Health

NJ waited 2 weeks after deadly outbreak to inspect pediatric center. Was that the right call?

NJ waited 2 weeks after deadly outbreak to inspect pediatric center. Was that the right call?

The kids started getting sick on an unseasonably warm day in late September.

Yet it would not be until Oct. 9 — and after the death of two children — when the Wanaque Center for Nursing and Rehabilitation notified the state Health Department of a viral outbreak inside the long-term care facility in northern New Jersey. And then another 12 days before state inspectors walked in the door.

The devastating adenovirus outbreak at the Wanaque Center in Haskell has so far led to the deaths of 10 children and infected 19 more. How the outbreak began remains unknown.

But an examination of how the outbreak unfolded and spread rapidly has raised questions over why state health officials waited two weeks before deploying a team to see for themselves how Wanaque was managing the crisis.

The state’s response will be part of what the state Senate Health, Human Services and Senior Citizens Committee will examine when it holds a hearing on Dec. 3 to discuss the outbreak, said Sen. Joseph Vitale, the committee chairman said. 

Death stalked the Wanaque center. Still, they delayed sending kids to the hospital, workers allege

“We will ask as many questions as we are able to, but this will be one of them,” said Vitale, D-Middlesex. 

“We want to know when it was reported, how the department responded and how the facility responded,” Vitale said, adding he wanted to be cautious “until we know all of the facts.”

“No doubt we are all concerned about this, and as a layperson, I say something is amiss here,” he said.

Death stalked the Wanaque center. Still, they delayed sending kids to the hospital, workers allege

Wanaque notified the state and local health departments about the outbreak after business hours on Oct. 9., according to Health Department spokeswoman Donna Leusner.

“The state immediately counseled the facility on infection control protocols, to be implemented immediately,” Leusner said.

The next day, the department’s Communicable Disease Service — along with the U.S. Centers for Disease Control and Prevention and the local health department began working with Wanaque to recommend infection control practices, she said.

The state dispatched two registered nurses from its Health Facilities, Survey and Field Operations office on Oct. 21 and conducted a surprise inspection. A state inspection specialist has remained on site.

The state conducted a second surprise inspection on Friday after a report by NJ Advance Media citing workers at the Wanaque Center who alleged that administrators delayed sending critically ill kids to the hospital because they did want to lose Medicaid funding if a pediatric bed went empty. 

The decision to wait two weeks before sending in state health employees was based on the science of allowing one incubation period to elapse to see whether Wanaque’s handling of the outbreak was working, Leusner said.

The incubation period of the adenovirus virus is two weeks, the department said. 

“It would have been impossible to determine that an on-site presence could have been useful before an incubation period’s worth of time,” health department spokeswoman Dawn Thomas said.

“Containing the virus ultimately depends on facility management and clinical staff following these protocols under all circumstances, for every patient, and Department of Health is taking every action it can to hold the facility accountable for this,” Thomas said.

Wanaque Center’s for-profit owner, Continuum Healthcare, which has repeatedly refused comment, did not return calls on Friday. 

“The Commissioner believes that DOH staff responded appropriately at each time point, given the information we had,” she said.

Adenovirus is actually a group of viruses that are rarely fatal. They mimic symptoms of the flu and common cold, often attacking the respiratory tract, but can also cause gastroenteritis and conjunctivitis. They tend to affect infants and children, according to the Centers for Disease Control and Prevention.

Illnesses from the virus are usually mild and people typically recover in a matter of days. But in some cases, infections from adenovirus can be potentially life-threatening, particularly those with weakened immune systems.

All of the pediatric patients at Wanaque Center are medically fragile. Most need ventilators to help them breathe. Some had severe birth defects and significant health problems.

Why these died, however, remains puzzling to some.

“These kids were really fragile and severe adenovirus certainly can be fatal,” observed David Cennimo, an epidemiologist at University Hospital in Newark and a professor of medicine at Rutgers University Medical School. “It’s a bad respiratory illness and you can end up on a ventilator. But these kids were already on a ventilator and I wonder why they couldn’t support them through this.”

Not involved directly or knowing specifics about their cases, he said he wondered if there were secondary infections. There are many unanswered questions, he added.

“I don’t understand it. It’s a medical care facility. These kids are monitored. I can’t explain it,” he said.

State health officials, while they continue to investigate, said they may never know the answer to how the virus spread.

“It’s impossible for us to know what exactly were the factors related to the spread,” said Christina Tan, the state’s epidemiologist who heads the health department’s Communicable Disease Service. “There are many factors.”

Adenovirus is not an airborne threat. It does not get spread through a building’s heating and ventilation system, like Legionnaire’s Disease, explained Tan. Rather, the virus moves through respiratory droplets or contact.

The state inspects these facilities every nine to 15 months, Leusner said.

The Wanaque Center had been repeatedly cited for deficiencies in handwashing and infection control, both before and after the outbreak, according to state and federal inspection reports. 

During an inspection last month, the state said there were germicidal disposable wipes, sanitizers, masks, gloves, and gowns available on every wing, and mostly in every room for the staff and visitors to use prior to entering the room. The report said there were also guidelines regarding adenovirus for visitors visible in each room, warning visitors not to visit if they are sick, and observed staff cleaning the rooms with germicidal cleaning solutions.

But the report noted deficiencies in handwashing procedures, where members of the staff did not wash their hands long enough.

Washing hands is imperative. Not a quick rinse, but for at least 20 seconds. They teach health care professions to sing “Happy Birthday” to themselves about twice. At Wanaque Center, state inspectors found that some nurses were not getting even through the first verse, in terms of timing.

Cennimo said there was a high likelihood that the only way it would have moved from one bed-bound patient to another was by someone who was caring for the kids.

“I would be concerned that whoever was caring for the kids was the contact vector between them,” Cennimo said.

Vitale, the health committee chairman, said the he hopes to find out whether the outbreak spiraled because of human error or systemic weaknesses. Maybe it’s both. he said.

“These children are medical fragile and depend on other people for their survival,” Vitale added. “It shouldn’t have happened to this degree. One child gets sick and maybe two, but this many? 

NJ Advance Media Staff Writer Spencer Kent contributed to this report.

Ted Sherman may be reached at tsherman@njadvancemedia.com. Follow him on Twitter @TedShermanSL. Facebook: @TedSherman.reporter. Find NJ.com on Facebook.

Susan K. Livio may be reached at slivio@njadvancemedia.com. Follow her on Twitter @SusanKLivio. Find NJ.com Politics on Facebook.