It was a dry run nobody want-ed to have. Even as a nursing home has emerged as the epicenter of a COVID-19 outbreak in Washington state, a different virus – norovirus, the highly contagious stomach bug that comes on quickly and dramatically – has been tearing through multiple facilities in Vero Beach.
The virus, perhaps best known for its outbreaks on cruise ships, has sent a stream of seniors to the hospital, put others in quarantine, and has cleaning staffs scouring surfaces from elevator buttons to saltshakers.
More than 200 residents of the Isles of Vero in both independent and assisted living were still confined to their apartments as of late Monday after 32 people came down with gastrointestinal illness last week. Over the weekend, residents were notified by letter that Isles management hoped to be able to get back to normal by mid-week.
A couple of miles west at The Brennity, residents were over their earlier “flu shut-down,” according to the family of one couple living there.
Calls to Brennity management were not returned by press time, but the Health Department said while norovirus is often called the stomach flu, it is not influenza virus. There are no flu virus outbreaks at this time, a spokeswoman said – meaning whatever afflicted Brennity residents was something other than the flu.
Suspected norovirus cases were up this week over last in multiple “facilities,” said Health Department spokeswoman Stacy Brock on Monday, though she refused to further describe what sorts of facilities were involved, if any, beyond senior living.
The department doubled down on its message to the community at large to wash hands frequently – hand sanitizer does not work on norovirus. It also urged people to stay at home if sick, and for 24 hours after symptoms stop.
“Healthy people usually recover within one to three days at home without medical care,” said Miranda Hawker, director of the county’s Health Department. “But the very young and the elderly are at greater risk for dehydration and severe illness.”
The illness typically lasts one to three days, with an onset of symptoms – nausea, diarrhea, vomiting, muscle aches and low-grade fever – within 24 to 48 hours of exposure. People can spread the disease while they have symptoms and for several days after. Patients must be symptom-free for 72 hours before isolation orders are lifted.
No deaths have been reported in the current norovirus outbreaks, the Health Department said Monday.
Word of the outbreaks began to spread early last week after Indian River County Fire Rescue sent out an operations advisory email concerning Isles of Vero after experiencing “a sudden increase in calls related to nausea/vomiting.”
“The staff has not yet been able to pinpoint a root cause as most of the patients are from the Independent Living area,” the memo read. Residents in independent living tend to circulate more, including outside the facility, than those in assisted living.
Multiple reports say COVID-19 can also have symptoms of diarrhea and vomiting, especially early in the disease’s progression. But there was no mention of testing for COVID-19 among the suspected norovirus patients, and not all patients were tested for norovirus either, according to the Health Department. As of Monday, officials said some patients’ tests had come back positive for norovirus; they were still waiting for results on others.
By Friday, things were looking up at the Isles, four days after the outbreak became obvious.
“The infection was contained. The afflicted residents are recovering,” said Lou Iannuccilli, executive director of the Isles, in an email late Friday evening.
But by Monday, things were in doubt again, with confined residents getting a notice over the weekend that it would likely be mid-week before they could see their neighbors and have meals together.
The scare began in earnest on the preceding Tuesday morning, March 3. With residents’ TVs tuned to non-stop COVID-19 updates, an unsettling parade of ambulances was pulling up to the Isles portico to take people to the hospital.
As one ambulance, believed to be the fourth of the day, sent masked paramedics inside with a stretcher, one resident rose from her rocker on the front porch and turned her gaze toward a lake instead. “I can’t take all this. It’s too much,” she said.
At that point, residents weren’t sure what the illness was. Neither was the Health Department, which as of Wednesday still hadn’t tested for norovirus. But symptoms – vomiting and diarrhea that came on quickly and seemed to resolve quickly – pointed to norovirus, not to COVID-19, the department said.
Based on symptoms, the Health Department sent out a press release with the boldface, all caps banner: NOROVIRUS IS ON THE RISE IN INDIAN RIVER COUNTY.
It said patients should not prepare food or care for others while sick and for two to three days after recovery. Surfaces contaminated by an episode of illness should be cleaned immediately with a bleach solution, the release said.
Norovirus spreads by fecal-oral transmission.
At the county government level, an advisory that went out to fire-safety personnel referred to “other area facilities dealing with viral issues” besides Isles.
The advisory urged personnel to use proper protective personal equipment, or PPE “when indicated,” and to wash their hands after every call.
With no one identifying the illness going around on Tuesday, Isles residents headed down to the dining room for what turned out to be their last group meal for at least a week. They were greeted by a masked staffer passing out tiny bottles of hand sanitizer from a blue plastic bucket.
That scenario probably added to confusion, if not a sense of foreboding. The mask, it turned out, was for asthma. But the hand sanitizer could only have helped kill flu and coronavirus. Hand sanitizer has no effect on norovirus; only soap-and-water handwashing can slow the spread.
That afternoon, management met with health officials to determine how to proceed.
By evening, residents had orders to stay in their apartments, with meals and snacks brought to them by aides. “Both dining rooms will be closed until further notice,” a memo delivered to residents read. “Please be patient. We will update as the week progresses.”
On the Isles management’s end, the sick tray service included “strict control of the tray’s return to dining and dishwashing areas,” said Iannuccilli, in a long email spelling out in detail all the efforts the Isles was making.
“We follow a rigid and extensive protocol to prevent the spread of all infectious diseases,” he wrote.
A designated outbreak leader made sure the Isles had adequate supplies of disinfectant, masks and gloves. The facility’s two dining rooms were closed, and housekeeping services were suspended in apartments of residents who were ill.
Common areas were methodically cleaned, as were surfaces commonly touched.
