Life is slowly returning to normal for Dr. Carl Shrader, the medical director of Sundale Rehabilitation and Long-Term Care, as well as its residents and staff.
For almost three months, Shrader, who is also a WVU Medicine physician, was consumed with trying to figure out how COVID-19 works and contain the virus to protect the nursing home’s 80-plus residents, who have an average age of 85.
“I felt I had been pushed to the edge many times,” he said during a recent interview in a conference room at the facility.
Now after dealing with more than 50 cases of COVID-19 — both staff and residents — Schrader learned Saturday the last confirmed case at Sundale, an 83-year-old asymptomatic woman, is also negative.
There are no more positives in the facility.
What Shrader accomplished — mostly clearing the facility of the virus — has not been easy. There were good days and there were bad days, but he has emerged wiser about the virus and appreciative of the regular mundane things of life, such as spending time with his wife Erica and their three children, ages 10, 8 and 6.
“I am grateful for what normal looks like,” he said.
Indeed. As a safety precaution, Shrader and his wife decided to send their children to her mother’s to stay and keep them safe from the virus. They only recently returned home.
“I saw them the first time Easter Sunday,” said Shrader as he showed a visitor a picture of his children, Andrew, Elizabeth, and Nate.
What is it?
COVID-19, short for corona disease 2019, is an infectious disease that attacks the respiratory system and is caused by the coronavirus 2. There are just under six million cases in 188 countries across the world.
According to the Centers for Disease Control and Prevention, symptoms of the virus show up two days to two weeks after exposure.
rimary symptoms include cough, fever and chills, shortness of breath and difficulty breathing, muscle and body aches, headache, fatigue, a loss of taste and smell, sore throat, congestion or runny nose, nausea or vomiting and diarrhea.
People can also have the virus and not show any symptoms at all.
People who are more at risk for COVID-19 — first identified in Wuhan, China in December — are those 65 and older, or live in a nursing home or long-term care facility.
Other coronavirus risk factors include obesity, kidney disease and diabetes – all prevalent in West Virginia, which also has an older population.
In Monongalia County, there have been a total of 121 confirmed cases and 99 people have recovered. Statistics from the state Department of Health and Human Services as of May 27 show 61.7% of the confirmed cases in the county were females, and 33.59% of the confirmed cases were people 70 and older. The state said 82% of the confirmed cases in Monongalia County are Caucasians.
COVID-19 shows up
It started back in March at Sundale with a resident in her 70s. The woman was at the nursing home recuperating from a stroke. Shrader said she was sent to nearby Mon Health Medical Center for treatment of a urinary tract infection. Once treatment was completed, she was returned to Sundale.
In the early morning hours the following day, however, the woman’s temperature spiked and she was then sent to J.W. Ruby Memorial Hospital, and was tested for the virus. She was positive. The date was March 22 and the state of West Virginia — the last state to report a confirmed case of the virus — was waking up to a new reality. COVID-19 had arrived.
Right after the woman’s diagnosis, four more Sundale residents developed respiratory issues, one of the main symptoms of the virus.
“I called Ruby,” Schrader said. “They had four isolation rooms in the emergency department.”
Shrader said he was asked to keep the people with confirmed cases at Sundale because the hospital was afraid of being overwhelmed with positive cases. Only two patients at a time were sent to Ruby, he said.
But the genie was out of the bottle at Sundale. Because the infectious virus was spread by droplets, Shrader knew he had to take action.
The spread and mitigation
Shrader said he had to start testing people. The West Virginia National Guard stepped in to help with the testing at the facility.
“I wanted to avoid a repeat of Kirkland,” said Shrader, referring to the Washington state nursing home where a COVID-19 outbreak started and led to dozens of deaths.
Because the novel coronavirus is contagious, Shrader and his staff created a COVID-19 unit on the first floor of the building’s eastern wing. All of the positive patients were moved into that wing and their rooms were disinfected.
The virus tends to start in the upper respiratory tract. The most common COVID-19 test, is a nasal swab.
When getting a nasal swab to test for COVID-19, a long stick with a soft brush at the end is inserted far back in the person’s nostril and twirled around for several seconds to collect cells and fluids. If done right, the test will cause a person to tear up and sometimes will trigger a gag reflex if the back of the throat is touched. The sample is then sent to a lab for testing. Results are typically available in several days.
Because of the newness of the virus, Shrader said he had trouble getting a hold of testing materials, but was able to finally get some from Ruby and Mon Health Medical Center, as well as the state. By March 24, 50 patients and 46 staff members had been tested.
“We knew the incubation period was two weeks,” he said.
But, it still took days to get the results back. Results for the first case did not come back until April 6 and the results for the next round of tests took a week to come back.
But Shrader, who eventually had more than 20 confirmed cases of the virus at one time at the nursing home, had leverage plus an April 15 mandate from Gov. Jim Justice to test all residents and employees of nursing homes for the virus ensured he had supplies and could test weekly.
The Justice-mandated testing caught nine asymptomatic cases at Sundale on April 22. No employee or contract worker was positive, Shrader said.
Now the Centers for Medicare & Medicaid Services, a department within the federal Department of Health and Human Services, is recommending what Sundale did at the beginning of the pandemic, weekly testing and isolation, for other facilityies, Shrader said.
Sundale staff
Shrader is quick to praise Sundale employees and contract workers for their dedication when the pandemic was at its height.
“They’re like family to me,” said Shrader, who shared a Certificate of Recognition from the governor to Sundale nursing staff for their work during the pandemic.
Nurses and aides who worked on the COVID-19 wing were also given a $3 an hour raise, while employees who worked with non-COVID patients received a $2 an hour raise. Some of the outside therapists who work with Sundale residents received a $7 an hour increase.
Despite the hefty raises, life has not been easy for Sundale employees. Some took up temporary residence at the Holiday Inn Express to keep family and friends safe.
Laura Pingley, a registered nurse, has been at Sundale for 15 years. She worked on the COVID floor and admitted being scared when the pandemic first broke out.
“I took an oath and the job supersedes that,” she said. “My dad calls me his hero.”
For Tracy Atwood, a licensed practical nurse, who also worked with COVID-19 residents, said her biggest fear was taking the virus home to her 11-year-old daughter, Jessica, who has been staying at her grandmother’s. Atwood has been living at the Holiday Inn Express.
“She is still there, but I got to see her this weekend,” Atwood said. “I have a son in Pittsburgh. His fiancée won’t let me come see him. …It has been stressful. You wonder if this is going to ever end.”
Lessons learned
COVID-19 was new and came with a learning curve.
Shrader said he learned that he did not have to immediately send a positive patient to the hospital. Instead, he said because the coronavirus affects the respiratory system and the patient develops low oxygen levels, the best option is conscious sedation. Also positive residents were put on their stomachs for several hours at a time to expand lung capacity.
Schrader might do things differently, given the chance.
Communication with staff should have been handled differently as well, he said.
“I was in survival mode,” he said. “They wanted to know what was going on.”
One of the best decisions he made, however, was to allow the residents to have video meetings with their families. This way, he said, family can talk directly with a loved one and find out how they are. For the time being, however, no direct visitation is allowed. Shrader said there are discussions underway at the state level to change this policy. And Sundale is working on other options to bring people face-to-face again.
Shrader has applied for a grant from WVU Medicine to study the antibodies a person develops after having and recovering from the virus. He wants to study whether a person can develop an immunity against the virus and how long it will last.
“We have to co-exist,” he said. “This is not going to go away for a while.”
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