Westminster Canterbury in Richmond, which has nearly 900 elderly residents, was home to Virginia's first known COVID-19 infection at an assisted living facility. (NBC12)

By March 12, Westminster Canterbury Richmond — a nearly 900-resident senior living facility near the city’s picturesque Bellevue neighborhood — was on lockdown.

That day, staff got the news that a resident in neighboring Hanover County had tested positive for COVID-19, the disease caused by a new strain of coronavirus. The proximity of the case activated the emergency response plan at Westminster Canterbury, which offers independent and assisted living as well as a nursing facility, said CEO John Burns.

“We closed our manned gates and kept two tented entrances where people could be screened,” Burns added. From that day onward, visitors were restricted. Patients and staff members had their temperatures taken before they stepped onto the property. They were asked a series of questions, too — had they traveled, did they have contact with people who had? Did they have any symptoms of the disease?

“Our criteria was, if it’s in the vicinity, we’re shutting down,” Burns said. “We knew this thing was coming.”

The strict new measures still didn’t prevent COVID-19 from getting in. The week before, a male resident and his wife returned to their independent living apartment from their home in Florida. On Friday, March 6, the man fell in his apartment and was admitted to the nursing facility. Burns said nobody there suspected COVID-19 — he didn’t have a fever or shortness of breath. But his mental state was declining, so he was admitted to VCU Medical Center for further treatment.

“I guess because of the circumstances and his travel history, they decided to test him there,” Burns said. “And he tested positive.” Burns learned about the result at 9 p.m. and worked overnight to make sure residents — and staff — were prepared for what came next.

Burns credited the facility’s detailed preparations — and intensive efforts to contain the disease once a positive case was confirmed — with preventing the spread. Staff dropped notes at the entrance of every apartment, informing residents they couldn’t leave their units. The facility screened a 9 a.m. television briefing to spread the news about the case. And staff worked with the Richmond City Health District to identify every known contact of the couple since their return from Florida. 

Burns said those included approximately 288 other residents — and a few staff members — who attended the same Capitol Steps performance at Westminster Canterbury’s performance arts center.

“They all come out of quarantine tomorrow morning,” Burns said in a phone interview on Monday. Residents are still strictly restricted from leaving the grounds, unless they have a vital medical appointment.

To date, no other resident has come down with symptoms of COVID-19 or required testing for the virus. The resident who tested positive was admitted to the intensive care unit at VCU, but Burns said he’s in the process of recovering. 

His wife — who’s able to Skype with him from the facility — didn’t meet the state’s criteria for testing. Burns said her results are pending with LabCorp, but she’s never shown signs of the disease.

“She’s well and fine and active,” he added. “But I can tell you — I’ve been in this business a long time and I’ve never experienced anything like this.”

Burns was referring to the coronavirus outbreak — which he described as “the greatest public health crisis of our time” — but also to the current guidelines for nursing homes and assisted living facilities across the commonwealth. While both are required to maintain infection control programs, Burns said the current recommendations are unprecedented in his roughly 15-year career.

There’s good reason for it. While there’s mounting evidence that COVID-19 can cause severe illness even in younger patients, elderly adults are still at much higher risk of dying from the disease. Co-occurring conditions, such as heart or respiratory disease, can also increase mortality rates.

It’s unclear exactly how many of Virginia’s 254 cases are nursing home or assisted living residents. There have been at least four cases at Canterbury Rehabilitation and Healthcare, a separate, unaffiliated Richmond nursing facility with 190 beds, and another case at The Kensington Falls Church, an assisted living and memory care facility in Northern Virginia. One of the state’s three most recent deaths was a woman who lived in a long-term care facility in James City County.

But in a news briefing on Sunday, state epidemiologist Dr. Lilian Peake said that the Virginia Department of Health didn’t know the total number of positive cases at nursing homes or assisted care facilities across the commonwealth. Health Secretary Dr. Daniel Carey later clarified that local health departments did collect that data.

Virginia State Epidemiologist Dr. Lilian Peake updated General Assembly lawmakers Thursday on the state’s response to COVID-19. (Ned Oliver/Virginia Mercury)

“In terms of the cases, our local health departments — they know it’s Mr. X or Mrs. Y at a particular location,” he said. “We do know at the local health department level. She was really talking about protecting individuals’ privacy and not revealing protected information.”

Regulations for nursing homes come from the federal Centers for Medicare and Medicaid Services, with the Virginia Department of Health responsible for enforcing them, said Amy Hewett, the vice president of communications and strategy for the Virginia Health Care Association-Virginia Center for Assisted Living (VHCA-VCAL). She said it was also important to note the difference between nursing homes — federally regulated, with more stringent restrictions — and assisted living facilities, which are overseen by the state’s Department of Social Services.

But both have taken steps to significantly reduce the risk of exposure to elderly patients. On March 13, CMS issued new guidelines recommending that nursing homes immediately restrict all visitors and “nonessential personnel” such as barbers and other personal care workers. The agency also recommended canceling all group activities and actively screening residents and staff for symptoms.

VDSS issued identical recommendations on March 17, Hewett said. And the agencies represented by VHCA-VCAL — which include 345 nursing facilities and assisted living facilities across the commonwealth — are “following the CDC guidelines for screening for symptoms of COVID-19, implementing protective protocols like providing in-room meal service versus communal dining and modifying their activity programs to employ social distancing,” she wrote in a follow-up email on Monday.

Dana Parsons, the vice president and legislative counsel for LeadingAge Virginia (an association of nonprofit senior living services) said her members had also been actively implementing infection control plans for COVID-19 even before the disease was discovered in Virginia. 

Even with federal and state guidelines, Burns said there could still be differences in how protocols and policies are implemented. Westbury Canterbury, for instance, has the resources to go above and beyond — including a dedicated travel log to track residents and staff who travel outside the state and ensure they’re quarantined upon return.

But not every facility has the same resources, he added. Inspection guidelines from CMS are also changing frequently. On Monday, the Virginia Department of Health — along with other health agencies across the country — was directed to suspend most in-person inspections for the next three weeks and prioritize high-priority cases, including “targeted infection control surveys” of identified providers. It’s not clear exactly which facilities will be included in those surveys.

“I know there are facilities with more than one case,” Burns said. “And that’s a tragedy. Job one, when you have a positive case, is to keep it at one case. And I don’t know if everyone has the capacity to do that.”