Fresh from intensive care, Aaron Lorick struggled to speak as COVID-19’s signature cough buffeted his words. Yet he was determined to issue a warning.
The Hanahan nursing home where he worked was putting staff and residents in danger, he said. Missteps let the virus prey on the frailest people in their care.
Lorick wanted to help them. He also feared for his coworkers at Heartland Health and Rehabilitation Care Center, not to mention their families. His own wife and toddler were already sick with the virus.
So on April 23, a few days after his discharge from a hospital, he risked his employment to speak with a Post and Courier reporter and lay out a series of failures that, he feared, had put countless people at risk.
The 44-year-old’s job as a certified nursing assistant required close contact with the patients he bathed, changed and hand fed. He knew of at least two who’d been infected by the virus. Yet, he said, nobody at Heartland had bothered to inform the staff.
“They didn’t tell us anything,” he explained. “They told us we didn’t have an outbreak at our facility.”
In reality, Lorick witnessed the dawn of one of South Carolina’s largest and deadliest nursing home outbreaks, one that ultimately would cost at least 15 residents their lives and point to deeper problems within an industry catering to the state's most vulnerable residents.
Yet all he’d had to protect himself was a thin surgical mask — far from the layers of gear recommended by health experts. His supervisors had forced staff to reuse their lone masks for weeks, he said.
Given most residents were unable to move around the 135-bed facility, risk came largely from staff spreading it. Yet, workers, including him, cared for those with — and without — COVID-19, going back and forth, back and forth.
Then there was the lag in testing. State officials would trace the first case to March 26, but the entire facility was not tested until a month later. Neither staff nor residents knew who was infected.
The day Lorick issued his warning, just one other facility in the entire state had more reported cases.
Over the months since, gaps in oversight have left the public in the dark about nursing home outbreaks, at Heartland and other facilities across South Carolina. In most cases, whether or not they have current infections, or how many, is anybody’s guess. State health officials don’t require nursing homes to test their residents and staff — even though they house the very people most at risk from the virus.
Yet outbreaks like the one at Heartland teach critical lessons.
After Lorick’s appeal, The Post and Courier began to retrace the outbreak there to learn what went wrong — and to see how facilities can avoid future missteps. Reporters interviewed current and former staff, residents and residents’ family members. They also reviewed more than 500 pages of emails, state health department records, and police and fire reports.
In response to inquiries from the newspaper, representatives of the facility stressed that safety was, and remains, their top priority.
After the initial outbreak, they ramped up testing and now keep on hand an adequate supply of protective gear, said Julie Beckert, a spokeswoman for the facility’s Ohio-based owner.
“It is easy to Monday morning quarterback from the safety of one’s home, but it doesn’t help the cause or recognize that our employees and leadership team have been true heroes working on the frontlines learning and altering the way we deliver care,” she said.
Recent measures have brought Heartland’s count of new infections to zero, she added. But for many it came too late.
“I don’t even know how I’m alive,” Lorick said that day in April, still coughing, struggling for a deep breath.
He wondered if he’d ever be well enough to return to Heartland and the residents he adored.
First signs of danger
In early March, back before Lorick got sick, a Leprechaun green wreath hung on the door to Elizabeth Carroll’s room inside Heartland. St. Patrick Day’s was approaching, but the festive spirit did little to assuage her daughter’s concerns as she eased the door open.
Carroll, a 78-year-old with dementia, had moved into the nursing home just two months earlier. Since then, her daughter, Sharon Smith, had spotted bruises on her mother’s body along with new, severe skin deterioration.
The novel coronavirus was in the news, and someone had checked Smith’s temperature on the way in, but she was more worried about her mother’s care.
She knew the facility had a poor health inspection record. That included a one-star federal rating, the lowest possible. After a 2018 inspection, Heartland got slammed with a $234,000 fine — one of the largest handed out in the state in recent years — for problems like regularly being short staffed. (A spokeswoman insists the facility has since addressed these issues).
Smith stepped into the room, cramped with two beds.
First, she greeted her mother, a devoted Christian with a warm smile who loved birds and gospel music.
Then she said hello to her mom’s new roommate. Her family had connections to the woman, a longtime Hanahan resident who had arrived a week or two earlier, in late February.
When the woman first arrived, she seemed fine. Then she developed a cough. Smith heard she had pneumonia.
Now, Smith watched her cough and cough. The woman’s chest heaved with rapid, shallow breaths. She coughed with such force that she began to throw up.
Smith felt terrible for her. She hit the call bell, grabbed a pan and hurried over, standing beside the woman to catch her vomit. When the coughing ebbed a bit, Smith left to clean the pan, then returned to wipe the woman’s face and comfort her.
Eventually, an employee came to help. But the nursing assistants each had so many patients it was hard to get to everyone right away.
Aaron Lorick was among those working that day. As midnight approached, almost an hour after his shift ended, he messaged his wife.
He’d be late; his replacement had not yet arrived. It wasn’t unusual.
A single mask
A few weeks later, Lorick’s wife noticed a face mask in her husband’s car. It was cotton, blue with pleats.
“What is this?” Gamilah Lorick said, reaching for it.
“Don’t pick it up!”
Aaron Lorick had worked all weekend. Among his patients was Vikki O’Driscoll, a 62-year-old former bus driver who was disabled after a vehicle accident. Around that time, O’Driscoll contracted the virus, although Lorick had no way of knowing that.
The nursing home had just begun testing patients. O’Driscoll would eventually be tested, but the results would take a week. A nationwide lack of materials was causing critical delays.
Lorick explained to his wife that the staff had received one mask each. They were told to keep it for two weeks because Heartland had no more supplies. The facility did not have a stockpile of protective gear, like gowns and N95 respirators, prior to the outbreak.
Gamilah pointed at one of the mask’s strings, which had popped off. Her husband said he planned to tape it or staple it.
He’d have to make do.
First cases emerge
As March faded into April, Sharon Smith learned that her mother’s roommate, the woman with the severe cough, had been hospitalized with a confirmed COVID-19 infection.
Smith had little idea what was going on inside Heartland. Neither did many other residents’ loved ones.
By then, the governor had declared a state of emergency and restricted visitation at nursing homes.
Smith didn’t know that a staff member had tested positive. She didn’t know that other residents were showing symptoms, too. And she didn’t know how much her mother had suddenly weakened, that the older woman mostly stared straight ahead now, her mouth open.
Smith did know that her mother had not received a test for the virus. Without known symptoms like coughing, she wasn’t immediately in line for one.
‘I’ve never felt this way’
Not long after his wife found his mask, Lorick slept most of the day.
It was a Monday, and he’d worked that weekend. Given he had been helping with a large-scale move of residents from around the facility into one hall, pushing their beds down the long corridors, she figured he’d just worn himself out.
He’d told her that nobody explained to him why they were moving certain people into one area.
The next day, Lorick awoke still exhausted, now with a fever.
A day later, he barely could stand. Everything hurt. His back in particular was killing him.
“I’ve never felt this way before,” he told Gamilah.
She rubbed his back, pounded it, warmed it with a compress. When she looked up common symptoms of COVID-19, she saw: “extreme fatigue.”
Gamilah prepared to take him for a coronavirus test.
A wildfire’s spread
The same day that Gamilah researched symptoms, Vikki O’Driscoll died. Her brother wouldn’t learn the virus had killed her until he read her death certificate, five days later.
Late the following day, Sharon Smith got a phone call: She and her siblings needed to go to Heartland. Their mother’s condition had been deteriorating rapidly and now was so grave they should say goodbyes. They could enter the facility one at a time.
When Smith arrived, she remembered her mother’s former roommate and how she had coughed so badly she vomited. Now, as she stepped into the room, she watched her mother, Elizabeth Carroll, pant heavily in her bed.
Carroll died the next morning.
Around the same time, Gamilah Lorick sat at the desk in her home office with a runny nose, eyes burning. She logged off work and found her husband on the phone, his tone somber.
His test had come back positive.
Gamilah began to cry. She didn’t feel well, and they slept with their toddler in bed every night.
The Loricks didn’t know it, but the state Department of Health and Environmental Control had already begun gathering information about Heartland’s outbreak. Health officials had found 24 residents and 10 staff had tested positive — so far.
On Easter Sunday, one week after Lorick first felt exhausted, Gamilah drove him to Summerville Medical Center. His condition had worsened each day.
By then, Gamilah had tested positive, too. Their toddler also showed symptoms.
At the hospital, Lorick’s oxygen saturation sank dangerously low. A key indicator for blood clots had skyrocketed. He had pneumonia in both lungs.
The medical team admitted him to a hospital room.
As Lorick battled the virus, Heartland began testing residents who showed symptoms. One whom Lorick especially liked, Ken Jones, tested positive. The whole hall where Jones lived was hard hit.
The 60-year-old was moved to another hall now set aside for residents with COVID-19. He heard that 45 to 50 other residents were housed there, too.
Staff were supposed to wear masks, and most did. But some let them hang around their necks.
The next day, Hanahan fire officials showed up for an inspection.
Assistant Chief Michael Bargeron noticed some staff weren’t wearing face coverings. When done tending to a patient, some slipped their masks off their faces while still in the COVID ward, which Bargeron dubbed the “hot zone.”
The situation wasn’t entirely dire. To Bargeron, staffing levels seemed decent. And he welcomed the fact that the COVID ward had its own air system, which meant that potentially contagious particles weren’t being pumped to other parts of the building.
Most concerning to him was the reuse of gowns that were meant to be disposable.
Staff also donned and doffed the gowns in the same room, which meant that potentially soiled gear was being brought into an area that was supposed to stay virus-free. A nurse also told Bargeron that staff had been pulling gowns off, over their heads, without cleaning them.
Bargeron saw high risk of cross-contamination.
Beckert, the Heartland spokeswoman, said the facility quickly addressed the concerns. She said the fire department used safety standards that were more strict than state health guidelines, and that DHEC’s own inspection of the facility flagged no serious violations.
Either way, when Bargeron offered to train staff on properly handling its protective gear, he said he didn’t hear back. Heartland officials felt it was important for staff to stick with their in-house training, to remain consistent across the company’s other facilities.
The fire department attempted the training anyway and sent a crew to the facility after a few days passed, Bargeron would later say.
Heartland turned them away.
Empty rooms, quiet hallways
April was awful. Residents died, often back to back. Nurses called devastated families to deliver bad news. Other times, they dialed the coroner.
As staff walked the hardest-hit hallways, they passed room after room where residents once called out to them, now empty.
Residents’ families suffered, too, from afar. They included loved ones of Maretha Martin, a 94-year-old former hairdresser who was bedridden. Partially paralyzed by a stroke, she was among the oldest residents at Heartland. Lorick called her “momma.”
Her family had long been unhappy with her care at Heartland. Now, with the nursing home shut down to visitors, their worry turned to anguish.
On April 20, a nurse called them. Martin’s blood pressure had plummeted, and staff were rushing her to the hospital. There, she tested positive for the coronavirus.
A doctor said Martin had suffered a heart attack and a stroke — most likely a week earlier. Her son, Lorenza Bell, pictured her suffering all that time. How had nobody noticed?
Back at Heartland, the death toll rose. It became common to see coworkers break down crying, exhaustion and anger lining their faces.
Some staff quit in fear of contracting the virus. Others were quarantined at home battling COVID-19 themselves. Those who remained worked harder than ever.
Housekeepers cleaned soiled laundry not knowing who had COVID and who didn’t. Many staff, especially nursing assistants who provide the most hands-on care, were close to the residents falling ill and dying.
And they all worried about Lorick, their colleague who grew sicker every day.
Fight for life
Three days after Lorick was admitted to the hospital, he got transferred to the intensive care unit, where he stayed for about a week battling pneumonia.
Then, he began to improve.
Everyone felt relieved. On April 21, he went home.
That same day, DHEC released its first tallies of COVID-19 infections at each of the state’s nursing homes and other long-term care facilities.
The data showed a cluster at Heartland: 57 known cases among staff and residents at the 135-bed facility. It did not reveal how many had died.
Residents’ loved ones learned of the cluster when the data hit the news.
Sharon Smith thought back to her mother’s roommate who had tested positive. She recalled her mom’s strange breathing, her rapid deterioration before dying.
Her mother’s death certificate said she died of a stroke, but Smith knew that COVID-19 could cause dangerous blood clots. Because Heartland never tested her mother, Smith figured she might never know if the coronavirus played a role.
In the press, Heartland defended its handling of the virus, saying the facility moved quickly to protect residents and staff. That included creating an isolation unit with barriers to separate it from other parts of the building. In that unit, ideally staff should have been wearing full protective gear, including gowns and face shields.
Beckert, the spokeswoman, said the facility did not have a stockpile of gear, other than surgical masks and gloves, prior to the outbreak. But she stressed that Heartland was able to quickly gather better protective gear once administrators confirmed the virus was in the building.
She also insisted there was no proof that Lorick contracted the virus on the job.
“The community is where employees are getting infected,” Beckert told The Post and Courier.
Yet by mid-April, 10 employees had confirmed infections, and that tally would swell to one of the state’s highest.
Lorick was home from the hospital when a coworker messaged him complaining about negative news coverage of the cluster.
The woman also typed, “We are so worried about you.”
“I just got out of hospital last week,” he responded. He asked how the residents were doing.
They were dying, she answered, “a lot of them.”
She listed three, then three others she figured would pass away soon. Another wouldn’t eat. One “was in a bad way.” Another was dying, “and we are all getting sick too.”
“Are the positive workers still working?” Lorick asked.
“I dont think so but i am confused about that,” she typed.
When she’d asked the administrator if he expected them to work while sick, she added, he got mad “and said no but keep in mind i cant replace you all.”
‘This is not your ending’
Around the same time, Martin, the former hairdresser who’d been hospitalized, was sent back to Heartland. She was placed in the facility’s hospice unit. The state’s visitors ban had an exemption for when deaths were imminent, so that allowed her family a special visit.
Bell, her 71-year-old son, could say goodbye in person.
He entered the facility a final time on May 1. Before, during his daily visits, he brought Martin her favorite plates of catfish, cornbread and greens, or crackers and chocolate.
This time, he wore gloves, a gown, a mask and a face shield. His mother was not responsive, but he felt sure she could hear him.
“We love you,” he told her. “This is not your ending. This is just your beginning.”
She died that evening.
Start of the end
Two days later, Lorick woke with chills. No amount of Tylenol helped.
Gamilah drove him back to Summerville Medical Center and dropped him off, given visitation was banned there, too.
His fever continued to rise, and a scan showed the pneumonia had worsened. A doctor readmitted him to the hospital.
By then, the situation at nursing homes across the state had become so dire that health officials announced they would test residents and staff members at every facility in the state. At least five weeks had passed since the first staff and residents at Heartland had tested positive.
Four days after his readmission, Lorick called Gamilah to describe a crushing pain in his chest.
Alarmed, she asked, “Have you ever felt that before?”
He told her a test showed he likely was having a heart attack. Pain wracked his chest.
“I don’t know how long I can hold on.”
Someone told Gamilah that he needed a stent, and soon an ambulance sped him to the larger Trident Medical Center.
He arrived just after 5 p.m. That night, he managed to talk to Gamilah on the phone. They spoke almost every hour at first. Then the calls slowed.
At 2 a.m., he told Gamilah goodbye, that he loved her.
“Remember that you have to come home,” she warned.
He just answered with “mmmhmmm.”
“Aaron, you have to get some rest,” she urged. “You’re going to wear yourself out.”
In the morning, her phone rang again. The voice on the other end wasn’t his. Instead, a stranger said her husband's heart had stopped. They'd gotten him back, but he was on a ventilator.
Losing Aaron Lorick
Lorick remained on the breathing machine for 31 days. He'd suffered brain damage.
The woman urged Gamilah to come.
Gamilah raced to the hospital. When she arrived, nurses met her in the hallway, so she peered into her husband’s room. The curtain was drawn.
Aaron Lorick had already died.
Back at Heartland, word seeped from text to text, from one coworker to another, along the forlorn hallways. Staff broke down crying. Many felt like walking zombies.
Would this nightmare ever end?
Life ends, life re-opens
Lorick’s funeral was held on June 19, a sunny Friday, at Hilton’s Mortuary. The North Charleston funeral home sits at the bustling crossroads of Montague Avenue and the railroad tracks.
Mourners gathered outside under the carport. Four rows of foldout chairs, draped in crisp white cloths, sat spaced 6 feet apart.
From a stroller parked among them, two tiny tennis shoes appeared, white ones with a dash of sparkle. The Loricks’ toddler, 19-month-old Erin, watched cartoons on a cell phone, too young to know they were here to say goodbye to her father.
Nobody hugged; nobody kissed.
But some things remained unchanged. People read Scripture. A priest prayed. Loved ones shared memories of Lorick.
When it was Gamilah’s turn, she remembered his 22 years of nursing assistant work.
“He loved his patients,” she said.
When she sat down, a hymn played, “It is well, it is well with my soul ...”
Just then, a freight train barreled down the tracks, carrying the day’s commerce, its horn blaring over the hymn’s reassurance.
At that point, Lorick’s passing wasn’t reflected in the latest update from Heartland. But the enormity of its outbreak was clear: No fewer than 15 dead.
No clear answers
Two months after Lorick’s funeral, gaps in the state’s testing and reporting requirements keep the public in the dark about outbreaks at the state’s nursing homes.
While Heartland’s cluster illuminates just how crucial rigorous testing is to controlling the virus’ spread, state health officials don’t mandate testing at any nursing home. While DHEC offers some guidelines, the agency largely relies on nursing homes to test as they see fit and self-report their cases.
In its weekly summary data, DHEC also does not clearly indicate whether outbreaks at nursing homes are current, despite federal guidance for how to make those determinations.
Delays in testing results pose an issue. But either way, other reporting models are more revealing.
North Carolina’s state health agency identifies long-term care facilities considered to have their outbreaks under control, based on test results. Even a private South Carolina provider, Pruitt Health, on its website reveals more information, such as the number of nursing home patients who have been tested.
And there’s been almost no way for families of nursing home residents in South Carolina to see for themselves if situations have improved.
In-person visits have been banned since March. On Friday, Gov. Henry McMaster called on DHEC to issue guidelines that nursing homes can use for limited visitation. But there’s still no telling when doors can actually reopen.
While Heartland continues to monitor for symptoms, it has not tested all patients and staff since mid-June, spokeswoman Beckert said. However, she added, the situation has greatly improved in recent weeks, insisting the facility has “recovered” from COVID-19.
Several facilities with early clusters, including Heartland, have reported scant new infections to DHEC. Some have reported none at all. But because DHEC releases nothing about how many tests, if any, have been performed at these facilities, it’s nearly impossible to verify.
Caleb Connor, an Aiken attorney, said it’s critical for state health officials to disclose more information to families, so they can act as watchdogs against neglect. He and other lawyers who litigate issues with nursing homes said they’ve been fielding calls from every corner of the state.
“People are assured there’s nothing wrong, everything’s under control,” he said. “The next thing they know, they get a call that their loved one is in the hospital.”
As of Wednesday, more than 4,800 people have been infected at 165 South Carolina nursing homes. The virus killed 704 of them.
Among employees, the group of 33 who tested positive at Heartland remains among the state’s highest. The numbers from the facility now also show a 16th death: Aaron Lorick.