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Staff photo by C.B. Schmelter / NHC HealthCare is seen on Monday, April 6, 2020 in Chattanooga, Tenn.

This story was updated at 10:17 a.m. on Tuesday, April 7, 2020, with more information.

More than 150 residents and staff at nursing homes in Tennessee have tested positive for COVID-19, but unlike neighboring Georgia, the state will not say how many senior-living facilities have seen infections.

Long-term care facilities across the country have been sources of COVID-19 outbreaks — sometimes called "clusters" or "hot spots" — drawing attention for large numbers of coronavirus- related fatalities. At least 40 coronavirus deaths are connected to a Life Care nursing home in Kirkland, Washington, which emerged as an early center of the coronavirus pandemic in the United States.

Long-term care facilities are susceptible to deadly outbreaks of the virus, because close quarters help the virus to spread quickly, and COVID-19 is more likely to cause serious illness in older, unhealthy people. Eight of Hamilton County's nine coronavirus-related deaths have been in people between the ages of 65 and 81, according to data from the county health department.

In Chattanooga, at least one COVID-19 case was confirmed in a resident at NHC HealthCare, in Glenwood, in late March. The patient tested positive for COVID-19 after being transported to the hospital, according to a letter sent from the nursing home administrator to families on March 24.

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Becky Barnes, Hamilton County Health Department administrator, said during a press conference on Monday that there are currently no additional cases or known clusters of COVID-19 within nursing homes in Hamilton County.

But in other parts of the state, such as Gallatin and Cookeville, large hot spots of the virus have emerged in the past week.

More than 100 people — 74 residents and 33 staff members — tested positive for the coronavirus at Gallatin Center for Rehabilitation and Healing, the Tennessean reported on April 2. Many of those people were hospitalized and five residents have died.

The Tennessean also reported 28 patients and 16 employees at Signature HealthCARE of Putnam County tested positive for the coronavirus last week. The facility had 320 employees and patients tested after two COVID-19 cases were identified. The "vast majority" of the group that tested positive were "symptom-free," meaning they could have unknowingly spread the virus to others, according to the Tennessean.

A spokesperson for NHC in Chattanooga did not respond to questions asking if staff or residents had been exposed to the virus, how many others were tested and if any additional residents were taken to a hospital. Instead, the spokesperson sent the following emailed statement:

"The center had already taken steps to isolate the patient when symptoms occurred to prevent additional exposure prior to hospitalization per CDC and CMS recommendations," the statement said, referring to the U.S. Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services. "No partners [employees] have reported positive test results at this time. We can confirm no additional patients at NHC Healthcare Chattanooga have tested positive at this time."

Spokespeople for the Tennessee Department of Health and the office of Gov. Bill Lee failed to release data or respond to questions asking how many cases of the virus were confirmed in long-term care facilities across the state and in which nursing homes the virus was confirmed as of press time on Monday. The Chattanooga Times Free Press first requested this information on April 1.

During a press conference late Monday, Tennessee Health Commissioner Lisa Piercey responded to a reporter's questions about COVID-19 data for long-term care facilities. She said the department is currently working to compile that information, but it's outside typical protocol.  

 "We just started collecting that information, and so we have to get through that process of collecting that information. But we are working towards being able to identify those results," Piercey said. 

At least 47 senior-living facilities in Georgia have a confirmed case of COVID-19, according to data released Friday by the Georgia Department of Public Health. The closest facilities to Chattanooga reporting coronavirus cases were Maple Ridge and Townsend Park in Cartersville. However, the report didn't include how many cases were at each facility that would indicate if there were any outbreaks, which is defined as having two or more cases.

State regulators and the Centers for Medicare and Medicaid Services conducted an inspection of the Kirkland Life Care facility on March 16, finding serious infractions that they said placed residents in immediate danger. The center is one of more than 250 nursing homes and senior facilities in 28 states that are owned and operated by Life Care Centers of America, based in Cleveland, Tennessee. Federal authorities have since proposed a $611,000 fine for the facility.

The Kirkland outbreak prompted the CDC and CMS to issue strict guidance, calling on long-term care facilities to limit non-essential visitors, cancel all group activities and communal dining, and implement active screening of residents and staff for fever and respiratory symptoms.

On Friday, Life Care Centers of America spokeswoman Leigh Atherton said in an email that "no Chattanooga-area Life Care facilities have a confirmed case of COVID-19," and the facilities are working to safely engage residents through window visits, room activities, and phone and video calls.

In Tennessee, an executive order by Lee turned some of the CDC guidance into law by banning all visitors from entering "nursing homes, retirement homes, or long-term care or assisted-living facilities, unless to provide essential assistance or to visit residents receiving imminent end-of-life care, provided such visits may be accomplished without unreasonable risk to other residents."

Kristi Wick, the Vicky B. Gregg Chair of Gerontology at University of Tennessee Chattanooga, leads a task force known as "COVID-19: Older Adult Community Response." The group is focused on the needs of older adults in Southeast Tennessee whose lives are now impacted by the coronavirus.

Wick said so far the group has worked primarily on securing needed supplies and food for isolated seniors, because keeping them healthy at home is key to keeping them out of nursing homes and hospitals. Group living situations, including independent living or congregate housing sites, are one of the task force's major concerns.

"We've been trying to provide guidance out there. Everyone seems to be on track with trying to follow the CDC's guidelines for cleaning common areas and things like that, but [congregate housing] along with the assisted livings, nursing homes and all the towers, they're a particular concern for hotspots, for sure," Wick said.

Since nursing home infection rate data is normally monitored, Wick said it's likely that COVID-19 is no exception.

"I'm sure somebody is tracking it on some level. It's just how much transparency there is around it, and part of that may not necessarily be on purpose," she said. "It's just a matter of everybody trying to handle so much information at one time. There's just not enough way to get it all put together, but I feel certain someone's tracking it."

Staff writer Andy Sher contributed to this story. 

Contact Elizabeth Fite at efite@timesfreepress.com or 423-757-6673.

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