Well into November, Hillcrest Commons had a perfect record: not a single confirmed coronavirus infection.
Its parent company, nonprofit Berkshire Healthcare Systems, puts out daily numbers for each of its 18 facilities. Hillcrest Commons Nursing & Rehabilitation Center was at zero, zero, zero — until November 18th.
"By looking at the data, the history of the data, it appears as if the first positive cases were staff members," says Patricia Farley-Bouvier, who represents Pittsfield in the state legislature.
She says after those early cases, the virus exploded within days. It went from two residents to 93 in just one week. Soon most residents were infected.
"It’s 166 residents out of 224," she says. "And so that’s about 74% of the facility has tested positive. That’s stunning."
As of Wednesday, 171 Hillcrest residents had tested positive and 31 had died. Among the staff, 76 had tested positive. There have been other outbreaks in senior living facilities this fall, but Hillcrest Commons appears to be the deadliest.
It’s not clear what the initial spark of the outbreak was. "To know and pinpoint exactly what was the sentinel event, I don’t know that we know that," says Berkshire Healthcare vice president and spokesperson Lisa Gaudet. "But I think we know that when we see community spread in any community, and there are nursing homes in those communities, and workers live in those communities, we then see that translate into the community that our residents live in."
It became clear during the many nursing home outbreaks this spring that coronavirus levels in the area around a nursing home, and where the staff lived, were a key factor.
"Right around Halloween, there was at least one large party with people who were largely unmasked," he says, "and I don’t remember exactly how many people at that party contracted the virus but many did, and they started spreading the virus to people in their own social circles."
At least two other gatherings inside local restaurants also led to major clusters, he says. Cases skyrocketed, and the virus got into Hillcrest Commons. Dr. Kulberg can’t say for sure whether staff or visitors — or both — brought it in.
"We do know that there were quite a few staffers who had the virus," he says, "and the prevailing thinking is that many of these staffers became ill outside the institution, as a result of their own social connections, and thereafter brought the illness into the facility."
However it got there, once the virus was in, it ran roughshod over all the infection control measures that were supposed to stop it, like personal protective equipment and hand hygiene.
This virus takes no prisoners. It is relentless in its pursuit of the next body that it wants to infect.Lisa Gaudet. Berkshire Healthcare Systems
The local paper, the Berkshire Eagle, has been covering the outbreak closely and reported that Hillcrest Commons got a low, one-star rating from federal regulators, and low quality scores have been linked to higher risk for infections.
But Lisa Gaudet from Berkshire Healthcare says the facility has repeatedly passed recent state inspections to check for proper defenses against the coronavirus.
"Their last infection control survey before their outbreak was in July by the state department of health. They were deficiency free on it," she says. "They had another one last week. Same thing. So their practices are tight."
How, then, to explain how the virus ripped through Hillcrest Commons?
"I don’t have a great answer for that," Gaudet says. "I think it’s the same answer that we are all grappling with across the state: Why is this spreading so quickly, so fast, and how come so many people are finding themselves in this situation?"
State Rep. Patricia Farley-Bouvier says she and others are continuing to seek answers about what went wrong at Hillcrest Commons. She’s very concerned about the residents and staff at Hillcrest, she says, and "at the same time, I’m concerned about the residents, their family and the staff at the next nursing home."
Outbreaks in nursing homes across Massachusetts were so common and deadly this spring that nearly two-thirds of the state residents who have died of COVID-19 lived in them. State and long-term care industry officials say they've learned a great deal about how to fight the virus, but cannot feel secure that they can keep it at bay everywhere.
On her Facebook page this week, Farley-Bouvier posted about the Hillcrest outbreak, and some relatives of residents wrote that they were frightened for their loved ones. WBUR reached out to them but so far none has responded.
Farley-Bouvier posted that she saw a "direct line" between social gatherings in Pittsfield and Hillcrest deaths. Some commenters wanted people held responsible, while others warned against trying to “shame and blame.”
Lisa Gaudet from Berkshire Healthcare calls for sympathy and support for the staff members who walk through the doors every day despite the risk, and who suffer personal losses when residents they care for sicken and die.
"Maybe that's what the pandemic has taught us, is that we need to be there for each other in our greatest moment of need. And for our residents and our staff at Hillcrest, it's now," she says.
Gaudet says the Hillcrest Commons outbreak appears to have turned the corner. Positive tests have slowed to a trickle.
But one of the company's other facilities, Kimball Farms Nursing Care Center in nearby Lenox, has also been experiencing a recent outbreak, with several dozen residents and staff infected so far. Eight residents there have died.
"This virus takes no prisoners," Gaudet says. "It is relentless in its pursuit of the next body that it wants to infect."