Marquis Hope Village Outbreak: How Did This Happen?

On Friday, June 5, the Marquis Hope Village Post-Acute Rehab Center alerted residents and families to the concerning news that seven cases of Covid-19 had been confirmed at the facility.

Less than one week later, on Thursday, June 11, that number had grown to nearly 70, including 36 staff members and 33 residents — virtually all of the total population of 38. The coronavirus has contributed to three known deaths as of Friday.

That made it the state’s largest active outbreak at a long-term care facility and second-largest all-time behind only the infamous Foster Creek — a Southeast Portland facility the state shut down last month after it was linked to 119 cases and 29 deaths. It has since been the target of millions in lawsuits from residents’ families.

The Canby facility serves a population of older residents with chronic medical conditions and, typically, who have recently been released from hospitals for treatment or procedures. They are, in the words of Marquis representatives, “medically fragile.”

“Many have chronic conditions that put them at high risk for their health to rapidly change,” April Diaz, vice president of clinical services for Marquis Companies, told the Canby Now Podcast. “Sadly, when they are infected with the coronavirus, because of the nature of the infection, they often don’t have the strength to fight it.”

The rehab center is located in the same building as an assisted living facility (also operated by Marquis), with 74 residents, and on the campus of the Hope Village Senior Living Community, which is home to hundreds of seniors.

The obvious question, and many Canby residents have asked it, is “How did this happen?”

For the Marquis Hope Village outbreak, it all comes down to the asymptomatic spread of Covid-19, which has become something of a flashpoint in recent days after a confusing statement by the World Health Organization that seemed to suggest such transmission is “very rare.”

WHO officials later attempted to “clarify” and walk back the remark.

The possible genesis for the outbreak was on May 31, when a staff member reported not feeling well and was placed on leave pending a test for Covid-19. A full four days later, on June 4, the employee’s results came back: positive. By that time, the first resident had developed a low-grade fever.

“With the presence of the virus positively confirmed, a comprehensive and aggressive testing program for all residents and staff in both our post-acute and assisted living facilities was immediately put into place,” Diaz said. “As we secured testing capacity, our goal was to strategically schedule testing with a correct time period to ensure we did not obtain false negatives by testing too early in the viral illness.”

Staff was also directed to wear N95 respirators at all times and implement strict isolation precautions in alignment with Centers for Disease Control guidelines.

Widespread testing of residents and staff at long-term care facilities is a relatively new approach, after months of symptom-based testing strategies. Country Side Living, Canby’s first-known outbreak at a senior home, never saw facilitywide testing, based on the recommendations of the Oregon Health Authority.

Some of this, especially in the earlier days of the pandemic, was based on limited testing availability. But it was also the general policy of OHA, as recently as this month, to “not recommend routine screening of asymptomatic people for COVID-19, including health care and other essential workers.”

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“In general, testing people without COVID-19 symptoms is not useful because the sensitivity of molecular testing in asymptomatic people is low,” a June 2 OHA memo offering Covid-19 guidance to clinicians read. “Therefore, a negative result does not significantly increase confidence that a person is not infected.”

At Marquis, the issue was not necessarily fully asymptomatic people — those who never develop symptoms over the entire course of their sickness — but those who were “presymptomatic.” Diaz says as many as 40 percent of those who test positive for Covid-19 show few, if any, symptoms for several days before becoming sick — but can still infect others at that time.

“So, it stands to reason that the more cases there are in a close-knit local community, the more potential carriers there will be without symptoms,” she said. “That means the virus can gain a wide foothold long before its presence is even detectable, as happened at the Hope Village Post-Acute Rehab facility.”

The thought of a deadly virus spreading invisibly among a large population, with its carriers none the wiser, was the nightmare scenario that caused politicians and officials to shut down large gatherings and implement widespread stay-home protocols several months ago.

It was, evidently, the exact scenario that played out at the Canby facility.

“Despite aggressive screening and monitoring of staff and residents,” Diaz said, “the virus was spread throughout the facility by asymptomatic staff and, then, residents that did not know they were infected.”

In other words, by the time they knew the virus had infiltrated their facility — it was already too late.

There is only so much that can be done to prevent an outbreak when a virus is widespread in the surrounding community, Diaz said. An employee can be infected at the grocery store or a restaurant, or even at home by a friend or loved one, and unknowingly bring it into the facility — as appears to have happened here.

“Research by leading health experts has proven that a facility’s location is the primary determining factor, and what matters most is the rate of infection in the state and community around it,” Diaz said. “So even a top tier, highly rated facility like Marquis Hope Village can’t necessarily prevent a virus like this when it is rampant in the surrounding community.”

Though anyone can be sickened by Covid-19, those who are older and have underlying medical conditions are at much greater risk for serious complications or death. Of the 173 deaths the state has linked to Covid-19 as of Saturday, only 12 have been younger than 60.

Most cases of Covid-19 have mild or moderate symptoms, and the vast majority recover.

Public health officials recommend residents observe at least six feet of physical distance from anyone not in your household, wash your hands as frequently as possible, and wear a face covering while in public to mitigate the risk of asymptomatic carriers spreading the virus unknowingly.

If you develop a fever or respiratory symptoms such as a cough or shortness of breath, contact your primary care provider or Clackamas County Health Centers.

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