Denver's Leading Local News: Weather, Traffic, Sports and more | Denver, Colorado | 9NEWS.com

Health officials are reflecting on the lessons learned from battling COVID-19 outbreaks in nursing homes

A lack of testing at the beginning of the pandemic may have caused the virus to spread undetected by asymptomatic carriers

DENVER — For the first time, we’re getting a look at how some of the deadliest COVID-19 outbreaks in the state started and what was done to try and save lives.

In Morgan County, at least 57 residents and 36 staff members tested positive for COVID-19 at the Eben Ezer Lutheran Care Center.

Through documents released by the Northeast Colorado Health Department, 9NEWS has learned an employee first tested positive on March 30. Several employees had family members that worked at the Cargill meat plant, where a large outbreak was also reported.

The first resident tested positive on April 4. Documents reveal it was a challenge to get the facility the proper PPE and testing it needed. 

"In March, long-term care facilities were not deemed Tier 1 facilities so there were challenges to obtaining the appropriate PPE and this also meant they weren’t deemed a priority for testing," the document from the Northeast Colorado Health Department says. "Testing resources across the board weren’t readily available at that point in the timeline of COVID-19 response in Colorado or across the nation.  In our region the only people getting tested at that time were those who were symptomatic or hospitalized."

RELATED: State health department allowing visitors at nursing homes again

RELATED: Grim blame game over COVID-19 deaths in besieged nursing homes

RELATED: Order of disinfectant wipes redirected by FEMA, Colorado nursing home says

At least 18 residents died over the next two months before the outbreak was declared over on June 15. That means the facility has had no new cases for 28 days.

The first hint of COVID-19 happened in Sierra Rehabilitation and Care Community on March 26, when data provided by Jefferson County Public Health shows an employee first had symptoms. They reported to work the next day, were tested for COVID-19 and hospitalized the same day on March 27. The first resident started showing symptoms two days later on March 29.

According to CDPHE outbreak data, the facility was considered to be an outbreak on April 3. A 9Wants to Know analysis of the Jefferson County data shows the virus took off from there. Thirty one residents showed symptoms in April, and then three more in May.

As many as 14 residents died after a COVID-19 diagnosis and 29 residents had coronavirus before the outbreak was considered contained and resolved on June 16.

Fourteen residents required a hospital stay and nine recovered.

Forty four staff members tested positive. One person was hospitalized and 86% of those initially out for confirmed or suspected COVID-19 cases are back to work. All were able to get a test.

"One of the things that we have also learned is that the spread is often caused by asymptomatic cases, people who are not displaying symptoms," said Annie Nolan with Jefferson County Public Health. "I would say the larger outbreaks, those were largely due to asymptomatic spread."

Keeping sick patients isolated is one of the most important strategies health officials use to stop outbreaks in senior care centers. But why do some facilities see dozens of cases while others see none? 

It’s a question public health officials still fully don’t have an answer to.

"It’s not black and white, for sure," Nolan said. "It’s a combination of a lot of factors and it’s different for every facility."

SUGGESTED VIDEOS | Next with Kyle Clark