Coronavirus Live Updates: U.S. to Issue New Distancing Guidelines as Jobless Claims Are Set to Soar

After the first positive coronavirus test at a Virginia nursing home in mid-March, its administrator said, the staff restricted visitors, conducted temperature checks at the end of every worker’s shift and isolated residents who had tested positive into separate areas.

Even so, there suddenly was another case. Within two weeks, dozens of others inside were falling ill. Now, about a month after the first case, at least 46 residents are dead — more than a quarter of the facility’s population and one of the highest known death tolls in the United States.

The facility’s medical director, Dr. Jim Wright, said he had asked the state health department how to test a suspected case before the outbreak began. But even as the situation grew dire, it took almost two weeks for all the facility’s residents to be tested for the coronavirus. Virginia had only about 300 test kits available in mid-March.

“You can’t fight what you can’t see,” Dr. Wright said.

Virginia had only about 300 test kits available in mid-March, said Dr. Danny Avula, the Richmond health director, and to get one at the time, residents of long-term care facilities first needed to test negative for the flu and other respiratory viruses.

“We could have limited the spread in Canterbury had we been able to test more,” he said.

The lack of widespread testing and the difficulty in retaining staff members were additional challenges for the nursing home, where residents, who are older and therefore more vulnerable to the coronavirus, live in close quarters.

The New York Times has tracked hundreds of clusters of coronavirus cases across the country, and the 10 deadliest have been in nursing homes and long-term care centers. More than 21,000 residents and staff members at nursing homes and other long-term-care facilities have contracted the virus, and more than 3,800 have died.