N.J. waited 2 weeks after the fatal focus to check the pediatric center. Was that the right call?

Children began to worsen on an endlessly hot day at the end of September.

Yet it would not be until October 9 – and after the death of two children – when the Wanaque Center for Nursing and Rehabilitation announced the state health department of the virus occurrence within the long-term care facility in northern New Jersey. And then another twelve days before the state inspectors came in.

A devastating adenovirus outbreak in Wanaque center in Haskell has led to the deaths of 10 children and another 19 infected. As the outbreak began, the disease remains unknown.

But exploring how the outbreak and spread of the epidemic quickly provoked questions raised why state health officials waited two weeks before the team deployed to see how Wanaque was managing the crisis.

The State Response will be part of what the State Senate Committee on Health, Human Services and the Elderly will review when it discusses on December 3 to discuss the outbreak, said Senate Joseph Vitale, said the chairman of the committee.

Death to Wanaque. Yet they put down the mission of the children to the hospital, the workers say

"We will ask as many questions as we can, but it will be one of them," said Vitale, D-Middlesex.

"We want to know when it was reported how the department responded and how the device responded," Vitale said, adding that he wanted to be cautious, "until we know all the facts."

"I doubt everything, and as a layman, I say there's something wrong," he said.

Death to Wanaque. Yet they put down the mission of the children to the hospital, the workers say

Wanaque announced the state and local health department a focus on the working days of October 9, according to Donna Leusner, a spokeswoman for the Department of Health.

"The State immediately advised the facility on infection control protocols to be implemented immediately," Leusner said.

The next day, the Department for Transmissible Diseases – along with the United States Centers for Disease Control and Prevention and the local health department, began working with Wanaque to recommend infection control procedures, she said.

The State sent two authorized nurses from the Office of Healthcare, Surveys and Field Operations on 21 October and conducted a surprise inspection. The State Inspection Specialist remained in place.

The state carried out a second surprise inspection Friday after the NJ Advance Media report quoted workers at the Wanaque Center claiming the administrators had postponed the mission of critically ill children to the hospital because they wanted to lose Medicaid funds if the baby bed was empty.

The decision to wait two weeks before the dispatch of state healthcare professionals was based on the science that it would allow one incubation time to come to see if Wanaque could cope with the outbreak, Leusner said.

Adenovirus virus incubation time is two weeks, the department says.

"It would be impossible to determine that on-site presence could be useful before the incubation period," said Dawn Thomas, a health spokesperson.

"Containing the virus ultimately depends on the management of the facility and the clinical staff under these protocols in all circumstances for each patient and the Department of Health is taking all the steps that can make the facility responsible for this," Thomas said.

Wanaque Center is a pro-profit owner, Continuum Health Care, which repeatedly declined to comment, did not return the call Friday.

"The Commissioner thinks that the DOH staff responded appropriately at any given time to the information we had," she said.

Adenovirus is actually a group of viruses that are rarely fatal. They mimic the symptoms of flu and frequent colds, often attacking the respiratory tract, but they can also cause gastroenteritis and conjunctivitis. They tend to affect infants and children, according to the Center for Disease Control and Prevention.

Diseases of the virus are usually mild and people generally recover in a few days. However, in some cases, infections caused by adenovirus can potentially endanger life, especially those with a weakened immune system.

All child patients in Wanaque center are medically fragile. Most need ventilators to help them breathe. Some have severe birth defects and serious health problems.

Why these dying, however, remains some mystery.

"These children were really fragile and heavy adenovirus would certainly be fatal," said David Cennimo, an epidemiologist at University Hospital in Newark, and a professor of medicine at Rutgers University Medical School. "It's a bad respiratory illness and you can end up on a fan, but these kids were already on the fan and I wonder why they can not support them."

He does not even know or know about specific cases, he says he asks if there has been a secondary infection. There are many unanswered questions, he added.

"I do not understand, it's the health facilities that are being watched, I can not explain it," he said.

State health officials who continue to investigate said they may never know how the virus has spread.

"It's impossible for us to know exactly what the spread-related factors are," said Christina Tanova, a state epidemiologist at the head of the health services department of communicable diseases. "There are many factors."

Adenovirus is not an airborne threat. It does not get into the heating and ventilation system of a building such as Legionnaire's disease, Tan explains. The virus is more likely to move through the airways or touch it.

The state controls these facilities every nine to fifteen months, Leusner said.

The Wanaque Center has been repeatedly cited for handwashing and infection control, both before and after the outbreak, according to federal and federal inspection reports.

During the inspection last month, he stated that hairdressing disposable napkins, disinfectants, masks, gloves and bathrobes are available on every wing, and mostly in every room for staff and visitors before entering the room. The report states that there are also guidelines for visitor adenovirus visible in each room, warning visitors to visit if they are ill, and observing staff cleaning rooms with germicidal cleansing solutions.

However, the report noted shortcomings in handwashing procedures where staff members did not need long hands.

Hand washing is essential. Not fast rinsing but for at least 20 seconds. They teach medical professions to sing "Happy Birthday" by themselves twice. At the Wanaque Center, state inspectors found that some nurses did not even get the first verse in terms of timing.

Cennimo said that it is very likely that the only way he would move from one patient to another would be a child care provider.

"I would be concerned that the child caregiver was the contact vector among them," Cennimo said.

Vitale, chair of the Health Committee, said he hoped to find out if the focus was spiral due to human error or system weakness. Maybe it's both. he said.

"These children are healthily fragile and depend on others for their survival," Vitale added. "This should not be done so that one child will be sick and maybe two, but this much?

NJ Advance Media Writer Spencer Kent contributed to this report.

Ted Sherman can be contacted at [email protected] Watch it on Twitter @TedShermanSL. Facebook: @ TedSherman.reporter. Find NJ.com on Facebook.

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