Kevin McKay felt the shock of defeat when he discovered the coronavirus had infiltrated the Southeast Portland nursing home he has owned and managed for over two decades.

He had started planning for an outbreak in January, stockpiling enough protective equipment to last him two years – just in case the disease made its way to Oregon.

As the virus spread in the state, he was strict with screening all staff for coronavirus symptoms, he said. He kept close watch over how his workers used masks, gloves and gowns and made sure they had ample supplies of sanitizer.

And yet the coronavirus made it into Cornerstone Care Option.

Two residents developed severe symptoms, he said. McKay then pushed for testing and was able to screen about half of the nursing home’s residents, most of them without symptoms. He found that 12 had the coronavirus and isolated them.

McKay said his experience shows the value of broader testing of residents and staff at all senior care homes – something President Trump called for this week and that multiple states are considering and, in some cases, doing.

So far, Oregon isn’t on the same path – mostly, it appears, because the state simply doesn’t have enough testing capacity to make it happen.

But state officials acknowledge the need, especially as Oregon starts opening up its economy. Some counties and long-term care companies have been picking up the state’s slack to address the deadly crisis.

Nearly six in 10 coronavirus deaths in Oregon are tied to the state’s nursing homes, assisted living centers and retirement communities even though the senior homes represent just 14 percent of all the state’s cases.

At least 30 of the homes now account for 480 coronavirus cases. New outbreaks continue to pop up, with a major outbreak in West Salem growing to 41 cases since the end of April.

McKay worked with Multnomah County health officials to get access to the state lab for testing, he said. It took a lot of calls, he said, because state guidelines at the time allowed no more than five people without symptoms in care homes to get tested, provided someone at the home was sick enough to be hospitalized.

McKay worked with Multnomah County health officials to get access to the state lab for testing, he said. It took a lot of calls, he said, because at the time the state was recommending that only people with symptoms get tested.

“I wasn’t taking no for an answer,” McKay said.

Finding out about the other sick residents helped Cornerstone contain the virus, McKay said, primarily because it allowed him to put the sick residents near each other. The outbreak in his 40-bed nursing home is essentially over – none of the residents or workers have died, state data show, and two people who were hospitalized have returned, he said.

McKay is looking forward to being able eventually to invite visitors back into the nursing home.

He believes twice-weekly testing is absolutely vital to reopening homes.

Oregon’s long-term care ombudsman Fred Steele said staff and residents must be tested regularly for the state to open up.

“Ideally, they’re catching that infection before it spreads to 10 or 15 individuals,” Steele said.

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Neither the Oregon Health Authority nor most of the counties with senior care homes hit by the novel coronavirus have any concrete plans to secure tests and check broad swaths of asymptomatic people in senior care.

Jonathan Modie, a spokesman for the health authority, said the agency wants to expand testing in high-risk settings, such as nursing homes, to prevent outbreaks and they remain a priority.

But each congregate setting “is different and needs to be assessed for its unique needs,” Modie said in an email.

Modie didn’t provide the number of residents and staff without symptoms that the state has tested or the number of senior care homes that have had all residents and staff tested.

As of April 20, state guidelines say that people without symptoms in senior care homes can be considered for testing, depending on testing availability.

But ahead of them in the testing line, according to the state, are all the people who have symptoms – with a priority for symptomatic healthcare workers, first responders and people associated with group settings.

The hierarchy appears to reflect the ongoing competition for testing supplies and lab capacity.

The state’s goal right now is for 15,000 people to get tested statewide, every week. That would allow contact tracers to identify the spread of the disease and prevent further infections, identify hot spots and curb outbreaks in group settings such as nursing homes, according to the state’s May 1 strategic plan.

About 57,000 people live and work in nursing and assisted living homes in Oregon. Thousands more live and work in adult foster homes and retirement centers. Testing all of them with the current tests available would likely take months.

Numerous other congregate settings also are susceptible to outbreaks. Two food processing plants and at least one homeless shelter have had outbreaks, as have four prisons.

And yet other states have already started across-the-board testing in senior care homes, particularly those that already have at least one case.

In Vermont, the state offers to test all residents and staff in group settings with at least one case. In New York, Gov. Andrew Cuomo ordered senior care homes to test all staff, twice a week.

Maryland’s governor on April 29 ordered that all nursing home staff and residents get tested for the coronavirus – whether or not they show symptoms. The order came after the state bought 500,000 coronavirus tests from South Korea, according to a news release from the governor’s office.

New Jersey has required that all staff and residents at nursing homes get tested by May 26. The state is working through a four-phase plan, starting with the senior homes with the fewest cases.

Of the 4,000 staff and residents who had been tested at 16 New Jersey long-term care facilities, about one in four residents tested positive, most who were asymptomatic, said the state’s health commissioner, Judith Persichilli.

“I want you to reflect on that,” Persichilli said at a news conference in early May. “Asymptomatic positive individuals are among us.”

Gov. Jay Inslee of Washington also has told his health officials to test all staff and residents in nursing homes, the state’s deputy chief medical officer said this week.

The Trump administration has also weighed in, urging the country’s governors to test everyone at every nursing home, though the administration stopped short of mandating testing.

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For the most part, Oregon counties point to the state’s guidelines for their approach to testing nursing homes: support when possible but no holistic testing.

In response to questions from The Oregonian/OregonLive, six of nine counties with coronavirus outbreaks at senior homes haven’t committed to across-the-board testing: Multnomah, Washington, Clackamas, Marion, Polk and Wasco.

While Multnomah County health officials haven’t made a definitive decision on expansive testing, they “have supported and will support facilities that want to do more comprehensive testing,” said county spokeswoman Kate Willson.

Washington County has no plans for wider testing, though some homes in the county area have found their own tests, a spokeswoman said.

Clackamas County has tested people in senior care homes with at least one confirmed case but hasn’t said if any home has had all residents and staff tested.

Marion County, one of the hardest-hit counties in the state overall, is prioritizing people in senior care homes who show symptoms. Getting tests for people without symptoms has been challenging, said county spokeswoman Jenna Wyatt.

“We are working diligently to acquire more supplies for testing kits to share with areas in need throughout the county,” Wyatt said in an email.

Yamhill and Linn counties, in contrast, are offering to test all staff and residents at senior care homes.

Yamhill County will do so as test supplies are available.

At least one home in the county already has had all residents and workers tested, said Lindsey Manfrin, director of Yamhill County’s health department. The department recommends that everyone at a senior community with at least one case get tested, and the county is able to provide that testing, Manfrin said.

“We do this to contain the spread in the facility to the best of our ability and identify any new cases where contact tracing may be needed,” Manfrin said in an email. She declined to say how the county was getting the tests.

Benton County signed an emergency contract with a Corvallis-based lab and tested all residents and all permanent staff at Corvallis Manor, the one home in the county hit by the coronavirus, said spokeswoman Lili’a Neville. That testing wrapped up earlier this month.

The county is now drafting a long-term contract to test all staff and residents at two other senior care homes that have asked the health department for testing help.

In Linn County, a batch of test kits arrived this week from the same lab Benton County contracted with.

The county has started to test residents with symptoms in care homes. If they are positive, testing will expand to include all staff and residents at the affected home, said health director Todd Noble.

For now, Linn County health officials also plan to test all staff at all homes once a month, Noble said.

The county is the site of the first senior care home outbreak in Oregon – the state veterans home in Lebanon. Nearly 40 people associated with the home have fallen ill and seven have died, according to state data.

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One Oregon company has gone out of its way to get testing done.

Avamere Family of Companies, a chain of senior care homes with about three dozen facilities in Oregon, has contracted with multiple testing labs to proactively test residents and staff without symptoms.

It completed the testing at two communities and is in the process of finishing at a Keizer care home.

One of the first two homes, Salem Transitional Care, has 26 confirmed cases and three deaths, according to state data, though Avamere has said only 22 residents and workers have tested positive. Avamere paid to test about 250 workers and residents there, with 15 testing positive, said Elizabeth Burns, Avamere’s chief medical officer.

None of those who turned out to have infections had symptoms at the time, she said.

“It’s the asymptomatic cases that are the Achilles’ heel of this pandemic,” Burns said.

Discovering those cases allowed Avamere to isolate residents while containing potential spread from infected workers who didn’t have symptoms.

Deschutes County has helped Avamere test residents and staff at a home in Bend, Burns said. But that has been the exception, not the rule, she said.

“We often find that the local health department is not able to provide support in communities with large outbreaks due to lack of staffing, resources, or the ability to come in a timely manner,” she said.

The company has also started to test a random sample of staff and residents at its senior care homes.

Avamere has paid about $250,000 to test people in its Oregon facilities, Burns said.

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Instead of broad testing, state and county health officials have tried to keep the coronavirus at bay through inspections of homes and, if necessary, helping them get protective gear for their caregivers.

The agency that regulates senior care homes, the Oregon Department of Human Services, sends someone weekly to every home with at least one coronavirus case to check on their practices for controlling infections. That includes looking at whether the home has enough staff and masks, gloves, gowns and face shields and is isolating sick residents.

On Wednesday, department officials visited Cornerstone in Portland, interviewing staff and watching them work, Mckay said.

He appreciates the extra pair of eyes, McKay said, but he won’t feel fully comfortable opening the nursing home up to visitors until staff and residents can get tested regularly.

“That’s the way through this crisis,” he said. “That would allow us to open our doors.”

Now, he’s preparing for the next time Cornerstone gets hit, which he said is “more likely than not” to happen.

In some ways, he’s better positioned for a future outbreak.

Nurses, nursing assistants and doctors have a more complete list of symptoms to watch out for, he said, because federal health officials now know more of them than they did in mid-April.

He also has the monthlong experience of battling an outbreak.

Yet he remains uneasy.

“We had a really strong system in place,” McKay said. “And it got in.”

This article was originally published by the The Oregonian/OregonLive, one of more than a dozen news organizations throughout the state sharing their coverage of the novel coronavirus outbreak to help inform Oregonians about this evolving heath issue.