NASHVILLE, Tenn. (WTVF) — Did the state and Metro health departments do enough to stop an outbreak of COVID-19 at a Nashville nursing home?
As of last Friday, the Trevecca Center for Rehabilitation and Healing had 55 cases, with four reported deaths.
But NewsChannel 5 Investigates obtained emails that reveal what was going on behind the scenes when people started getting sick there, and they raise questions about how the outbreak at Trevecca and other long-term care facilities are being handled.
[Note: Trevecca Nazarene University has no affiliation with the rehab center other than it is located adjacent to the campus.]
Word of the outbreak at the Trevecca Center came in late April during one of Nashville Mayor John Cooper's daily coronavirus briefings.
Dr. Alex Jahangir, the head of Metro's Covid-19 task force, announced on April 23 that "17 people there tested positive for COVID-19."
He described it as a developing situation and insisted that public health officials had only just learned of what was unfolding there.
"Once alerted to the situation, contact tracing immediately began," Jahangir insisted.
Emails obtained by NewsChannel 5 Investigates, however, reveal that a vendor who works closely with the Trevecca Center first sounded the alarm on March 27, nearly a month earlier, when a nurse at the facility started showing symptoms.
The vendor informed the state on the 27 that he had been told that the nursing home would not test anyone, even if they were symptomatic -- and that, he added, "just does not seem right, clinically or ethically."
State officials assured him that same day that "pertinent individuals more closely involved with that investigation" had been notified.
But there's no record of any sort of investigation underway at that point.
Then three days later, on March 30, the state got another tip that Trevecca Center had announced at a staff meeting that one of its employees had tested positive.
Under state and federal rules, long-term care facilities are required to notify the health department as soon as they have a confirmed case or at least two suspected cases.
But the Trevecca Center did not, even though the facility had just announced on Facebook they were "working closely with local and state health officials.”
Under Governor Lee's COVID-19 plan, when the state gets word of cases, health department employees are supposed to immediately mobilize to "protect residents and staff."
And while the head of the state division that regulates and licenses nursing homes suggested on March 30 that his team visit the Trevecca Center to determine whether the facility had followed protocol, in an email two days later on April 2, another employee wrote that he "still had not looked into it yet."
Meanwhile, by April 2, the vendor was now telling the state that several residents had started running fevers and were placed in isolation.
He said it did not appear they were being tested and he hoped "these residents hadn't been made more vulnerable by the inaction of Trevecca and (its owner) CareRite."
That night, the Metro Health Department got a tip from someone else with ties to the facility, expressing concern about the residents and what appeared to be a serious situation unfolding.
The next day, April 3, both the state and Metro tried contacting the nursing home, but afterwards, health department workers wrote, "It's clear they are avoiding us."
"They're being sketchy ... difficult to work with," one email said.
Another one noted, "When we call, we get placed on hold and no one comes back to the phone or we are told we will get a call back and no one reaches back out."
And they were clearly frustrated they were not getting any help from the state health department's regulators, writing, "The state's license group is awful and slow," adding that regulators had been notified "earlier in the week" and still "no response."
That came even as Dr. Tim Jones, the state's chief medical officer called this "clearly part of an outbreak and an imminent threat."
Finally, after still not hearing back from the Trevecca Center, Dr. Michael Caldwell, the head of the Metro Public Health Department went to the nursing home himself on Saturday, April 4th and left his business card, asking that someone get back in touch.
That night, the nursing home administrator called Caldwell back and confirmed they had two employees who had tested positive, a nurse and a maintenance worker.
But the administrator told the state that the residents all seemed fine.
The facility reportedly resisted efforts to test, even though multiple residents, reportedly, were now showing symptoms.
It took nearly two more weeks to finally start testing -- and the decision to test everyone took even longer.
By then, there were 45 cases of COVID-19, including some, sources say, in the facility's vulnerable respiratory unit, although the Trevecca Center's administrator denies that, telling NewsChannel 5 Investigates, "Every patient on the respiratory unit was tested for COVID-19 and came back negative. The other side of the second floor did have patients test positive, but those patients were not part of the respiratory unit."
During the mayor's briefing on April 23, as Dr. Jahangir described what was happening at Trevecca, he said of the official response to the outbreak, "And this is how public health will respond, by performing contact tracing quickly and responding immediately to a cluster of positive cases to contain the spread of this virus in our community."
But that, we now know, is not what happened at Trevecca Center for Rehabilitation and Healing.
We spoke with Dr. Gill Wright from the Metro Public Health Department who was involved in the response early on.
He told us, "In hindsight, 20/20, you always think something could have gone better."
But Dr. Wright said he did not believe there was anything they could have done to stop the outbreak..
"They may have had less, but I still think they would have had a number of their residents become positive," Wright said.
Administrator Carl Young responded in a statement:
“The Trevecca Center for Rehabilitation and Healing has followed and is committed to following the evolving regulations put forth by local and state health officials as we all navigate this global pandemic. The well-being of our residents and staff continues to be our top priority, and we will continue to take all appropriate measures in cooperation and coordination with local and state health officials, as well as the CDC, to keep our community safe.”