Six more residents of the Spokane Veterans Home tested positive for COVID-19 on Thursday and were isolated in one area of the facility, according to the Washington Department of Veteran Affairs.

The additional cases came after reports that 31 residents were stable at the Mann-Grandstaff VA Medical Center following hospital transfers that mostly occurred between Friday and Monday in ambulances.

The 47 residents remaining at the nursing home were retested on Wednesday, and 41 negative results were returned Thursday. Many of the new cases did not have symptoms when tested, but several now have mild symptoms and low fevers.

Another three residents were being cared for at local hospitals on Wednesday, according to the Washington Department of Veteran Affairs.

Two have died from COVID-19, for a total of 42 cases as of Thursday, including one resident who was transferred to the VA Medical Center on Wednesday.

Two patients who are negative for COVID-19 but roomed with positive residents are also being observed at the VA Medical Center, according to officials.

The diversion of COVID-19 cases allows the Spokane Veterans Home to focus on the care of residents without the novel coronavirus while Spokane’s VA Medical Center monitors positive cases and provides a higher level of care if someone’s condition worsens.

“We share a common mission,” Mann-Grandstaff VA Medical Center Director Dr. Robert Fischer said during a conference call with reporters. “We are delighted and privileged to lend a helping hand.”

The novel coronavirus outbreak at the Spokane Veterans Home represents the largest in the county and the first in the region, according to public health officials.

Case counts at six other Spokane County long-term care facilities and retirement communities aren’t close to comparable, according to the Spokane Regional Health District.

When the nursing home began receiving larger batches of test results from April 10 through 13, daily countywide case counts saw an abnormal uptick.

Between April 11 and 15, positive tests came back for 17 residents and one employee. Ten of 12 new cases countywide on April 11 were related to the nursing home.

Spokane County saw higher than normal daily case counts again between April 22 and 24, when another large group of results from the nursing home started to come back.

On the 24th – the last day countywide case counts rose by double digits in a day – nine of 16 new cases were related to the Spokane Veterans Home.

Fischer, the federal VA Medical Center Director, said from his perspective the state-run nursing home did everything it could it could to prevent the spread of COVID-19.

“I don’t believe they were doing anything wrong,” Fischer said. “As a matter of fact, I hail their efforts.”

In long-term care facilities where staff members and residents are getting sick, people exposed to the novel coronavirus in the community are the ones bringing it inside, said Dorothy MacEachern, a state health department infection preventionist working with local health officials on their COVID-19 response in long-term care facilities.

Even with screening in place, MacEachern said a person who does not experience symptoms or has yet to display them can spread the novel coronavirus.

The nursing home’s first case at the end of March was an employee who was awaiting a COVID-19 test result and returned to work on the floor where the first 19 cases were confirmed.

Another 18 employees have tested positive since, while 98 have been negative. A number of them did not have symptoms when tested.

The first employee case went three days without symptoms but wasn’t required to wear a mask at work.

That employee, along with one other, has since recovered and returned to work, but the case underscored to experts the importance of wearing masks to prevent the spread of the novel coronavirus, according to MacEachern.

“They were one of the first, and this is really where it became evident about asymptomatic health care staff,” MacEachern said.

MacEachern said transferring patients to the VA Medical Center is a good strategy, noting that other long-term care facilities do not necessarily have that option.

“In any nursing home setting, if there was a shared room and one person had COVID and the other didn’t and they had the opportunity to move that person who was positive to a separate room, we would always advise that,” MacEachern said. “But not many facilities have that availability of a private room.”

The state health department and MultiCare personnel had already been helping the nursing home with infection control practices for weeks when a team from the VA Medical Center visited on April 20 to determine how it could support the nursing home.

The VA Medical Center determined it could do that best by converting a community living center into a dedicated COVID-19 unit within a week. In patient rooms, fans create a negative pressure environment to prevent the novel coronavirus from spreading between rooms through the air.

“To the best of my knowledge, this has never been done before,” Fischer said of the transfers between the state and federal facilities.

Fischer said the patients – ages 77 to 96, with minimal symptoms so far – represent the people at highest risk for COVID-19. A couple of them were in end-of-life care before their COVID-19 diagnoses.

One resident who is stable but has higher-risk conditions is being cared for in the medical center’s main inpatient unit.

“These patients do not seem to be suffering from the COVID disease, despite the number of patients we’re caring for,” Fischer said.

To staff the COVID-19 unit, “we are tapping into every nurse, nursing assistant, clinician from across the facility,” said Darci Raschke, a registered nurse and the medical center’s nurse executive.

So far, everyone working in the unit volunteered and will receive additional pay.

The facility first identified inpatient staff who could work on the unit, then people with recent experience in inpatient care. Officials also developed training for people who hadn’t worked in that type of care for a long period.

Many people working in clinics doing routine virtual appointments have since been reassigned after extensive training on protective equipment.

The medical center also is in daily contact with the U.S. Department of Veterans Affairs about sending more health care workers with COVID-19 and infectious disease experience to the medical center.

“It’s quite the undertaking,” Fischer said. “There’s a lot of folks down there.”

Fischer said the medical center is prepared to host the residents for the long haul, but he has also reached out to local hospitals to ensure they have capacity if his facility is overwhelmed.

“We will not return these veterans until they have tested negative twice and 24 hours between testing,” Fischer said.

The medical center has its own test kits that can be turned around at a California lab in two to three days. It has some limited same-day testing capability as well.

“Our testing capabilities right now look pretty good,” said Sam McComas, a registered nurse and deputy director of the hospital’s incident command team.

The VA Medical Center also is prepared if Spokane sees a surge in COVID-19 cases countywide.

The facility increased total bed capacity from 70 to about 140 and tripled its intensive care unit capacity from four to 12. The ICU capacity could further increase to 20. The medical center has 12 ventilators with six more ordered, along with a more protective equipment.

“We were incredibly prepared for this wave and this pandemic,” Fischer said.

Fischer said the medical center staff can sense they’re in the public eye as a focal point of Spokane’s COVID-19 response.

“We’re fulfilling our mission to care for veterans in our community,” Fischer said. “I am very happy with the role we are playing and very happy with my staff.”

Spokesman-Review reporter Arielle Dreher contributed to this report.