Since the start of the coronavirus pandemic, a nagging fear has been that the deadly virus would take hold in vulnerable hubs, such as nursing homes and long-term care facilities with frail and elderly residents. That’s why this week’s outbreak of cases at Hale Nani Rehabilitation and Nursing Center, the state’s largest nursing home, is concerning.

As of Friday, at least 12 cases of coronavirus were confirmed at the Makiki facility among workers and residents (among a statewide total of 27 new positives). Hale Nani, in immediate response to its initial case on June 12, implemented aggressive infection control measures, with active monitoring and repeat testing underway for all residents and staff. So far, most of the cases involve those who live or work in one unit, and luckily, have been asymptomatic.

“When there has been exposure in a health-care setting like this, resulting increase in infections are possible and unfortunate, but not unexpected,” said Dr. Sarah Kemble, deputy state epidemiologist. “We could continue to see a number of new cases over the next two weeks.”

That ominous prediction must serve as a reminder — warning, really — for all kupuna facilities to redouble their efforts to keep operations as hygienic as possible, adhering to strict cleaning protocols; to continue screenings; and to minimize contact with nonessential personnel and visitors.

Last week, the Arcadia Family of Cos. took the initiative to test some 550 of its health care workers, the first mass testing at nursing homes on Oahu. That reasonable precaution came after three positive cases among workers at two long-term care facilities, Kalakaua Gardens and the Maunalani Nursing and Rehabilitation Center.

“Many nursing facilities on Oahu share staff, which is a large concern with respect to the spread of COVID-19,” noted Suzie Schulberg, CEO of Arcadia Family.

The sharing factor was sobering to hear, and puts pressure on operators to heed the Centers for Medicare & Medicaid Services’ updated recommendations to local governments and long-term care facilities to help mitigate the spread of COVID-19. These focus on infection control, use of personal protective equipment (PPE) and COVID-19 tests, symptom screening for all, and strict staffing and visit policies to avoid transmission.

Last month, Hawaii’s U.S. Sen. Brian Schatz noted an analysis that found the virus had infected more than 153,000 residents at over 7,700 senior facilities nationwide, and that one-third of U.S. COVID-19 deaths have been nursing home residents or workers.

Hawaii’s kupuna cases this week highlight the close living quarters of adult residential care and assisted-living homes, which often involve hands-on care. All such facilities and the state must ensure that staffers have enough PPE; see that safety guidelines and infection control procedures are understood and followed, including daily screening of staff; restrict in-person contacts but enable phone and digital visits; and enable testing as well as swift reporting and quarantining of positive cases.