In this Aug. 19, 2020, photo, a pedestrian walks past the Maplecrest Rehabilitation and Living Center shown in Madison. Credit: Rich Abrahamson / Waterville Morning Sentinel via AP

The first worker who tested positive for COVID-19 at the Madison nursing home that’s now battling a deadly outbreak of the disease was apparently allowed to work on Aug. 11 even after she reported feeling several different symptoms associated with the illness.

In the employee and visitor screening log at Maplecrest Rehabilitation and Living Center, the certified nursing assistant affirmed that she had a sore throat and a cough, as well as chills that caused shaking and muscle aches that were unrelated to exercise, according to a state inspector who later visited the facility.

The facility’s own protocols stipulated that an employee with at least two of those symptoms should leave work, the inspector found. But the worker reportedly didn’t tell her supervisors about the symptoms, and they didn’t review the log. The direct care worker then put in a 10-hour overnight shift, from 8 p.m. to 6 a.m.

Later that day after she left work, a Wednesday, the worker called Maplecrest’s nursing director to report that “she had been exposed to persons who were positive for COVID-19,” according to the inspector’s report.

She was then taken off the work schedule and tested for the coronavirus herself. The result came back the following Tuesday, Aug. 18: positive.

Now, after three visits between Aug. 25 and Sept. 4, state health inspectors have concluded that Maplecrest’s “failures” to follow federal guidance for screening workers for COVID-19 symptoms “contributed” to the facility’s ongoing outbreak, according to documents the BDN obtained from the Maine Department of Health and Human Services.

As a result of the failures at Maplecrest, Maine DHHS has required the nursing home to come up with a corrective plan and threatened to cut Medicare and Medicaid funding for any new admissions if it doesn’t address the deficiencies by Oct. 1, according to a letter it sent the facility this past Wednesday.

The state agency, which oversees nursing homes for the federal Medicare program, has also imposed a number of new conditions on the Madison facility, including additional training for all its staff and the hiring of two watchdogs: an infection control consultant and a temporary manager with the authority to make changes including the hiring and termination of staff.

For now, there are still a number of unknowns about the nursing home outbreak. Maplecrest’s parent company, North Country Associates, has not responded to multiple phone calls or emails seeking comment.

And while the Maine DHHS documents have shed new light on the outbreak, they contained few additional details about the worker who may have brought the disease in on Aug. 11 and to whom she may have spread it.

They also did not say whether that worker was the same person who is believed to have introduced the coronavirus to the nursing home. State health officials have said that person caught the disease from a parent, who caught it from another child who attended the now-infamous Aug. 7 wedding in the Millinocket area that was the source of a broader, statewide COVID-19 outbreak.

Jackie Farwell, a Maine DHHS spokesperson, declined to confirm whether they were the same person.

What’s plain is how serious the secondary outbreak at the retirement home has become: at least 39 people at the Somerset County facility have been infected, including 15 workers and 24 residents. Six residents have died.

The outbreak has caused stress for both the facility’s residents and their family members. Earlier this week, Amanda Roy expressed concern that her 61-year-old mother, Anna Littlejohn, who recently tested positive for COVID-19, will have a hard time fighting it because of her other health problems.

Roy also said she worries that staff of the nursing home could have contributed to the spread of the disease between different units of the facility because they alternated working in units for residents confirmed to have COVID-19 and units for those who had initially tested negative. The facility’s administrator told Roy that staff were alternating units, she said, but North Country Associates has not responded to that allegation.

The Maine DHHS documents provide yet another example of how the failures of institutions to follow established infection control measures can easily contribute to new outbreaks of the coronavirus.

At least 177 cases of COVID-19 have now been linked to the Aug. 7 wedding in East Millinocket. The disease spread so dramatically at least partly because more than 60 guests packed into an inn on Millinocket Lake for a reception at which they didn’t wear face masks or stay at least six feet from each other, all in violation of the state’s restrictions on large gatherings.

Then, a guest of the wedding who works at the York County Jail is thought to have caught the disease and introduced it to the correctional facility, where staff were not screened for virus symptoms or required to wear face masks. That secondary outbreak has now infected at least 86 people associated with the jail, including 48 inmates.

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