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Photos From Midland Nursing Home Reveal How Good Intentions During A Pandemic Can Be Dangerous

By Mitch Borden

The Easter holiday was quiet this year, especially for the patients at Midland Medical Lodge. For weeks, the nearly 80 residents at the nursing home were barred from having family and friends visit.

Instead, relatives wrote letters — a socially distant way of checking in on family as concerns over the coronavirus grew across the state and country. They could even schedule a “window chat,” and stop by to talk with loved ones from outside the facility’s walls. For Easter though, the nursing home's staff wanted to do something to celebrate. So an employee donned a fuzzy bunny costume, put on a surgical mask, and delivered plastic eggs and candy to residents, posing for photos along the way.

You can see the joy in their faces. Residents grinning with big smiles. Some holding plastic eggs, others going in for hugs with the Easter Bunny. A kind and seemingly innocuous gesture, but one that could have dangerous consequences during a pandemic.

The now-deleted Easter photos were uploaded to the nursing home’s Facebook page. “Thanks Easter Bunny!” read the post. 

When Dr. Larry Wilson first saw the pictures, he was surprised.

“I don’t know what happened in between photos, but there is a lot of close contact,” said Wilson, the chief medical officer at Midland Memorial Hospital.  

Wilson is helping lead the local response to the coronavirus crisis. He hadn’t seen the photos until Marfa Public Radio shared the images with him. That close contact he described is a problem according to local health officials because it goes against important guidance from the Centers for Disease Control and Prevention: stay socially distant from people — especially the elderly and infirmed.

In healthcare settings, workers often have to get close to patients to care for them, which is necessary. But after speaking with the nursing home’s management about the photos, according to Wilson, “they recognized that [the way candy was passed out] was probably inappropriate.”

But they told him their goal was to “bring some cheer and happiness” during the holiday.

When the Easter Bunny posed with patients at Midland Medical Lodge, the coronavirus was already spreading through the nursing home. Days before the photoshoot, four office workers tested positive for the disease and were quarantined. Since then, at least 40 residents and staff at the private facility have been diagnosed with the coronavirus — four residents have died.

As of April 28, Midland Medical Lodge alone accounts for approximately 45% of the coronavirus cases in Midland County and the majority of fatalities.

Well before the area's first confirmed case of COVID-19 and before Gov. Abbott issued guidelines for state-licensed nursing facilities, Midland Medical Lodge took their own precautionary steps to mitigate the spread of the coronavirus. 

On March 12, administrators wrote on the facility’s Facebook page that going forward it wasn’t allowing visitors, because residents there were the “most susceptible to complications” related to COVID-19. 

As the Midland Medical Lodge put it, the temporary measure would ensure a “safe and healthy environment” for residents.

There's a good reason why nursing homes and long-term care facilities are one of the last places health officials want a coronavirus outbreak to occur. These facilities are where the aging, injured and sick go to live — the exact populations the CDC says are most at risk of dying during the pandemic.

While the nursing home took precautionary efforts, the series of photos taken over the Easter holiday show that staff disregarded basic safety measures that could limit the spread of COVID-19 among the most vulnerable.

In the photos, you can see the employee, dressed as the Easter Bunny, is wearing a mask. But you don’t see disposable gloves or a gown, which are basic pieces of personal protective equipment, or PPE,used to prevent the spread of infections.

“Even with PPE...you still want to make sure you are adhering to social distancing,” said Whitney Craig, Midland’s Director of Health and Senior Services.

“I’m sure it is probably difficult for [nursing home workers] to not be more friendly, more nurturing, but the recommendation is that you still maintain that social distancing even with PPE.”

According to the CDC, healthcare personnel — which include clerical staff — are one of the primary ways the coronavirus infiltrates long term care facilities.

At Midland Medical Lodge, an administrator tested positive on April 3 for the coronavirus after being hospitalized, according to the city. A day later, another office worker was found to have the virus. And shortly after that, a third and a fourth employee were quarantined after it was confirmed they had COVID-19 as well.

At this point, officials at the Midland Health Department thought the risk posed to nursing home residents was low. Their reasoning, no residents were showing any signs of COVID-19 at this point. The facility had not allowed any visitors for weeks. And all of the confirmed cases at the nursing home had been office staff who worked away from residents. But looking back, Craig sees how the virus could’ve jumped from an administrator to a clinician — accelerating the outbreak.

“Somebody could have come in and picked up paperwork…they could have had a conversation while they were passing by in the hallway,” theorized Craig.

The coronavirus is incredibly infectious, the main way it spreads is when a person with the virus coughs or sneezes, expelling water droplets. There’s also evidence that people not showing any of the symptoms of COVID-19 can spread the disease as well. 

The virus can stay viable outside of a human body for hours to days. And it’s believed people can pick up the virus from touching contaminated surfaces,ranging from countertops, doorknobs and fabric

In every photo from the Easter celebration, the employee is wearing a mask, but there isn't anything covering their costume’s fabric mittens. And there’s no evidence the nursing home's employee took steps to disinfect the costume and plastic eggs in-between visits with residents.

Two days after the photos were taken, two residents tested positive for COVID-19, as well as a part-time nurse. 

There’s really no way to track how and when the coronavirus spread through the nursing home, according to the city’s health department. But after Midland Memorial Hospital began mass testing staff and residents there, they found multiple people who were asymptomatic, meaning they didn’t exhibit symptoms of the coronavirus but had it.

Midland Medical Lodge declined a phone interview with Marfa Public Radio but instead answered some questions through email.

In the facility's response, Keri Powell, an administrator with Midland Medical Lodge says the worker dressed as the Easter Bunny had tested negative for the virus, but she didn’t answer questions regarding the lack of protective gear in the photos and why social-distancing measures weren’t followed.

“There is still much unknown regarding the Coronavirus and its disease process,” Powell wrote. “However, our facility Medical Directors feel the probability of transmission and/or the negative impact that the brief Easter interactions with the negative employee whom [sic] was wearing a mask to be low.”

Since her response on April 24, there have been reports of at least one staff member from Midland Medical Lodge who originally tested negative for the coronavirus, who has now been diagnosed with COVID-19.

In her email to Marfa Public Radio, Powell said the facility will continue to follow guidelines set by the CDC and Centers for Medicare & Medicaid Services.

At this time, it’s unclear how many residents, other than those photographed, were in contact with the costumed employee on Easter.

As of April 28, three women and one man in their 70s, 80s, and 90s have died as a result of the outbreak at the facility. Sixteen staff members have been infected and 24 residents have tested positive for COVID-19.

The Midland Health Department declined to comment on the situation after being shown the Easter Day photos. A city spokesperson said the department “is under immense strain” and could not confirm whether any of the residents shown in the images had tested positive for the coronavirus.

Editors Note: The figures in this article related to Midland Medical Lodge's outbreak have been updated to reflect the figures at the end of April 28 at 6:50 pm. This is an ongoing story so the number of COVID-19 cases and deaths linked to the nursing home may change.

Mitch Borden is Permian Basin Reporter & Producer at Marfa Public Radio.