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A Pinellas memory care unit treated COVID-19 patients on-site. More than half were infected.

Evacuate residents who test positive for the coronavirus or treat them on-site? It's a difficult question facing Bon Secours Maria Manor and other facilities housing dementia patients.

ST. PETERSBURG — A COVID-19 outbreak has spread like wildfire through Bon Secours Maria Manor nursing center, infecting more than half of the residents in their memory care unit in less than two weeks.

In past outbreaks at Pinellas elder care centers, county officials quickly transferred residents who tested positive to local hospitals. But after Bon Secours transferred the first 13 COVID-19 cases to hospitals on June 10, the state told them to stop.

Most of the memory care residents who tested positive are still there and being treated for the coronavirus on-site.

In fact, everyone in the unit — those who tested positive and negative — are being kept in the same wing. The Florida Department of Health told the facility to assume all the residents in the wing have tested positive, said a Bon Secours spokesperson.

The residents who tested negative were moved together, the spokesperson said. But that has not stopped the virus from spreading throughout the wing.

So far, at least 45 of the 66 residents in the unit have tested positive, or 68 percent of the unit. The nursing center has also had at least 35 employees test positive. Four residents have died: Nora Gagne, 85, Anne Bergeron, 91, William Coleman, 91, and Isabel Conroy, 84.

“Due to the nature of the secured memory care unit, and location of the positives within the unit, all residents were assumed positive even if their tests were initially negative,” said Bon Secours spokesperson Jennifer Robinson.

The decision not to evacuate the entire wing has left residents’ families distraught.

“I don’t care what the excuse is — you should never be commingling positive cases with negative,” said Cynthia Tibbs, whose mother lives in a different wing of Bon Secours. “It could be a death sentence for anyone who is negative.”

Related: Florida adds 5,000-plus coronavirus cases for second day in a row

The facility said the decision follows guidelines from the Centers for Disease Control and Prevention that advise memory care facilities to weigh the potential risks and benefits of moving residents.

“Moving residents with confirmed COVID-19 to a designated COVID-19 care unit can help to decrease the exposure risk of residents,” the guidelines say. However, they also warn that changing a resident’s environment, “may cause disorientation, anger, and agitation as well as increase risks for other safety concerns such as falls or wandering.”

Across the country, many health departments and nursing homes are deciding to treat memory-care residents in their quarters. That is partly to avoid overwhelming hospitals, and partly to protect patients with Alzheimer’s disease or dementia from disruptions that could further affect their health.

“Transfer trauma” — the stress a person with dementia faces when their living environment changes — is a real concern for all memory-care residents.

Even a regular stay at the hospital for non-coronavirus related issues can be disorienting and cause a patient’s health to deteriorate rapidly, said Karl Steinberg, a hospice and nursing home medical director in San Diego.

But while it might make sense to treat dementia patients who test positive for COVID-19 in the same place, Steinberg said it also creates an unavoidable risk for others in the facility.

“I am a big proponent of letting people stay in place,” he said. “But if I had loved one in a facility that had COVID, I would probably want to pull them out and not wait for them to get it.”

Related: 13 residents test positive for coronavirus at Bon Secours nursing home

Memory care units are particularly vulnerable to a rapid coronavirus spread, even though Gov. Ron DeSantis has banned visitors to elder-care facilities since March 15, essentially locking them down, and required increase precautions and testing.

Residents diagnosed with Alzheimer’s and dementia can’t be confined to their rooms. Many pace and wander the halls with little understanding of the risks of social contact, while caregivers try to redirect them.

Some don’t want to wear a mask, and staffers can’t force them to do so. Testing is another struggle.

“Are you going to hold the dementia patient down and grab their head really hard to take the swab and put it in their nose?” Steinberg said.

Bon Secours said residents are isolated in their rooms. Staff members are keeping them away from other residents’ rooms whenever they need to move around, the facility said.

Nursing homes nationwide have also been treating their residents in place because of the overwhelming strain on hospitals, said Manisha Juthani, an infectious diseases specialist at Yale University.

“Florida is now experiencing what we all did here in the Northeast in March-May,” she said. “Once it became clear that the hospitals were filled to capacity and nursing home residents were stable in their homes with no major added benefit to going to the hospital, homes had to close to visitors and stable patients stayed in the homes. This was, and is, the most appropriate course of action.”

She added: “It is very challenging for families.”

Related: Hospitals revert to no-visitor policies as coronavirus cases increase

So far, all the COVID-19 cases at Bon Secours have been limited to the memory care unit, which is sealed off, the facility said. All staffers who tested positive must receive two negative tests 24 hours apart before they can return to the facility at 10300 Fourth St. N.

The facility said it also tests all staff and residents weekly, has set up separate entries for staff of the memory care unit and increased monitoring of vital signs, among other measures.

But Tibbs worries the precautions won’t be rigorous enough to keep the virus from spreading to the rest of the nursing home.

“How do you expect our numbers to get lower when you are housing everyone together?” she said. “As far as I’m concerned, you guys are really not doing a great job at containing this.”

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