INDIANAPOLIS — After months of not being able to see their loved ones in person, outdoor visitation has begun at some long-term care facilities as the state health department allows facilities with no new COVID-19 cases among residents or staff to reopen this month.

But health officials say the risk is still there and urged long-term care facilities to consider whether now is the right time.

Though the state’s guidance is thorough, the Johnson County Health Department is urging facilities to use caution. While fewer cases and deaths are being reported, there is still an elevated risk for the elderly, said Betsy Swearingen, health department director.

On Monday, the Indiana State Department of Health’s weekly report showed 268 facilities in Indiana have at least one case and 173 have had at least one death. The state does not name which facilities, however.

Overall there have been 5,147 cases reported at long-term facilities, and 1,140 deaths. That number went up by 205 cases and 58 deaths in the last week.

There is always a chance of a spike as things open back up and larger gatherings begin again, Swearingen said.

Another concern is the likelihood that an asymptomatic carrier could spread the virus to a facility without their knowledge, she said. The CDC estimates that 35 percent of those who have been infected with COVID-19 are asymptomatic carriers.

The health department has reason to be cautious given anecdotal evidence. At some point during the outbreak, an individual made an unauthorized outdoor visit to an assisted living facility and caught COVID-19, spreading it to others and causing three deaths, Swearingen said.

“Right now, they are encouraging outdoor visitation. But we have known in the past that outdoor visitation can still lead to the contraction of COVID-19, and it has led to the subsequent deaths of three Johnson County residents,” she said.

“So it is our line, as the health department, that it is still too soon for these types of things. I can’t force long-term care facilities not to allow visitors, but we will strongly caution against that at this time.”

In its visitation guidance, the state health department cites a Japanese study that found “odds that a primary case transmitted COVID-19 in a closed environment was 18.7 times greater compared to an open-air environment.”

Though outdoor transmission is possible, it is less likely, according to a Chinese study the state cited. The study looked at 318 cases where COVID-19 was transmitted from an infected person to multiple others. Of those 318 cases, just one originated from an interaction that took place outdoors, the study says.

Not all facilities are allowing outdoor visitors and are opting to stay closed due to the ongoing risk or because the facility does not meet one or more of the state’s requirements to begin visits.

“The long-term care facility residents are our most vulnerable population and they are the ones who need (to be) protected. Obviously, we have seen that in our numbers. That’s why we are thinking like we are thinking,” Swearingen said.

As for the long-term care facilities that chose to open back up, she is urging administrators to do what is best for their residents and follow CDC and state health department guidance closely, she said.

The state handed down several guidelines before allowing facilities to take this step, and all had to come up with individual plans.

According to the guidelines, facilities must: not have a new COVID-19 infection reported within 14 days; establish a set visitation schedule; have adequate staff to help enforce the guidelines; wipe down visitation areas between visits; require visitors and residents to wear masks; screen visitors for symptoms; and provide hand sanitizer.

Visitors must be 12 or older and agree to follow state guidelines and any additional guidelines set by the facility. Visitors must submit to a health screening, provide contact information and provide a doctor’s note or test results if they have been diagnosed with COVID-19 at any time. Visitors may bring food, but cannot share it with the resident.

Several facilities are also directing visitors to keep their distance and not share hugs or kisses with loved ones.

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