Visitors at nursing homes and other health care facilities will be screened for disease as the nation attempts contain the spread of the novel coronavirus.

Federal and state health agencies announced guidelines Monday as the number of COVID-19 cases continues to rise.

As of Monday night, Washington state continued to have the highest number of confirmed COVID-19 cases in the United States, with 162 cases in eight counties. There have been 23 deaths due to the respiratory disease thus far in Washington state, and 20 of those deaths were residents at the Life Care Center in Kirkland where a local outbreak has led to a lockdown.

There are two confirmed cases east of the Cascades: one in Kittitas County and one in a Grant County resident who died on Sunday night.

There are no confirmed cases of COVID-19 in Spokane County.

Several counties, including Spokane, are waiting for test results for their residents, however. The Kittitas County resident, a woman in her 60s, is in home isolation, and health officials are working to inform those who had been in close contact with her.

The Grant County patient who died of COVID-19 was treated and died at Central Washington Hospital in Wenatchee. The patient had no travel history to countries affected by the spread of the virus.

Theresa Adkinson, Grant County health administrator, said the patient had not left the county recently according to their investigation so far, indicating that the disease is spreading locally.

“It’s pretty safe to assume we have it in our other communities as well,” Adkinson said, noting that Quincy, where the patient was from, is not at higher risk than Moses Lake just because that is the only town with a confirmed case.

“Because it was community-acquired, it came here at some point,” she added.

Last week, county health officials released a list of places where the patient went last month before entering the hospital, including several events at the Quincy senior center and the local high school for a theater production. Health officials ask people who were at those events to monitor their health for two weeks for fever, cough and difficulty breathing, all symptoms of COVID-19.

Grant County is not monitoring anyone directly, but there may be county residents being tested locally by doctors. Since federal and state officials opened up more avenues to test Washington state residents for COVID-19, health care providers can now submit samples directly to labs or the University of Washington. Local health districts are then notified of any positive test results. Adkinson said her office is in contact with local health care providers to work to coordinate responses and slow the virus’s spread.

“It’s not about keeping it out; it’s about slowing it down,” she said.

Visitor guidelines in place at several facilities

On Monday, the federal Centers for Medicaid and Medicare Services implemented stricter guidelines for visitation at nursing homes that have Medicare and Medicaid patients.

Nursing homes should actively screen visitors, according to the new guidelines, for people who have symptoms of COVID-19 including cough, fever and difficulty breathing. Additionally, any person who has had contact with a confirmed case of COVID-19 or traveled to a country that has community transmission of the disease in the last two weeks should not be allowed in the facility. Also, a person residing in a place where community-based spread of the virus is occurring should be restricted from visiting residents.

CMS recommends that facilities in counties with or adjacent to a county with a confirmed case of COVID-19 limit visitation, meaning individuals should not be allowed to come into the facility except for certain situations, like end-of-life or essential visits for a resident’s well-being. All other nursing homes nationally are recommended to discourage visitation, meaning normal visitation is allowed but not advised.

CMS Administrator Seema Verma also announced that inspectors nationwide will focus on infection control protocols in facilities to ensure that nursing homes are following rules for staff knowledge of transmission precautions, hygiene and cleanliness. Additionally, Verma added that Medicare patients have the option to be tested.

“We’re letting our patients know that they can get a coronavirus test with no cost-sharing,” she said at a White House news briefing Monday.

CMS guidelines encourage facilities to offer virtual communication (like video or phone calls) in lieu of visits as well as offering a phone line or listserv for families to receive up-to-date information. Visitors to nursing homes are advised to report to the nursing home if they begin to show symptoms of the disease within two weeks of visiting.

Mann-Grandstaff Veterans Administration Medical Center in Spokane will begin prescreening veterans and staff for COVID-19 symptoms this week before they come into the facility. Those found to be at risk will be isolated to prevent the potential spread of the disease. The state Department of Social and Health Services has also implemented screenings at its 24-hour facilities, including Eastern State Hospital. Visitors will be screened for symptoms and have their temperature taken.

“We are doing everything we can to keep this virus from entering into our facilities. Our staff are already carrying out infection-control protocols, and this extra step will help us ensure the health and safety of our clients and staff,” Dr. Brian Waiblinger, chief medical officer at DSHS, said in a release last week.

State leaders discourage large public gatherings

Gov. Jay Inslee announced Monday he would not hold any public bill signings for the rest of the 2020 legislative session, due to recommendations from medical and health officials. The signings will still be telecast. The news comes just a few days after the governor discouraged public gatherings for those at highest risk for becoming severely ill if they get COVID-19.

About 80% of people with COVID-19 do not need to be hospitalized and experience very mild flulike symptoms. About 20% do require hospitalization, for oxygen or respiratory support and treatment. Those most at-risk for developing severe disease from COVID-19 are people over the age of 60, people with underlying health conditions or immunocompromised people and pregnant women. Last week, Inslee encouraged those at-risk to avoid large gatherings, if possible. Kathy Lofy, state health officer, stressed the importance of testing people who have symptoms and are at-risk of developing severe illness.

“I think what’s important is that people who are sick with fever, cough or at higher risk for having complications, people who are older, with chronic medical conditions or pregnant women, those people (should) call their health care providers to see if they need to be tested,” Lofy said at a news conference last week.

Last week, the state Department of Health went its own way, differing from the CDC on personal protective gear guidelines. Health care workers wear protective gear, including a mask, goggles, gown and gloves to treat COVID-19 patients. DOH has decided to require surgical, not N95, masks for most COVID-19 care, following the World Health Organization’s guidelines, prompting some questions from unions and health care workers.

DOH said that decision was a result of consultation with their infections team, health care providers and facilitators statewide “to address the issue in a way that worked best for our particular circumstances,” a statement from DOH said. “It did not have to do with supply shortages or resource conservation.”

Local health districts and hospitals can choose which guidelines they want to follow, however.