The coronavirus has killed three of the six people confirmed to have the virus in rural Toole County, an especially deadly tally at least partially tied to the state's first outbreak in an assisted living facility.
The small county in northern Montana has a population of about 4,800 but accounts for three-fifths of the state's five total deaths from COVID-19, the disease caused by the coronavirus. Statewide 217 people have been sickened and at least 32 have recovered, while 19 have been hospitalized.
COVID-19 hits those who are older or have existing health conditions hardest. Toole County reported its first case of the virus March 25. That was 79-year-old Bev Rogers, whose family said she died four days later.
In the Cut Bank Pioneer Press newspaper, the family wrote that Rogers had been a resident of the Marias Heritage Center, a 38-bed retirement and assisted living facility under the umbrella of the Marias Medical Center, the county hospital.
"When she was living at your facility, she would mention you each by name and brag about how well you cared for her. You had concern for her until the end," the family wrote in the paper.
On March 27, two days after Rogers' positive test for COVID-19 was reported, the Marias Medical Center posted a press release to its Facebook page saying the county had confirmed additional COVID-19 cases that included employees at the Marias Heritage Center. The release did not say how many employees were ill.
"The situation also exposed others to COVID-19 and, as such, we expect that there could be other positives," the release read.
The Toole County Health Department said Wednesday that it could not provide details about how many of the county's six total cases are connected the assisted living facility, citing privacy laws.
The state provides information about the age and gender of patients, however, and Toole County cases have been mostly in an older population. In addition to Rogers, the cases include a man between the ages of 70-79, a woman between 80-90, and another woman between 90-99. The other two cases are a woman between the ages of 10-19 and a woman between 40-50.
Little information specific to the assisted living facility was available from either the Toole County Health Department or the Marias Heritage Center.
The health department has put out press releases and videos on its Facebook page about case tallies and deaths in the county. Many local health agencies and counties have relied on Facebook during the pandemic to get information out to the public.
Local county health offices and medical facilities, including Toole County, have been overwhelmed trying to respond to COVID-19 cases, making it difficult to find time to respond to media requests for information.
Asked Tuesday and Wednesday over the phone and in messages about what measures have been taken at the Heritage Center to protect residents from further spread of the virus, the county did not answer and directed questions to the facility.
The Heritage Center also did not return messages left by phone and online asking about the degree of exposure at the facility and what measures were being taken to protect residents, employees and others from further spread of the virus.
The health department did post a release on its Facebook page Wednesday about the county's third death and sixth positive case, the test results for which came back Tuesday.
"We know this virus is deadly and now that reality has hit home in a terrible, tragic way. You as a community need to come together and stop this by following guidance provided. We are working diligently around the clock to stop the spread and keep our community informed," the release reads.
Toole County Commission Chair Joe Pehan told Lee Newspapers on Monday that health care facilities in Shelby are on lockdown, and patients and residents are not allowed out of their rooms, to help prevent the spread of the virus. Employees wear protective suits when delivering meals, he said.
"We're taking every precaution to keep everyone safe and keep this from spreading in all our facilities," Pehan said. "The whole town, we're on the governor's shelter-in-place (order) so there isn't hardly any movement in the town of Shelby whatsoever."
Jim Murphy, the head of the Communicable Disease Bureau in the state Department of Public Health and Human Services, said Monday the Toole County situation is the first outbreak of COVID-19 in Montana in a congregate setting. The state monitors those types of outbreaks, and Murphy noted that because the coronavirus is a new disease, even a single case would be considered an outbreak.
Congregate settings present heightened risks, Murphy said, for several reasons, including the opportunity for the virus to spread and, in this case, the percentage of those involved who would be more likely to get severely ill because of their age.
"A COVID-19 case that is in a nursing home or congregate setting is a lot more of a risk than somebody in a private house," Murphy said.
Any time there's an outbreak in a settling like an assisted living facility, Murphy the state works with the local health department and offers them assistance.
The governor's office said earlier this week it was sending Toole County additional personal protective equipment for health care providers, and health care staff from other areas of the state.
Administrative rules in Montana detail how quickly a health care provider must notify counties, and in turn how fast counties must notify the state, about reportable illnesses, which includes include COVID-19. Murphy said Toole County has been "very rapid" in reporting information about its cases and alerting the state to the situation at the assisted living facility.
"It was all handled in the same evening, the result came in in the evening and they initiated conversations with a couple jurisdictions and clinicians that were involved," Murphy said.