Lack of readiness, questionable federal inspection helped fuel first U.S. COVID-19 outbreak

When a nursing facility outside Seattle found itself in the middle of the first known U.S. outbreak of COVID-19, the response was hampered by a lack of viable tests and a federal inspection that diverted time away from patient care.

Inside the country's first COVID-19 outbreak
Inside the country's first COVID-19 outbreak 13:24

On the morning of February 29 the world turned its attention from news of the coronavirus in China and Europe, to the Seattle suburb of Kirkland. What was predicted by public health experts had arrived: the first COVID-19 outbreak in the United States. And it was spreading in the most vulnerable of places — transforming a 5-star, skilled nursing facility into the first hot-zone in the country.

It was our initial encounter with the invisible enemy, and on display, the federal government's readiness. Despite President Trump's message at the time, COVID-19 was not going away. So far, more than 9 million Americans have been infected and 230,000 people have died. When the virus struck Washington state, there was a lack of testing and personal protective equipment.  Instead of jumping in to help patients, the federal government jumped to questionable conclusions. Tonight, we'll take you where the outbreak started and show how events unfolded.

Nancy Butner is a vice president at Life Care Centers of America. We met her at the Kirkland nursing facility she ran for 14 years. We are the only reporters to be allowed inside since the coronavirus cut a deadly swathe through this facility. Today, it's a quiet, COVID-free place, a stark contrast from what happened here eight months ago. We began speaking with Butner remotely in June.

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  Nancy Butner

Bill Whitaker: In the end, how many people did you lose to this disease?

Nancy Butner: We had about 38 patients that passed.

Bill Whitaker: And staff?

Nancy Butner: We lost no staff. Was about 67 staff I believe that were diagnosed with COVID.

On February 12, before anyone suspected COVID-19, Nancy Butner's nursing staff noticed a cluster of residents with the same respiratory illness. Days later, more would come down with a fever and cough. By then, Life Care knew it had a respiratory infection spreading in the building.  

911 Call
Dispatcher: 911 Emergency…  She's having difficulty breathing or can she…
Caller (Life Care):  Absolutely, and she was diagnosed with pneumonia a couple of days ago...

One by one, Life Care started sending sick residents to nearby Evergreen Hospital.

911 Call
Dispatcher: Okay, is this the Life Care Center of Kirkland?
Caller (Life Care):  She's short of breath...

Nancy Butner: We thought we had pneumonia, patients with pneumonia

Bill Whitaker: At that time, could you test for COVID-19?

Nancy Butner: No. No COVID-19 tests were available.

In February, testing for COVID-19 was limited to the CDC's lab in Atlanta, and reserved for people who had traveled to China or had contact with an infected person. None of the patients then in Evergreen Hospital qualified. And when the government moved to expand testing operations, the tests they shipped to public health labs were defective.

Bill Whitaker: The CDC's test was the first one approved and the first one put out there, and it didn't work?

Dr. Geoffrey Baird: It had a problem with one of the-- the components of the test caused some false positives.

Dr. Geoffrey Baird chairs the Department of Laboratory Medicine and Pathology at the University of Washington School of Medicine. He watched as the administration's bungled roll-out stymied national testing and surveillance, as the virus gained a foothold in the United States. Scientists in Baird's world-renowned lab had been monitoring the novel coronavirus since December and Dr. Baird had invested millions to prepare for it - including making their own COVID-19 test.

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Dr. Geoffrey Baird

Dr. Geoffrey Baird: We could make a drug test to detect heroin or we could make a blood test to detect cancer. We can just do those. And then we can just offer those tests. We could've done that also for this.

They first needed emergency approval from the FDA and ran into one bureaucratic wall after another.

Dr. Geoffrey Baird: You have to send in the paperwork on paper. Then you also have to send it in on, you know, a flash drive. And then to gain approval, you would need to prove that the test worked on a larger number of cases than actually had been reported in the United States.

Bill Whitaker: It's fair to say that this was all going on at a time when we really needed those tests?

Dr. Geoffrey Baird: Oh, yes. Oh, yes, of course.

As more cases of COVID-19 were confirmed in the U.S. and public health labs were still saddled with the faulty CDC test, Dr. Baird's lab, along with the Association of Public Health Laboratories, beseeched the FDA to let them use their own tests. Dr. Francis Riedo is the medical director of infectious disease and prevention at Evergreen Hospital, where sick patients were filing the ICU.

Dr. Francis Riedo: It was on February 27th that they announced that testing would be available at the local health department beginning on February 28th.

Dr. Riedo wasted no time, testing two patients, including a 73-year-old woman from Life Care whose symptoms had started 9 days before.  

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Dr. Francis Riedo

Dr. Francis Riedo: So that night the chief of epidemiology called me and said, "You have two positives." And I thought the odds of two individuals in a suburb of Seattle-- just seemed too implausible.

He then tested another 42 patients, 32 came back positive for COVID-19. Twenty were from the Life Care nursing facility.  

Bill Whitaker: It must have indicated to you that this virus had been spreading around the community for days, if not weeks, before it popped up on your radar. So you knew, it's out there.

Dr. Francis Riedo: We knew it was out there. 

Nancy Butner: I got a call at home about 11:30, 12:00 at night on February 28th that we had a patient that tested positive.

Overnight, this tidy one-story building became the face of the first outbreak in the United States. Inside Life Care, Nancy Butner and her staff were the first to witness how wily this virus could be.

Nancy Butner: I think one of the most difficult things is that we didn't know what it looked like. And we didn't know what it would do to the patients, those early days. 

Bill Whitaker: It almost sounds like the virus was getting away from you?

Nancy Butner: Oh. There's no question that we were not in control. The virus was in control.  We couldn't readily test for it for that first week. So we didn't know if patients had it or not.

It came down to a guessing game of who they thought had COVID-19 and who didn't, isolating some and not others. No one in this country had come up against anything like this before.  Butner's staff had to improvise PPE on the spot, buying up oversized men's shirts and wrap-around dresses from Walmart. While 40 of her employees, including the medical director, became sick and could no longer come to work. Outside, the media gathered to film the parade of ambulances and to talk to heartbroken family members.

Bereaved son: We wake up daily to news of another death.

Bereaved daughter: My mother, I got a phone call this morning that she had passed at 3:30 in the morning

Bereaved son: This is a picture of my mom, back in 1979. They transported her to Evergreen Hospital and by 6 a.m. she had passed away.

As if responding to a slow-motion mass shooting, local authorities declared a multi-casualty incident, putting hospitals on notice to receive critically ill patients.

Dr. Jeff Duchin: I felt like I was standing on the beach looking at-- a big tidal wave coming at us.

Dr. Jeffrey Duchin, a 22-year veteran of the county health department, was in-charge of the local government response to Life Care. We met him on a windy afternoon in Seattle.

Bill Whitaker: This is the kind of public health outbreak that you've trained for your entire career.

Dr. Jeff Duchin: It was overwhelming in so many ways because it erupted so quickly, so unexpectedly. There was just a lot of desire in our public health community to try and do something about it.

Knowing the virus was way ahead of them in the city of Kirkland, Dr. Duchin raised the alarm with the CDC, asking for a team of epidemiologists, disease investigators and lab support. And with Life Care's essential staff down by a third, Nancy Butner called in a federal lifeline of doctors and nurses. 

Bill Whitaker: Three days into the crisis, you write to the Department of Health and Human Services and ask them for a strike team that comes out within 24 hours to tackle emergencies. You wrote to them--

Nancy Butner:  Right.

Bill Whitaker:  --quote,"we will agree to whatever it takes to receive federal assistance. Simply stated, we are desperate for licensed nurses and nursing assistants." That sounds like a real cry for help.

Nancy Butner: We desperately needed staff. We needed nurses and aides to help us-- care for the patients. 

In the first four days, 27 Life Care residents were taken to the hospital, by the end of the week, seven residents had died inside the home. With a house on fire, it would take, not 24 hours, but 5 days for the strike team to arrive. But before doctors and nurses turned up, another federal agency moved in, the Centers for Medicare and Medicaid Services - not to help with patient care, but to investigate the nursing facility.

Bill Whitaker: How did that impact your ability to care for the residents in the middle of this crisis?

Nancy Butner: Hours of staff time were averted to managing a survey process instead of managing a crisis in the facility and patient care.

Bill Whitaker: So these federal investigators showed up before the federal strike team came to help you.

Nancy Butner: Yes.

Bill Whitaker: Did that make any sense to you?

Nancy Butner: It was infuriating. They didn't truly understand COVID or what the facility was going through or what we had been through.

Bill Whitaker: Did you say to them, "Look, we are in the middle of a crisis. Why don't ya let us handle this crisis and then we'll answer your questions?"

Nancy Butner: They knew how many staff were lost. They knew how many patients were hospitalized. They knew there was a lot of patients that were sick and it was an unknown virus. I explained that to them. But I can't tell them to leave.

But state health officials tried to do just that. We searched hundreds of public documents and found emails that show they pressed the governor's office to get the federal inspectors to "call this off." 

According to Life Care Centers of America, federal inspectors interviewed employees and demanded thousands of documents, diverting more than 400 hours of staff time away from patient care. The result was a 48-page 'statement of deficiencies' which said that Life Care failed to manage the outbreak, putting residents in immediate jeopardy. We wanted to speak with Seema Verma, the administrator in charge about the timing of the inspection and the findings, her office declined multiple requests for an on-camera interview. 

Nancy Butner: I think they wanted a scapegoat for what happened at Life Care Center Kirkland. I think that they wanted someone to blame for COVID-19 spreading. We had nothing to do with the spread across the nation.

Life Care was fined more than $600,000. In addition, the state inspectors, working in partnership with federal investigators, filed their own report, accusing Life Care of the same serious mistakes they say cost lives. Life Care appealed both and in September, a judge in the state case sided with the nursing facility and concluded that it was not a case of negligence. Although the federal case is still pending, Nancy Butner sees this as vindication for Life Care of Kirkland.

Nancy Butner: He found that everything we did during that time was appropriate. He ruled in our favor. I think that it was very clearly written by the judge that what we did was the best that we could do.

During the first week of the outbreak, the CDC warned skilled nursing facilities in the U.S. "are at the highest risk of being infected by coronavirus." Still, nearly 80,000 nursing home residents have died nationwide. And the people who battled the first outbreak in Kirkland, Washington, they worry the country wasn't paying attention.

Dr. Francis Riedo: I think the messages that we sent out in those first five days were a stark warning.

Bill Whitaker: What do you mean?

Dr. Francis Riedo: That it's coming. The numbers are expanding on a daily basis. You better be prepared.

Bill Whitaker: Who's responsible for the-- the missteps and mistakes?

Dr. Geoffrey Baird: It took a village to screw it up this bad. We don't really have an approach to public health that works really well in this country.

Bill Whitaker: Sounds like you give the U.S. a failing grade?

Dr. Geoffrey Baird: I am not happy with how we responded and I would hope that we learn from this and do better the next time, 'cause there will be a next time, for sure.

Produced by Julie Holstein and Michael Karzis. Broadcast associates, Emilio Almonte and Mabel Kabani. Edited by April Wilson.