At Life Care Center, a nursing home in Kirkland, Washington, 18 residents have died from the coronavirus, and another 31 residents had tested positive. At Issaquah Nursing & Rehabilitation Center, also in Washington, one resident has died from the virus, and two others are infected.
The spread of the coronavirus in nursing homes and assisted living facilities highlights the particular threat these communities face from the illness.
On Tuesday, the American Health Care Association, or AHCA, and the National Center for Assisted Living, or NCAL, released new guidelines meant to protect residents, who are the most vulnerable to complications from the disease.
"This is the greatest threat to nursing home residents that we have seen in many years, if not ever," Dr. Michael Wasserman, president of the California Association of Long Term Care Medicine, told NBC News.
The most worrisome example of what the virus can do in a nursing home has been at Life Care Center. At least 18 residents there have died from the coronavirus in the past month, as well as one person who visited the facility.
Eleven other patients at Life Care Center have passed away since the outbreak began, though it's unclear whether they, too, had been infected with the new virus. Dozens of other residents at the facility have tested positive for the illness.
Historically, fewer than seven residents pass away each month at the facility.
Several other facilities for older adults in the Seattle area have also reported cases.
The new guidance is part of an urgent push to keep the virus out of other elder care center across the country. They advise staff to ask visitors whether they've had respiratory symptoms, such as a fever, cough, sore throat or shortness of breath, and then wash their hands before having any contact with the residents.
"This is unprecedented action that we're taking," Mark Parkinson, president of the AHCA and the NCAL, said during a media briefing Tuesday. He added that visitors should also be asked about recent international travel and whether they've been in other facilities with confirmed cases of COVID-19, the illness caused by the coronavirus.
Within the past 24 hours, the Centers for Medicare and Medicaid Services released similar guidance to counter the spread of the coronavirus.
And, effectively immediately in the state of Washington, Gov. Jay Inslee announced Tuesday that children are temporarily banned from nursing homes, and any adult visitors must remain in resident rooms. The rules do not apply to end-of-life situations, however.
Visitors may also be required to wear protective equipment, such as gloves and gowns.
"Older folks don't have the reserve to handle illnesses," Dr. Richard Baron, a geriatrician and the president of the American Board of Internal Medicine, said. "They really are fragile, and their clinical status can change very quickly."
"If there is one single thing that matters most right now, it's that if someone has a fever or a cough or feels sick, do not visit a nursing home," Wasserman said. "There should be no exceptions."
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But cutting off physical contact with friends and family, even temporarily, can be difficult. The recommendations suggest facilities develop alternative methods of communication for residents to engage with the outside world.
Debbie Meade, an AHCA member and the CEO of a Georgia assisted living facility called Health Management, said her staff has started offering residents cellphones so they can videoconference with family while visits are restricted.
"This is to protect the patients and the residents," Meade said during a call with reporters.
The Los Angeles Jewish Home, an assisted living system in California where Wasserman also serves as the medical director, recently implemented a policy that each person who walks through the door — employees included — must submit to a temperature check.
While the AHCA and the NCAL recommendations do not recommend checking visitors or staff for fever at this time, Wasserman said the extra precaution is necessary.
"If we sit idly by and wait to find out how bad it is," he said, "we could very well be sitting around asking ourselves why we didn't do more."