Two Grand Forks nursing homes are battling double-digit COVID-19 outbreaks as cases continue to rise in long-term care facilities across the state. At Valley Senior Living on Columbia, an assisted care facility, 14 residents and 25 staff members are infected. At Tufte Manor, a senior living facility also operated by Valley Senior Living, six residents and four staff members are confirmed to have the virus.

Valley Senior Living has three locations in Grand Forks and, within those locations, operates several separate communities and levels of care. When residents in any of the Grand Forks communities test positive for COVID-19, they are transferred to the COVID-19 Care Area at Valley Senior Living on Columbia, adjacent to Altru Hospital.

On Tuesday, Oct. 14, there were 21 people being cared for in the COVID-19 Care Area, Valley Senior Living spokesperson Sally Grosgebauer told the Herald. That number is down from 23 people on Monday, Oct. 13 -- more than double any other time during the pandemic. The COVID-19 Care Area has the capacity for 26 single-occupancy rooms and can be expanded, if necessary, by adding beds to the rooms.

Of those residents being treated for COVID-19, three are hospitalized and two are in critical condition.

The outbreak in the local nursing homes seemed to happen fast, according to Duane Kargel, 85.

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"It's strange, because we had first a couple of people, then a couple of people got out, then a couple went in, and then all of a sudden, boom," he said. "They started hauling us over here like a van."

Kargel is one of the people included in that count of positive cases among Valley Senior Living's Tufte Manor residents. After noticing he felt under the weather and was coughing more often recently, he tested positive for COVID-19 on Friday, Oct. 9, and was moved from his apartment to the COVID-19 Care Area that same day.

There, his condition declined over the weekend, but, in a call Tuesday morning, Oct. 14, he said he was feeling optimistic for the days ahead.

"It's a miserable illness, I'll tell you," he said. "I hope you don't get it."

The North Dakota Department of Health reports that 365 people have died due to COVID-19 in the state, including 212 residents of long-term care facilities. Tufte Manor and Valley Senior Living on Columbia are among nine long-term care facilities in the state that have more than 10 confirmed active cases.

"We find ourselves in the midst of a COVID storm," said Gov. Doug Burgum during a news conference on Wednesday, Oct. 14. "We are in a dangerous trend line. October has been the deadliest month for North Dakota .... We are averaging seven deaths a day in October in North Dakota."

Despite the rise in cases, Chris Jones, executive director of the North Dakota Department of Human Services, said retaining family visitation is an important component to avoiding social isolation of those in long-term care.

"We are focused on making residents safe, but family visitation is key," said Jones, noting that of the 250 facilities in the state, 195 are allowed to do indoor visitation, and all facilities have outdoor visitation. Further restrictions may be made by individual facilities, depending upon their unique circumstances.

Valley Senior Living Medical Director Chris Henderson called the outbreaks one of the most difficult medical situations he's dealt with in his career.

"The treatments available are minimal and the hospital capacity is not unlimited for those that need critical care," he said. "The pandemic is and will continue to be extremely taxing on our staff. There is a great amount of fear for the residents, whether they are positive for COVID-19 or worried about contracting the virus, and families are hurting and struggling. Families are not able to be together during times of great sadness when they normally could lean on each other for support. More prevalence of the virus in our community will continue to equate to more in our long-term care communities.”

Grosgebauer said, though safety protocols in the facilities have evolved, they have remained largely the same since the beginning of the pandemic. Employees are required to wear face shields in addition to masks, and residents are tested weekly, or once every three days in communities where positive cases have been reported.

For a period in July, Valley Senior Living facilities briefly attempted to reinstate socially distanced dining and other activities, but quickly determined the risk was too high and suspended the activities, Grosgebauer said.

Valley Senior Living CEO Garth Rydland urged the community to think of the high-risk long-term care residents. He noted that the system's staff positivity rate on Monday was double what has been for a single testing event since May with 17 staff members positive. Two-thirds of those staff members were asymptomatic.

"There needs to be an immediate change in our community to save lives .... There are many more cases in our community than we realize," he said. "We are all interconnected. I wish people could see the direct result that they have on our residents, staff and our families in long-term care. I wish they could spend a day caring for our residents who are suffering with COVID-19. Please social distance and wear face masks. Dial back your unnecessary interactions for a while until this wave subsides. All I ask is that people continue to care.”

Meanwhile, the staff at the COVID-19 Care Area at Valley Senior Living on Columbia treat him very well, Kargel said, though the conditions weren't as comfortable as what he's used to at Tufte Manor. He also noted that medical staff was much more "secretive" about treatment in the COVID-19 ward.

When asked to comment on the perception of secrecy, Grosgebauer pointed to the inability to discuss any single resident's treatment due to patient privacy laws. Henderson said that, generally speaking, people who become sick enough with COVID-19 that they require help breathing can be given dexamethasone, a type of steroid pill, which has been shown to reduce mortality by 15% to 20%. He also said that, if a resident is transferred to a hospital for a higher level of care, additional treatments are available.

Like all COVID-19 patients, Kargel has been unable to receive any visitors since he tested positive. Instead, his daughter drops off treats, such as candy and pop, for medical staff to give to him.

Mostly, Kargel said he spends his time asleep, and, when he's awake, he reads books to pass the time. His mind has been foggy since his diagnosis though, he said.

"I sure never thought I'd be the one to get it," he said. "I was always pretty cautious, but you never know."