Coronavirus brought in from a dialysis center and from an asymptomatic employee in the break room of a Hilo veterans home appear to be among the origins of the largest COVID-19 nursing facility outbreaks in Hawaii.

The latest report by the Hawaii Emergency Management Agency was released Monday after half a dozen new deaths were recorded over the weekend at the Yukio Okutsu State Veterans Home on Hawaii island, bringing the nursing home’s COVID-19 death toll to 24.

The agency found “multiple potential sources of infections” brought into the 95-bed facility by employees who appear to be “connected to known community outbreaks, unknown asymptomatic but infectious carriers (staff), and community outbreak exposure at a dialysis center,” the report said, adding that complacency by staff also may have played a role in the spread of the virus, particularly in the break room where employees gathered without masks. “Loose mask usage” by some staff was noted by Dr. K. Albert Yazawa, who conducted the assessment.

“I believe the nursing home culture at YOSHV was one that remained entrenched in pre-COVID norms of respecting individual resident rights over the health of the general population,” he wrote. “In this pandemic crisis, these were major errors that contributed to infectious spread.”

Yazawa observed no warning signs for staff, hand-washing stations or alcohol dispensers near a frequently touched time clock and said the setup of the central nursing station with resident rooms in hallways “designed like spokes on a wheel” made it hard for employees to “maintain distance and separate clean from dirty work stations.”

Suspected COVID-19 residents were not separated into a designated unit, and there were delays in testing until scheduled mass screening events occurred, the report said. What’s more, residents with dementia were able to wander and “probably also facilitated spread” with no use of physical barriers or signs.

A separate report by the U.S. Department of Veterans Affairs released Friday said that “there was very little proactive preparation/planning for COVID” at the only veterans care home in the islands, established in 2008.

“Many practices observed seemed as if they were a result of recent changes. Even though these are improvements, theseare things that should have been in place from the pandemic onset and a major contributing factor towards the rapid spread,” according to the VA report. “A basic understanding of segregation and work flow seemed to be lacking even approximately three weeks after first positive.”

Allison Griffiths, a spokeswoman for veterans home operator Avalon Health Care, which also manages Avalon Care CenterHonolulu and Hale Nani Rehabilitation and Nursing Center in Makiki, told the Honolulu Star-Advertiser in an email that the company is “very disappointed with how politically charged this situation has gotten.”

“The lack of collaboration and support by the Department of Health and other state agencies is unprecedented. Avalon operates in six states. This is the only state where we have seen this type of blatant politicization of a crisis situation and a complete lack of support, collaboration, or assistance following an outbreak in a health care facility,” she wrote.

In every other state in which Avalon operates, the state health departments have worked to help with personal protective equipment, testing and other support to ensure the health and safety of the residents and community, Griffiths said. “We are also heartbroken by the hostility and lack of aloha towards our staff — who are all local folks who live in Hilo — and have put themselves in harm’s way to care for our veterans whom they love like family. They are health-care heroes, as are all health care workers, who are fighting on the front lines of this historic public health crisis.”

Seventy nursing home residents and 32 employees have so far tested positive for the virus, according to Avalon. The home had 89 residents before the coronavirus outbreak at the facility.

In a third report set to be released today by the DOH Office of Health Care Assurance, inspectors found there was “no follow-up to ensure appropriate behaviors” or enforcement even though staff were trained June 10-15 on COVID-19 infection and control policies and procedures.

Also Monday, state health officials reported 56 new coronavirus infections — 4.8% of 1,162 new tests — bringing the total since the start of the pandemic to 11,459 cases. All but seven new cases were on Oahu.

It was the second day in a row that the statewide count fell below 100. Officials reported 77 new cases Sunday.

The official statewide death toll remained unchanged at 120, but it is expected to climb significantly once the DOH verifies the cause of death in most of the reported fatalities at the Yukio Okutsu State Veterans Home. More than 20 deaths are pending verification.

Yukio Okutsu was an Army sergeant in World War II and part of the 442nd Regimental Combat Team. He was awarded the Purple Heart and Medal of Honor.

There are 6,451 active infections statewide, and 4,888 patients now classified as released from isolation, or nearly 43% of those infected.

“With 24 deaths and 70 positive infections of our veterans, the VA’s report makes it clear that the facility’s management failed to take action to prevent this massive outbreak at a home entrusted with the responsibility of caring for our veterans,” U.S. Rep. Tulsi Gabbard said in a statement. “The culture of complacency that allowed this incredible loss of life and suffering must end. Those responsible for this must be held accountable. I will continue to support all efforts to conduct oversight and follow- through to ensure immediate action is taken to keep our veterans and their caregivers safe. Sadly, for many of the residents and their families, it’s too late.”

VA Report on Yukio Okutsu Veteran's Home by Honolulu Star-Advertiser on Scribd

Yukio Okutsu State Veterans Home – HI-EMA Report 9-11-2020 – REDACTED by Honolulu Star-Advertiser on Scribd