ARKANSAS, USA — While cases of COVID-19 rise and fall and affect different groups of people, a known constant understood by public health experts is the danger the respiratory virus poses to nursing home patients.
Despite that knowledge, efforts to keep the virus out of nursing homes and long-term care facilities are often hampered as the disease spreads in the community regardless of how tightly controlled the facilities are.
"What we do know is that this virus disproportionately affects the frail and elderly population and that's exactly who we serve," said Rachel Bunch, the executive director of the Nursing Home Trade Group, the Arkansas Health Care Association.
Through October, roughly 40% of the 1,800 deaths in Arkansas came to people in nursing homes. The Arkansas Department of Health typically issues reports on nursing home cases twice a week.
The fatality rate has been constant despite lockdowns and re-openings, though lately with spreading taking place in more rural areas, the danger to long-term care patients has grown.
"We have actually gone from one of the better performing states in the last few months to actually one of the not-so-well performing states," said Dr. Naveen Patil, the ADH medical director for infectious diseases.
Both the AHCA and the health department say the guidelines and restrictions in place for nursing homes closely mirror those handed down from the Centers for Disease Control.
The testing of staff is taking place weekly and often twice weekly. Visitors can only see their loved ones in person if a facility has been infection-free for 14 days.
Dr. Patil says inspectors and disease experts have been on the lookout for nursing homes falling short in their protective measures, but there aren't any recurring patterns in the state.
Yet the fatality rate remains constant.
"No one goes to work saying that, 'you know, I'm going to harm a patient.' Everyone is trying to do their best," Dr. Patil said.
"The major determinant, what we feel, is the increased number of cases in the community."
The report generated by ADH has undergone revisions and hasn't shown the public outbreaks in progress. Information often comes in from the individual facilities or parent companies and often may go without updates for several weeks.
The Oct. 26 report lists cumulative totals as well as columns of new and active cases.
The department also provided THV11 with a table listing every nursing home fatality since the start of the pandemic.
The top 6 deadly homes show the sporadic nature of nursing home containment in the state.
The Springs of Batesville leads the state with 21 deaths among its residents.
There are homes spread from El Dorado to Pocahontas among the top 6 and 25 facilities have at least 10 deaths.
They didn't all happen at once or in the same wave of case increases.
Second on the list is Hot Springs Nursing and Rehab with 20 deaths.
The facility has twice reported outbreaks that accounted for the high numbers, but twice they have controlled those outbreaks and listed no active cases on Monday's report.
"It's one of those things we can't explain about this virus," said Dr. Patil. "You can have two homes doing the exact same thing. The virus will get into one and go through it like a wildfire. The other home will see very little."
The parent company of The Springs of Batesville has two other properties with 10 or more fatalities and five total properties with active cases on Monday's report.
"The Springs is in constant contact with ADH, [Office of Long-Term Care] and the AHCA each and every time that a new case is identified and we strictly follow their guidance every step of the way," the company said in a statement.
"The situation we face — that all Americans face — is as heartbreaking as it is unprecedented. We feel nothing but gratitude toward our professional staff, who have gone above and beyond the call during this crisis, and continue to do so."
Despite the dire and dangerous situation in many places, families continue to weigh the risks and want to see their loved ones.
"The majority of calls that we receive and the majority of people that we hear from want to do more visitation," Bunch said.
Bunch and Dr. Patil indicated stakeholders will be meeting this week to develop plans for holiday visits. Advice and caution given to those families will sound a lot like that for everyone in a community.
The chances of getting inside a nursing home will improve if people curb the spread outside in the community.
"What I would encourage is for all facilities to continue to take all the precautions that they can," said Dr. Patil. "Basically, masking is one of the easiest things you can do."
The largest nursing home outbreaks in central Arkansas are both in North Little Rock, with Lakewood Health and Rehab and The Waters reporting 115 cases between them, though no new cases reported Monday.
The largest active outbreak in the state is in Walnut Ridge at Lawrence Hall Health and Rehab with 149 patients and staff listed as positive in Monday's report, down from 164 ten days earlier.