Judith Gregoire of Superior knew she had to do something to ensure her husband Bernard, 79, would be safe.

For years, Bernard Gregoire suffered from dementia, and it got to the point where she couldn’t leave the room without him taking off.

Judith Gregoire said she made the decision to put her husband of 47 years into long-term care at Superior Rehabilitation Care in September. He died Saturday, Nov. 14, during a COVID-19 outbreak at the facility after testing positive for the disease caused by the new coronavirus.

He wasn’t alone.

Fourteen residents, eight of whom were in hospice care, tested positive and died during the outbreak, said Marc Halpert, chief operating officer of Monarch Healthcare Management, the parent company of Superior Rehabilitation Center.

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The first confirmed COVID-19 deaths associated with a long-term care facility were reported to Douglas County on Nov. 25 and had occurred over the two weeks prior to that date, according to Kathy Ronchi, Douglas County public health officer.
“The facility has been compliant with COVID precautions and testing, and the majority of people are recovering well at the facility,” Ronchi wrote in an email announcing the newly reported deaths.

Halpert said the outbreak was discovered during routine testing for the disease. A total of 82 residents and 61 of 113 staff members tested positive for COVID-19. However, most people — 56 residents and 51 employees — had no symptoms, he said.

Visitation at the facility stopped March 13, Halpert said. In addition, staff and residents alike were required to wear masks and eye protection at all times, and handwashing was encouraged.

During the outbreak, Monarch relied on a pool of floating workers to adequately staff the facility. After completing their quarantine periods, 49 employees are back to work.

Lag in reporting

It’s clear not all of the deaths will be attributed to COVID-19. In two cases, the cause of death hasn’t been determined, and three people died of natural causes. Death certificates for nine people listed COVID-19 as the cause of death or a significant contributing factor, Ronchi said.

Until Tuesday, Dec. 1, the state Department of Health Services listed Douglas County as having only one death related to COVID-19. The lag in reporting was due to where the people were hospitalized, Ronchi said.

“There has been a delay because those who pass away at a Minnesota hospital go to their medical examiner and take longer to be reported,” Ronchi said.

Furthermore, not all of the people who died were permanent residents of Douglas County. That means their deaths would not be included in Douglas County's figures, but rather their county of residence.

To be counted as a death related to the pandemic, a person's death certificate must list COVID-19 disease or SARS-CoV-2 as an underlying cause of death or a significant condition contributing to death. Deaths among people who tested positive for COVID-19 that are the result of other causes, such as an accident or overdose, are not included, according to DHS.

Someone experiencing COVID-19 symptoms, even if they had end stage cancer and their death was expected, would have COVID-19 listed as a contributing factor, Ronchi said.

Health care providers or medical examiners determine cause of death. Douglas County Medical Examiner Darryl Witt said his office wouldn’t be involved in determining the cause of death in a health care facility.

Since DHS relies on death certificates to determine the number of COVID-19 deaths in the state, it can sometimes "take several days" for figures to be updated, said Dr. Ryan Westergaard, chief medical officer with the DHS Bureau of Communicable Diseases.

In the case of Bernard Gregoire, his decline happened within a week from when he tested positive for COVID-19.

“I sat and held his hand for hours, but he had so much trouble breathing. It was horrible," Judith Gregoire. said.

The following day, her husband sounded like his lungs were filled with phlegm and he was snorting to gasp for air. By that afternoon, he breathed his last.

“I don’t want what happened to my husband to happen to anyone else,” Gregoire said. “It’s the most horrible way to die.”

This story was updated at 3:10 p.m. Dec. 3 to include new information about the residency of some of the people who died and how that could contribute to differences in data. It was originally posted at 6:30 a.m. Dec. 3.