Charleston – The number of confirmed COVID–19 cases in West Virginia nearly doubled Tuesday. Most are in Monongalia County, where a nursing home is connected to at least seven cases. 

Monongalia County now has more cases – 16 – than any other county, officials said Tuesday.

During a virtual news conference earlier in the day, West Virginia Gov. Jim Justice reported that there were at least six confirmed cases of COVID-19 among residents and workers, including four residents and at least two workers, at Sundale Rehabilitation and Long-Term Care. Later Tuesday, the Monongalia County Health Department reported a seventh case related to the nursing home.

Tuesday night, the West Virginia Department of Health and Human Resources reported 39 confirmed cases in the state, including 16 in Monongalia County. It wasn't immediately clear how many cases were related to the nursing home. A spokeswoman said she didn't know.

Monday, DHHR had had reported 20 cases.

DHHR officials have also noted testing has increased.

In a news release Tuesday, the Monongalia County Health Department said testing of Sun Dale patients and workers was continuing Tuesday. Dr. Lee Smith, county health officer, thanked the National Guard for their assistance collecting samples.

During the news conference Tuesday, Justice advised West Virginians not to panic, but not to relax.

"We are the highest risk state of all,” he said. “Don’t relax. Don’t go into crowds. Do all the things. Wash your hands. Stay at home as much as you can.”

Michael Hicks, CEO of the nursing home facility, also known as Sun Dale Nursing Home, said Monday that a female resident was taken to Ruby Memorial Hospital around 3 a.m. Sunday and received a positive test result that afternoon. Officials said it was the first case in West Virginia contracted from someone in West Virginia instead of from someone out of state.

Mary Wade Triplett, a spokeswoman for the Monongalia County Health Department, said Tuesday it’s undetermined exactly how the woman in the nursing home was exposed to the virus.

Last week, the Washington Post reported that COVID-19 had been spreading through the Life Care Center nursing home in Kirkland, Wash., for at least nine days when a sick resident was taken to a hospital on Feb. 19. The New York Times reported Saturday that since the first positive tests at Life Care were confirmed on Feb. 28, 129 people there, including 81 residents, tested positive for the virus, and 35 people had died. Dozens of its workers were diagnosed.

COVID-19 may be fatal to both old and young, but particularly to the elderly. The governor asked nursing homes to halt visitation March 12. Hicks has said the nursing home halted visitation at that time.

In response to a question about how far along public health inspectors are in their attempts to find others who may have been exposed to those people, Dr. Cathy Slemp, commissioner of DHHR's Bureau for Public Health, said Tuesday those investigations are ongoing and conducted at the local level. She said a couple of the new cases were detected through those investigations.

Monday, Justice issued a stay-at-home order for West Virginia residents to begin at 8 p.m. Tuesday. People can be charged with obstruction of justice for leaving their residences for non-essential purposes, Essential purposes include, among other things, going to an essential workplace, buying groceries, going to a gas station or picking up a prescription. Any gathering of more than 10 people is prohibited.

He also ordered the closure of all "non-essential businesses.”

Even essential employess may work remotely,  Slemp said Tuesday. She said some health care providers are shifting to telehealth.

"Remember that just because you're designated an essential service doesn't mean it's always done in person," she said.

Brian Abraham, a lawyer for the governor, said WorkForce West Virginia received 16,000 unemployment applications Monday. The governor said 7,000 of those were processed.

Maj. General James Hoyer said the National Guard is working on a plan to assist food banks as well as on a “consolidated supply center" for medical and emergency management supplies.

Dr. Clay Marsh, vice president and executive dean for health sciences at West Virginia University, said that how West Virginians behave now, including whether they stay six feet apart, stay at home, and practice frequent hand washing, will influence the rate of patient intake at hospitals.

"The curve is not fixed," he said. "It's dynamic.”

Officials also said there are discussions ongoing about providing lodging for healthcare providers so they don't transmit COVID–19 to their family members.

State officials also continued to provide health tips to reduce spread, including: washing hands more frequently for 20 seconds, in between wrists and fingers; cleaning surfaces such as doorknobs;  being cautious of elevator buttons; staying home, especially if you are sick; staying six feet from others when you have to venture out; separating from others in your own home if they are sick; remotely working as much as possible; and if you are sick, calling health care providers for guidance before showing up. 

Those who haven't been diagnosed but show symptoms should still self-quarantine, they said. Symptoms may include fever, cough and shortness of breath, although people may be contagious before they show symptoms. 

Slemp said if you are sick and you don't know if you have the virus, behave as if you do and stay home. 

Following the advice will slow the rate of people visiting health care providers, potentially avoiding an overwhelming influx of patients like other states and countries have experienced, officials said.

Testing has been limited, so it's unclear how many West Virginians may unknowingly have the virus. 

Bill Crouch, DHHR cabinet secretary, said those who are feeling anxiety should contact one of West Virginia's 13 state-funded comprehensive behavioral health centers. 

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