The sirens seemed to sound non-stop outside the Life Care Center in Kirkland, Washington.
It was on the night she sent patients to the hospital that she expected them to be treated and eventually released. They never came back.
It was the date on which she discovered “the whole cascade of symptoms” of a virus that the asylum discovered it had invaded just four days earlier.
It was also the day she had to make some distressing calls.
At 3 am she can’t get rid of her head. She remembers the conversation with the woman on the other end of the line.
“I realized it was early in the morning, and it is very difficult to say that I am really sorry that your mother passed away,” said Earnest. “I cried with her.”
The two, who never met, shared a heartbreaking moment. Ten months later, they still sometimes speak, said Earnest.
Earnest, a registered nurse, offered to help Kirkland’s nursing home from her position as director of nursing at another Life Care Center in the state.
They needed all the help they could get. Nearly 70% of the team had tested positive for coronavirus in March.
She had no idea that the low-key building on a tree-lined street in a quiet residential neighborhood in Kirkland would become the first epicenter of the coronavirus outbreak in America.
“It was like chasing a ghost,” she told CNN in March. “You are on a battlefield where supplies are limited. Aid is slow to reach you and there are many victims. And you cannot see the enemy.”
Ten months since the initial outbreak, she and other frontline health workers here are finally getting the best weapon available to fight the virus: the vaccine.
Alice Cortez, nursing manager at the Kirkland Life Assistance Center, was the first to get the vaccine here.
“This is an exciting day for everyone, especially for my team,” she said, her voice choked with emotion.
“What I feel now is a new life, a new beginning, but a better life.”
Coronavirus remains a threat in nursing homes
But everyone here is well aware that the virus is still on the rise and remains a threat to the most vulnerable people: the people they care for.
On December 13, the Center for Medicare and Medicaid Services, which oversees nursing homes, said that 441,000 nursing home patients tested positive for coronavirus in the United States and 86,775 nursing home residents died from Covid-19. And 1,258 employees also died.
“There is not a day when I do not receive a phone call or a message that we have a new patient or positive team,” said Nancy Butner, vice president of Life Assistance Centers for the Northwest America division. Butner said some of his employees were recently hospitalized. And more patients died in other facilities.
“It’s relentless,” said Butner.
Initially, some families and the public blamed nurses, doctors and Life Care Center of Kirkland staff for the outbreak and for not controlling it better.
The phones kept ringing. Families were unable to attend – sometimes not doctors – because of other unwanted calls.
“It was very difficult to go into a patient’s room and listen to the phone. And you think you’re a doctor, and you get there and it’s a person saying they have a cure for Covid, giving a prescription that is crazier than they are, “Earnst said.
It was often the most shocking type of call: death threats, enough to demand security. Earnest was afraid to go to the car one night after treating patients.
“My husband said, ‘Make sure you have your gun,'” she said, now able to laugh at it. But he was serious and so were the threats.
Then there was the vision of the devastated families that appeared every day.
Some lost their mother or father at the facility, and still others had family members infected with Covid-19. They sat on chairs outside the window of their family members’ room, having lunch with them and having conversations muffled by the glass.
Inside, the team was dealing with a virus that no one knew well enough.
It was before the public was instructed to wear masks, before the elbow strike became the new handshake, before all the symptoms were known. And that was before tens of thousands of people started getting sick and dying in New York City, which soon became the second epicenter of the virus.
The Life Care Center appealed the decision. In September, a state administrative judge broadly supported the Kirkland Life Assistance Center, and not the state conclusions, which mimicked the federal ones.
The judge said the state agency “provided relatively little evidence that the facility did not actually meet any expected standards of care or did not follow public health guidelines.”
The federal appeal was not decided.
Changes made since the March outbreak
In the beginning, there were not enough coronavirus tests and it took days to get the results. Now, they have quick tests that take minutes.
In some rooms, there were three patients. Now, that is reduced to one – or two, if they can be properly spaced.
Before the virus, the facility accepted up to 124 patients. Now they have limited it to 97.
At that time, there was a constant concern about the lack of personal protective equipment. Now, a nearby facility has a large room filled with boxes of masks, gloves and other equipment.
However, 10 months after the initial viral outbreak, chairs for family members remain outside the bedroom windows. Room numbers are scrawled on the windows.
It became a semi-permanent device because visitors are not yet allowed inside.
There is no family holding hands or hugging and kissing. It is simply very dangerous, the virus very contagious. The team knows this now.
In the beginning, Earnest, a registered nurse, informed doctors and members of the Centers for Disease Control and Prevention what she saw in patients. They now receive constant updates and new security protocols from government agencies.
Covid-19 impacts the team inside and outside the nursing home
Butner says what people don’t always think is that the team needs to fight the virus at work and at home.
Earnest lost an uncle to Covid-19 this year. Therefore, before Christmas, she needed to “have a conversation” with her mother about how she would like to die.
“If she did, what did she want? Did she want to be on a respirator or did she want to be … let go?”
It was the most difficult conversation she had with the family. But she says she couldn’t help it. Nobody should.
It is horrible when they are taken and isolated and you cannot know what they want. Sometimes you can’t say goodbye, she said.
Earnest said he hopes the vaccine will make these conversations less urgent. But not everyone in the nursing facility is eager to get it.
“We did a survey with the staff at our facilities before doing vaccine education. Twenty percent said no, never. They would not be vaccinated, ”she said.
For now, she says, Life Care Centers of America is not making it mandatory. The reason is simple.
“We just couldn’t afford to lose 20% of our workforce,” she said. “Another effect of this virus is an extreme shortage of nursing staff for all health care.”
She hopes that, with education, the percentage will decrease.
For physician assistant Christy Carmichael, her decision to get the vaccine stunned everyone. Last week, she promised one of her patients who survived Covid-19 that she would be able to get the vaccine.
“I said yes. Unfortunately she passed away,” said Carmichael, before breaking down in tears after receiving the vaccine. “I promised her that she would make it, so it’s very sad that she didn’t get to see it today.”
CNN’s Leslie Perrot and Mallory Simon contributed to this report.