First official nursing home death from COVID-19 may offer clues
Could help health officials learn more about virus’s surge through state’s facilities
Protected by masks and gowns, Patrick Riel’s family gathered by his bedside at Johnson Memorial Hospital in Stafford Springs on March 20 to say goodbye.
When he passed, Riel became the first nursing home patient in the state confirmed to have died of the coronavirus — shocking his family and nursing home officials. The 88-year-old National Guard veteran had been at the
Evergreen Health Care Center in Stafford Springs for less than a week, undergoing rehabilitation after a stay at Rockville General Hospital. At the time, Connecticut’s epicenter of COVID-19 was 90 miles away in Fairfield County.
Despite an internal review by Evergreen owner Athena Health
Care, how Riel caught the deadly virus is as much a mystery today as it was on March 20. How did an avid fisherman and lung cancer survivor rehabilitating in a small nursing home become infected?
What happened inside the Evergreen Health Center following Riel’s death was an ominous sign of the devastation to follow — a road map into how the insidious virus was about to spread through facilities Gov. Ned Lamont called “petri dishes.” The march of the infection left a trail of death that took months to curb, taking nearly 2,800 lives — about twothirds of the total deaths in the state.
What the state did — or didn’t do — at Evergreen could offer a key window into how the virus spread so quickly at long-term care facilities across the state. Within two weeks, 10 residents at Evergreen would be dead — suspected of having COVID-19, according to death certificates obtained by The Courant. More than a dozen staff members got sick.
Across the state, nursing home staff have complained there wasn’ t enough personal protective equipment (PPE) at the facility, and there have been widespread concerns that a failure to move more quickly to test residents and staff allowed the virus to spread unchecked. Last week, Lamont hired a New Jersey company to do an independent review of what happened.
Riel’s family has questions of their own such as: Why did the state not do any contact tracing after his death given he was among the first people in the state to die of COVID-19? And why was no one in his family tested even though several signed the guest book and visited him at Evergreen?
A string of deaths
Within 36 hours of Riel’s death a second patient at Evergreen, Daniel Dimmock, died. Officials knew he had COVID-19 because he had tested positive. Riel also was tested for the virus at the hospital, but his result was inconclusive, family members said.
Then, three days after Dimmock’s death, two more patients died — both suspected of having COVID-19. At least one of them who was not in the same short-term unit as Riel and Dimmock, suggesting the virus was on the move inside the building. Within two weeks there would be 10 total suspected COVID-19 deaths in Evergreen from different parts of the building.
More than a dozen staff members also got sick, including the cook, many of them complaining that there wasn’t enough PPE available — a familiar refrain — and that staff were entering rooms with potentially infected patients without proper equipment.
Even as the virus spread, state officials decided not to test all of the patients in Evergreen. Many of the staff got tested privately, on their own.
“We did everything the protocols at the time told us to do,” Athena Health Care Marketing Director Tim Brown said. “We isolated the people who were sick, limited the staff that had access to them.
“We asked the state to test everyone, but back then tests were limited.”
DPH only had two test “kits,” or roughly 1,200 tests, at the time.
Privately, several nursing home providers say they believe the state’s response at the beginning of the pandemic was focused on protecting the hospitals because of fears the state’s critical care network would be overwhelmed. They believe crucial PPE and COVID tests went to hospitals rather than nursing homes.
At the time, CDC guidelines were still largely focused on symptomatic transmission and didn’t warn that people who had the virus and were asymptomatic could still pass it to others as they “shed the virus.” It would be weeks before state officials would have any idea how deeply the virus had already spread across the state.
Connecticut Department of Public Health officials did not respond to a request for comment.
Brown said Athena in late April eventually decided to use a private lab to test every resident at Evergreen. As of last week there had been 20 total deaths at Evergreen — half of them within two weeks of Riel’s death.
It would be months before the state had the testing capacity to launch a full scale testing program inside the nursing homes. Mass testing allowed state officials and providers to get a clearer picture of who actually had the virus even if they weren’t showing symptoms and to cohort them before they started shedding it.
It was only then that the virus was tamed inside long-term care facilities.
A sudden onset
Patrick Riel’s rehabilitation stint at Evergreen Health Care Center was only supposed to last a few weeks. But just days after he entered the facility, he suddenly couldn’t breathe.
The 88-year-old Connecticut National Guard veteran who liked to make stress balls out of yarn and hand them out as gifts had come to Evergreen from Rockville General Hospital in early March. A lung cancer survivor, Riel’s oxygen levels were low so he was hospitalized.
Family members said when he transferred to Evergreen, he was walking the hallway with assistance from staff until one day he started having trouble breathing. He went into the hospital about a week before he died and was tested for COVID there a few days later.
When it was inconclusive, a second test was taken on March 17, but his condition had worsened by then. Three days later, hospital officials called family members to come and say goodbye. Riel, who had been widowed twice, had a big family, including nine children and stepchildren and 14 grandchildren.
Early on the morning of March 20 his family members — all wearing full personal protection equipment — stood by his hospital bed as he died. Riel was the fifth confirmed COVID-19 death in the state, but the others were all in Fairfield County. Riel’s family suspected he had COVID-19, but it wasn’t until the morning after his death that the funeral home director told them he had indeed tested positive for the virus.
As Lamont was announcing the first death of a nursing home patient from COVID-19, Riel’s family members started putting together a timeline of where he had been and who he had contact with to try to understand how he might have become infected and who else might be at risk. They assumed DPH would be contacting them, but they said that never happened.
“None of us heard one word from the state or the CDC,” said Diane O’Hagan, Riel’s sister-in-law.
She said a few family members had visited Riel at Evergreen and had signed the visitors log at the front desk.
“We were really surprised,” O’Hagan said. “We thought they’d at least go through the sign-in sheet at Evergreen.”
They expected to be asked about their contact with Riel, especially since he had only been at Evergreen for a few days and had previously been in Rockville Hospital. Several family members had visited him at both locations. When no one from the state contacted them, family members who had been in contact with Riel self-quarantined on their own. Three family members eventually got tested and were negative.
“He was in pretty good shape when he got there, but he went downhill very quickly,” O’Hagan said.
The family still has no idea when or where he caught the virus and whether he was patient zero for the deaths that followed at Evergreen.
“He didn’t die there, but it doesn’t mean he didn’t get it there. It’s something we will never know,” O’Hagan said.
The state also did not respond to additional questions about Riel’s death. The review of what happened in the nursing homes announced last week is expected to cover the rate of transmission within facilities, staffing levels, availability of PPE, availability of testing, staff expertise and skill levels, and the establishment of the four COVID recovery centers.
Dialysis patients a factor?
How coronavirus got into some nursing homes and not into others remains an open question. Was it brought in by staff, who picked it up outside the buildings? Did residents coming from other facilities or the outside bring it with them?
In the past few weeks, Athena has created an internal task force to review it’s response to the virus. Brown said they have studied six facilities so far and believe that in four instances the first person who got the virus was a dialysis patient who had left the building for treatment, potentially bringing it back with them.
“Normally almost every day a nursing home resident is going to the doctors or for a medical appointment, but once the lockdown went into effect only patients who were getting dialysis or chemotherapy treatment were allowed out of the building,” Brown said. “There were lots of opportunity to get exposed to the virus once they left the building: ambulance personnel, hospital staff, other patients getting treated.”
Dr. Richard Feifer of Genesis Health Care, which runs Kimberly Hall North in Windsor, said federal standards are less rigorous for dialysis centers than they are for nursing homes. Kimberly Hall North was hit hard, with 46 deaths.
“The pandemic also underscores the clear health benefit of offering hemodialysis at the bedside within a nursing home using portable equipment,” Feifer said. “We are exploring ways to make this happen, but it will need government endorsement and approval, and payer support.”
Brown acknowledges there is no way to know for sure how the first patients got the virus and that another possibility is staff brought the virus in from the outside. But they have shared the dialysis theory with other providers because “it’s the only thing in these cases we can attribute it to.”
“If you look back, the virus either came into the building through asymptomatic staff that we didn’t know at the time could spread the virus or through hospital patients that we were admitting later on,” Brown said.
A fifth case was a woman who went with her family on an outing to the Danbury Fair Mall just before Lamont announced the lockdown.
The sixth case is Riel, and they are still stumped as to whether he brought the virus to Evergreen or contracted it before he arrived from the hospital for his rehab stint.
“It still just doesn’t make any sense how the virus came to Stafford Springs,” Brown said.
“We did everything the protocols at the time told us to do. We isolated the people who were sick, limited the staff that had access to them.”
— Tim Brown, Athena Health Care marketing director