The Essex Center nursing home in Elizabethtown is seen in June 2014. (Enterprise photo — Matthew Turner)

ELIZABETHTOWN — The coronavirus outbreak at Essex Center spread undetected for at least 19 days as employees waited for routine test results, nursing home administrators revealed Thursday.

The deadly outbreak has claimed the lives of four residents and infected at least 81 people as of Thursday.

New York state requires nursing homes to test all staff — not residents — every week for COVID-19. The results sometimes take so long to come back that it leaves gaping holes in the homes’ defenses, public health officials say. The nursing home at the center of Essex County’s first major outbreak now has the ability to get test results back within 72 hours, but that change only happened after people started dying.

“There are very few things in our lives that we have total control of, with certainty,” Essex County Public Health Director Linda Beers said during a virtual press conference on Thursday. “It’s your job to wear a mask. It’s your job to stay 6 feet away from other people. It’s your job to wash your hands. It’s your job to protect those who are vulnerable.”

Judy Frennier-Ryan, a 65-year old woman who had been staying at the Essex Center since February for rehabilitation services, was the first person in the county to die of COVID-19 related causes, the Press-Republican reported last week. Nineteen days before she died, however, three Essex Center employees were tested for COVID-19 as part of a weekly staff testing regime. As they awaited their results, the nursing home staff continued to come into work as usual because they had no symptoms, according to Grace Pfordresher, regional director for Centers Health Care, which operates the Essex Center.

On Aug. 17, the same day Frennier-Ryan died of COVID-related causes, the results of those employees’ tests came back positive.

Pfordresher declined to speak specifically about any one person’s case because it would violate federal privacy laws, but she did say that prior to Aug. 17, the company was unaware of any residents with symptoms of COVID-19.

On that day, several things happened in quick succession that kick-started a mass-testing effort that began to unveil the full scope of the outbreak.

“We had a patient that coded (went unresponsive), and that patient passed away,” Pfordresher said. “The patient’s roommate was sick and exhibiting symptoms. That patient was sent to the emergency room and that’s where rapid testing was performed, and that’s when we learned of the COVID. That (same day), we received results back for three employees that were positive, all on Aug. 17.

“We didn’t know we had COVID in the building.”

Residents and employees were screened for COVID-19 daily — meaning their temperature was taken, and they were asked a series of questions designed to reveal symptoms that could be associated with COVID-19, according to Pfordresher. All staff have been equipped with personal protective equipment since March, she said.

After receiving criticism for COVID-19 deaths in nursing homes under his policies, Gov. Andrew Cuomo signed an executive order on May 10 requiring nursing home staff to be tested for COVID-19 twice a week. Every nursing home in Essex County adhered to that order, according to Beers.

“Every nursing home in Essex County had positive staff at one time,” Beers said Thursday. “And we never had anything like this happen.”

In May, nursing home operators across the state said the twice-weekly mandate was financially and logistically difficult to adhere to. The governor’s order was amended in June, one month after it was signed, reducing the twice-weekly staff testing requirement to once per week. At that same time, state Health Commissioner Dr. Howard Zucker announced that an initiative to have every nursing home employee and resident in the state tested for COVID-19 had been completed.

That state effort is the only time all nursing home residents have been required to be tested for COVID-19. It was also the last time residents of Essex Center were tested for COVID-19 prior to Frennier-Ryan’s death on Aug. 17. At that time, all residents tested negative, according to Pfordresher.

Laboratories around the state have been overwhelmed with samples for months, so tests of people with symptoms have been prioritized at many labs. For the asymptomatic employees of Essex Center, results have regularly come back weeks after the fact, according to Pfordresher.

At one point, the turnaround time for the center’s routine staff testing was so slow that Essex Center administrators began searching for a new lab that could process samples more quickly, Pfordresher told the Enterprise after a virtual press conference on Thursday. Administrators called at least 100 different laboratories before they found one that could return results within 72 hours, Pfordresher said.

“Taking a test is not the problem,” Beers said. “It’s lab capacity. It’s finding a lab that has a quick turnaround time to do that. That’s where Essex Center and others have struggled. It’s that the labs are backed up.”

After Frennier-Ryan’s death and the three employees’ positive results on Aug. 17, the state Department of Health stepped in immediately, according to Beers. Each of the Essex Center’s 85 residents and roughly 86 employees were tested for COVID-19. Those results all came back within three days, giving some insight into how many people had been exposed to the virus.

Of the 81 Essex Center cases as of Thursday, 30 are staff members, 44 are residents, and seven are community members who came in close contact with a staff member.

Asked by a reporter how so many residents tested positive for COVID-19 if they were equipped with PPE, Pfordresher said she didn’t have an answer.

The county Health Department offered free drive-thru COVID-19 testing on Wednesday to some 60 people who came in contact with positive cases associated with the Essex Center outbreak. Roughly one third of them — 22 people — accepted the offer and were tested. Of those people, six tested positive and 16 negative.

On Tuesday, Essex Center staff and residents who initially tested negative were re-tested. Of the 107 re-tests processed, 12 new positives were discovered, 86 negatives were returned, and nine results were pending Wednesday.

There were 31 active cases of COVID-19 countywide on Thursday. Three COVID-19-positive people are hospitalized.

Essex Center has set up a separate part of its facility to house COVID-19 positive residents. The facility has an air filtration system installed, according to Pfordresher. A separate set of employees service the COVID-19 wing. All residents, regardless of whether they have COVID-19, have been separated into small “cohorts” with little intermingling between the groups. Staff are being asked to change their PPE between each patient.

Resident COVID-19 screening has been increased from once per day to once per staff shift. If a resident is tested for COVID-19, their families will be notified of the results, Pfordresher said.

Nursing home residents are among the highest-risk populations amid the coronavirus pandemic. As of Aug. 13, more than 402,000 people at some 17,000 facilities across the country have been infected by the coronavirus, the New York Times reported. At least 68,000 people have died as of Aug. 13, accounting for roughly 41% of total COVID-19 deaths in the United States.