‘You can’t have one without the other’: How asymptomatic COVID-19 virus cases spread inside Bethany Rehab

DeKALB – As the positive COVID-19 tests were racking up but the symptoms weren’t, Carrie Baldwin initially thought there was something wrong with the testing in the long-term care facility where she worked.

The director of nursing with Bethany Rehabilitation and Health Care Center, 3298 Resource Parkway in DeKalb, sent an email to the DeKalb County Health Department on Nov. 15 that included the daily log for the facility.

“I am truly questioning this last batch of test kits we received as there is absolutely no one with symptoms,” Baldwin wrote. “We will keep our plan of testing Tuesday and Friday next week of both residents and staff.”

Emails between the health department and Bethany staff obtained by the Daily Chronicle through the Freedom of Information Act show how the facility, which houses upwards of 160 staff and residents, has been battling a months-long outbreak since November.

The day after that email, Nov. 16, Bethany staff would report 12 cases.

Eventually, it would become the second largest outbreak in the county, currently with 109 cases and 10 deaths as of Tuesday. That’s following DeKalb County Rehabilitation and Nursing Center’s 126 cases.

It’s a trend seen throughout nearly a dozen DeKalb County long-term care facilities since the pandemic began: one day, no cases. The next, the deadly virus somehow infiltrates the highly regulated buildings and spreads despite best intentions, resulting in high case counts among staff and residents alike, and deaths in many cases. Such as is the norm these days, long-term care facilities report conducting regular testing on staff and residents, limited or barring visitors from entering the building, and rigorously tracking case spread among inhabitants and staff in an attempt to mitigate viral spread.

Cumulatively, deaths at long-term care facilities account for more than half the 100 reported deaths in DeKalb County to date. Most of those deaths occurred from Dec. 1 onward.

And while daily cases have dropped since the county struggled through a second viral surge that peaked around the holidays, there remain four long-term care facilities in outbreak mode, with Bethany and the county nursing center totaling the highest counts of the virus.

Asymptomatic spread makes the need for regular testing all the more worthwhile, since the virus can appear in someone without a trace.

Messages sent to Baldwin, Bethany administrator Brian Thor, and to Bethany’s parent company, Tutera, seeking comment went unreturned.

DeKalb County Health Department administrator Lisa Gonzalez said local health officials remain in constant contact with staff in the county’s long-term care facilities to help guide them on up-to-date health protocols and provide consultation for mitigation efforts. She said in working with nursing homes, health officials and staff are considering both asymptotic and symptomatic with the policies in place.

“You can’t have one without the other,” Gonzalez said. “Right now, we see both.”

Health officials have reiterated for months the dangers of asymptomatic spread and its prevalence throughout DeKalb County. It occurs in cases where people report no visible symptoms or changes in health, causing people to unknowingly spread the virus to others.

Gonzalez said health department staff work with protocols the nursing homes develop to address both kinds of cases.

“You don’t really deal with them differently,” Gonzalez said on cases which show symptoms or those which don’t. “Remember, most of what the health department is doing is, when a positive person shows up, the positive results come to us and we do follow up with the individual facility based on that positive case.”

Regional facilities battle virus, too

According to the Tutera website, the company runs facilities in Illinois, Missouri, Kansas, Oklahoma, Texas, Alabama and South Carolina. Of the 17 facilities in Illinois, five are in the northern part of the state.

In addition to Bethany in DeKalb, Crystal Pines Rehabilitation and Health Care Facility in Crystal Lake reported 86 cases and 15 deaths in an outbreak that is now closed, according to the Illinois Department of Public Health.

Dixon Rehabilitation and Health Care Center has 43 cases and 11 deaths in an open outbreak as of Jan. 29, according to the site.

Fair Oaks Rehabilitation and Health Care Center in South Beloit had eight cases and is now closed, while Oakley Courts Assisted Living and Memory Care Community in Freeport has not entered outbreak mode yet, according to the IDPH site.

An early timeline

Records and emails obtained by the Daily Chronicle help lay out a timeline by which Bethany Rehab has been battling the disease, including initial confusion regarding test results.

Reporting about a dozen cases on Nov. 16, Baldwin sent an email to the health department containing a spreadsheet with information about the outbreak at the facility, although identifying information was redacted for individual cases, records show.

In her email, Baldwin expressed concern that she didn’t think the results were accurate.

“No changes today. No one has symptoms,” Baldwin said. “I truly feel that can’t be true with this amount of positives and no one has symptoms. Healthlab sent us different tests that we used last time – which I won’t be using again.”

On Nov. 17, Baldwin said that she wanted to talk to the health department after an individual was retested and results showed a negative result instead of a previously confirmed positive one.

“One of the positive staff members that tested on Thursday and resulted Saturday evening – was tested Saturday morning and resulted last night as negative,” Baldwin said. “I feel that there is a test problem and we may not have as many positives as we think.”

But by Nov. 20, the facility was up to 21 cases in staff and three cases in residents.

By that time in November, DeKalb County as a whole was in the thick of the second surge, reporting 586 cases that week countywide, and 615 the week before. Cases were surging across age groups and in seven local long-term care facilities.

Trying to trace

In an email to the department on Nov. 23, Baldwin wrote about a patient that was admitted to Bethany, tested negative at the old facility, and tested positive the night before.

“She was not in my building long enough to get this from our facility,” Baldwin wrote.

The next day the health department asked if the patient, a woman, was admitted from another facility or from her home, and Baldwin responded that the woman was at home before being admitted to another facility, and then to Bethany.

In addition to being a senior living facility, Bethany facilities also welcome those in need of prolonged and supervised senior rehabilitation, whether from a hospital or a home.

On Nov. 25, Baldwin talked about a second resident that had multiple negative tests but tested positive at the hospital without respiratory symptoms.

Five days later, just before the facility publicly reported 43 cases on Nov. 30, Baldwin reported new positive cases, emphasizing some were reported in residents who’d been at multiple facilities.

“All of the above mentioned tested negative on [Nov. 24],” Baldwin said. “So – I have some thoughts – I did not have this resident outbreak until [redacted] admitted, which has been determined not to be a facility acquired. Also, of the 11 positives previously reported with the pink medium all of them have subsequently tested negative.”

However the jump in cases occurred, it kicked into high gear in December. On Dec. 10, the facility reported its first death. The next day there were 51 cases, then 73 cases a week later.

On Dec. 28 there were 85 cases, and on Jan. 4 there were 105 cases and six deaths. As a whole, DeKalb County reported its deadliest month of the COVID-19 pandemic in December, the majority at long-term care facilities.

Early negatives

Before its outbreak around the holidays, Bethany Rehab in DeKalb had reported some cases but, like many long-term care facilities in DeKalb County, had been able to avoid a large-scale viral surge in the eight months the pandemic had raged on so far.

On Oct. 16, the facility was firmly in the outbreak category, though with just two reported cases, both in staff. The facility had reported an earlier outbreak as well, with two cases also. The state health department requires all long-term care facilities to report COVID-19 activity, and considers an outbreak as two or more cases in the same facility.

“We are sorry to hear your facility is back in the outbreak category,” Kathryn Kovack, clinical team leader with the county, wrote in an email to Baldwin. in October “However, we are very confident you know how to move forward from here. … Thank you for all you are doing for your residents and staff.”

Emails show that the remainder of October was spent with Bethany and health department staff corresponding regularly on COVID-19 testing, most of which at that point still came back negative.

On Oct. 21, Baldwin sent an email indicating most of the staff and all residents were tested, and all 163 came back negative.

On Oct. 27, Baldwin reported that three rounds of tests had all come back negative. She also gave an update on the two positive staff members.

“I spoke to [redacted] today – he is still not feeling well,” Baldwin wrote to Runge and Kovac. “I updated the log with his symptoms. He remains off work. I tested [redacted] as a drive by with her new reported symptoms and have taken her off the schedule. She feels that is allergies but I’m trying to be proactive. Please let me know if you have any questions or additional guidance.”

By Nov. 3, Baldwin said they had gone back to weekly testing.

As of Tuesday, surges in COVID-19 cases in long-term care facilities seem abated, but four facilities remain in outbreak mode, with a cumulative 305 cases reported among them, and 18 deaths (most at Bethany and the DeKalb County nursing home, which reports 10 deaths).

Another promising step: the arrival of the COVID-19 vaccine, which has made its way to long-term care facilities in DeKalb County the week of Jan. 16 with the help of a federal pharmacy partnership.

It’s unknown how many of the reported cases at long-term care facilities have fully recovered. Health officials keep facilities in outbreak mode until the sites report no new COVID-19 activity for a month.

• Daily Chronicle reporter Katie Finlon contributed to this story.