CHARLESTON — With most of the state’s virus outbreaks in nursing homes, officials with the West Virginia Department of Health and Human Resources announced Monday that the same color-coded re-entry system for K-12 schools would also apply to when nursing homes can allow visitations.

Gov. Jim Justice signed an order Monday rescinding an Aug. 12 executive order restricting nursing home visitations by family members except in the case of end-of-life care. In its place, DHHR said that nursing home visitations and communal activities would depend on the new County Alert System color-coded map available at coronavirus.wv.gov.

Bill Crouch, secretary for DHHR, said the new system was developed with the assistance of the West Virginia Health Care Association, which represented nursing homes and assisted living facilities in the state. Crouch said the new system will be updated daily.

“In an effort to be very cautious and make sure we had a process going forward, we worked hard last week with the association for the nursing homes to develop a system whereby there was guidance to those openings, those facilities that could allow visitation and those who could not,” Crouch said.

The map, based on the Harvard Global Health Institute map, was originally developed to guide county school systems when deciding home to re-open schools and when to close schools in the event of outbreaks of COVID-19 in the community.

“That County Alert System will not only be an alert system for education, it will also be an alert system for nursing home visitation,” Crouch said. “Nursing can then use this guidance going forward.”

Counties with a population of 16,000 or more are graded on a seven-day rolling average of coronavirus cases per 100,000 people, while counties with less than 16,000 people are graded on a 14-day rolling average of cases per 100,000 people.

If the county is in the red (more than 25 cases per 100,000 people), nursing homes are required to remain closed to visitors, as well as restrict communal dining and all non-essential services. If a county is in the orange (between 10 and 24.9 cases per 100,000 people), only compassionate end-of-life visitation would be allowed, along with some communal activities, dining, and non-essential services. Counties in the yellow and green can have regular visitation, though family and friends are encouraged to call the nursing homes and arrange visitations ahead of time.

As of Monday, only Logan County was in the red, while Monroe County was in the orange. Trinity Healthcare Services in Logan has an outbreak, as does the Springfield Center in Lindside.

The state first limited nursing home visitation March 12. After a series of outbreaks in nursing homes in April, West Virginia became the first state to test all residents and staff at nursing homes and assisted living facilities starting April 20. Despite the handful of outbreaks, including a serious outbreak at Eldercare Health and Rehabilitation in Jackson County, many nursing homes only reported one or two cases.

Nursing home visitations were restricted again Aug. 12 after major outbreaks in Mercer and Grant counties. Justice said Monday that there were 31 outbreaks in nursing homes across the state, with the largest outbreaks in Grant, Kanawha, Logan, Mercer, Monroe, Raleigh, and Taylor counties.

“There is a significant amount of people who recover, but getting the fire out is not good,” Justice said. “Because what happens all the time is we lose some good West Virginians. We’ve got to some way stop the fire from happening, and that’s what we’re trying to do.”

Justice said the state would try the new color-coded system for nursing homes, but he would not hesitate to reinstate the full executive order to shut down visitations if he needed to.

“I am tremendously concerned about moving to color-coding to be able to achieve that,” Justice said. “I want that to happen, but I can assure you this: from the color-coding if by chance we have additional outbreaks because of visitation, then we’re going to have to batten down the hatches and go back to no visitation.”

Crouch admitted that there was a lull in nursing home cases between April and July. Over the last few weeks, Crouch said that DHHR was implementing strike teams to go to nursing home outbreaks. DHHR was also creating a team to help nursing homes be more proactive to control outbreaks before they spread in the facilities.

“Those teams need to include physicians, and we have a great group of physicians that have stepped up with telemedicine,” Crouch said. “We need physicians to see these patients as quickly as possible when we have an outbreak. We need to have experienced long-term care nurses on these teams. We have to have our regional epidemiologist. We need to have our health departments.”

“I keep talking about working together; that’s what we have to have here,” Crouch said. “We are tasking folks to work on these teams so we can have experienced individuals, so when we have an outbreak those individuals can immediately stem those outbreaks.”