ALBANY COUNTY — State directives on controlling the coronavirus are playing out in new ways at the county level, both for testing in nursing homes and for tracing those who could have come in contact with the virus.

Governor Andrew Cuomo on Sunday announced that hospitals can no longer discharge new patients into nursing homes that have tested positive or were suspected to have COVID-19.

“One of our top priorities is protecting people in nursing homes and seniors. This is where this virus feeds,” Cuomo said at his Sunday press briefing.

He noted that, although New York has one of the highest populations of nursing home residents of any state in the nation with over 100,000 residents, New York’s percentage of deaths in nursing homes is the 34th highest of any state.

He called nursing homes “ground zero” for the virus and said that diagnostic testing will now be required twice a week for both nursing home residents and staff.

Cuomo’s declaration came after weeks of complaints from nursing home managers that state policies were hurting their residents.

“From the onset of this pandemic, nursing homes and assisted living providers and their residents have not been treated as a top priority for assistance with staffing, PPE shortages, and COVID-19 testing,” said Stephen Hanse, president and chief executive officer of the New York State Health Facilities Association and the New York State Center for Assisted Living, in an April 23rd statement. “This was clearly evidenced by the State’s March 25th policy mandating that nursing homes admit hospital patients into their facilities that have a confirmed or suspected diagnosis of COVID-19. This treacherous virus spreads through nursing homes like fire through dry grass and the State’s March 25th policy served to unnecessarily fan the flames of this fire.”

On Sunday, after the governor’s new directive, Hanse issued a conciliatory statement: “In order to further protect our residents and staff, we are grateful that hospitals can no longer discharge new patients into nursing homes that have tested positive or were suspected to have COVID-19 … The only way we will defeat this virus is working together with the State to ensure all nursing homes and assisted living providers are afforded the necessary resources to accomplish this goal.”

On Tuesday, Hanse said that the state needs to provide more test kits for nursing homes and referenced other states where the National Guard is administering nursing-home tests.

“New York has 614 nursing homes with over 140,000 employees and roughly 500 assisted living facilities with over 45,000 employees,” said Hanse’s May 12 statement. “As such, the Governor’s Executive Order requires over 370,000 tests to be conducted every week.

“To date, the State has tested approximately 1.2 million individuals and this requirement will eclipse that total in short order. Consequently, we are requesting the State to direct the supply and allocation of tests to providers and ensure that the test results can be processed in a timely manner. Moreover, providers need the State to ensure additional staff will be available to fill-in for infected employees.”

Going forward, beds that hospitals had set aside for the COVID-19 surge will be used for coronavirus patients until they have recovered and tested negative for the disease.

“I understand the nursing homes’ perspective, but if they cannot provide the appropriate care, they have to call the Department of Health and let’s get that resident into an appropriate facility ...,”Cuomo said on Sunday. “If there’s any issue, the resident must be referred to the Department of Health, which will find alternative care. If a nursing home operator does not follow these procedures, they will lose their license.”

At Monday’s Albany County press briefing, Elizabeth Whalen, the county’s health commissioner, said, “We started last week with our nursing home and with all the nursing homes in Albany County to ensure that we are able to test all residents and staff.”

She called the new directive for twice-weekly testing of residents and staff “a good development but also a very large undertaking.” She said calls were made on Monday to all the nursing homes in the county “to start a discussion around the practicalities involved in doing that.”

Albany County Executive Daniel McCoy said that the state would be supplying the testing materials as well as personal protective equipment to the county’s nursing homes.

Whalen said that, prior to Cuomo’s new directive, nursing home patients with COVID-19 had been “cohorted,” meaning they were housed separately from healthy nursing-home residents. Now, she said, the state is setting up a resource center to enable transfers, and surge-capacity beds will be used in hospitals to defer discharge.

Also at Monday’s county briefing, McCoy announced that two more residents of Shaker Place, the county’s nursing home, had died on Sunday — a man and a woman, both in their seventies and both with underlying health conditions. This brings the county’s death toll to 61 and the death toll for Shaker Place residents to 10.

As of Monday morning,  Shaker Place had 53 residents who tested positive for COVID-19, with eight who have recovered. Also, 14 employees have tested positive and remain out, while 12 others have recovered and been cleared to return to work.

Tracing

While the state is launching and “army of contact tracers,” Whalen said on Monday, “We have our own army of contract tracers who from day one have been following all the cases, ensuring we have contacts, ensuring people have been isolating at home when sick, and ensuring those in contact with ill individuals undergo a mandatory quarantine.”

Cuomo’s directives for reopening require each of the designated 10 regions in New York state to meet seven metrics.  Cuomo announced on Monday that three regions  — the Finger Lakes, the Southern Tier, and the Mohawk Valley regions — had submitted plans that meet those metrics and can, on May 15, begin the first phase of reopening, which includes construction; manufacturing; retail for curbside pickup; and agriculture, forestry, and fishing.

Among the metics — and the one McCoy said would be toughest for the Capital Region to meet — is a requirement to have 30 contact tracers for every 100,000 of population. McCoy said earlier that the Capital Region hopes to submit its reopening plan by Friday.

Albany County alone would need at least 90 tracers; the county’s health department currently has 30. McCoy said on Sunday that he has talked to firefighters and emergency-medical-service workers about serving as tracers.

In order to meet the requirements for diagnostic testing, Whalen said, “We’re looking to partner with the initiative set up through the Bloomberg School of Public Health and the training module at Johns Hopkins.”

The county health department’s staff is doing training this week, Whalen said, so, when state resources are brought to the county, “we’re all on the same page.” This will also include a database, Whalen said, so “everybody is operating from the same playbook.”

Whalen said she believes the 30 tracers currently working in her health department had met the needs since the pandemic struck Albany County in early March “because of the testing that we’ve been able to do and because we have staff that are working long hours and are very dedicated to doing what they do.”

Currently, Albany County has 1,363 confirmed positive cases of COVID-19 with 847 people under mandatory quarantine and 15 people under precautionary quarantine. As of Monday morning, 3,294 individuals had completed quarantine, with 823 of them having tested positive and recovered.

Going forward, she said, there will be an exponential increase in the number of tests that are being done. “We will need additional resources,” said Whalen.

She went on about the work of tracing, “I expect it will be exactly the same as what we’ve been doing. Contact tracing is pretty formulaic,” she said, describing the process as talking to an individual who has tested positive, and making lists of the people that individual has come in contact with, then “reaching out from there.”

“It’s very detail-oriented work,” said Whalen. “What will be a little different is we’ll all be operating off the same database.” The work will be done remotely, she said, “off the same playbook.”

Whalen also said that, while she doesn’t know what testing the state will next mandate, “What makes sense to me is we would start where we know vulnerable individuals are, with the nursing homes.”

She went on, “Another piece of this is the risk.” In places where everyone wears a mask and uses good hand hygiene — for instance in a retail setting or in her own health department — the risk is low, she said.

“In a nursing home, it’s not always possible for patients to wear PPE,” whalen said of personal protective equipment like masks and gloves. “Where people are vulnerable and cannot wear masks to protect themselves, it makes sense we could continue testing.”