""They pointed a gun in my face. They pointed guns at my kids," Jones tweeted shortly before 5 p.m. Monday.

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