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A total of 12 people are now part of a cluster of COVID-19 cases at Hale Nani Rehabilitation and Nursing Center, the doctor leading the testing effort said Thursday.

For three days, medical workers with the Premier Medical Group Hawaii, led by president Dr. Scott Miscovich, have tested all Hale Nani residents and staff.

“Every one of these patients were asymptomatic,” he said. “No one was coughing or had fever.”

About 600 viral tests have been conducted, resulting in the COVID-19 diagnoses of seven residents and five staff.

The plan is to conduct blanket testing of all staff and residents weekly, until no positive results turn up for two weeks in a row, , Miscovich said. As an extra safeguard, the group plans to re-test everyone who worked and lived on the affected floor this Saturday too.

“We are working diligently to limit the spread of the virus to other residents of the facility and are communicating this news to our residents, staff, and their loved ones,” . “The facility has a dedicated infection control preventionist who is focusing on infection control throughout the facility.”

Five of the seven Hale Nani residents have been hospitalized to date, according to . The two remaining residents are in a dedicated COVID-19 unit at Hale Nani, according to . All five staff members are isolating at home.

Hale Nani officials have fashioned a former physical therapy unit into an isolation room. The entire campus has been mapped into color-coded zones — green, orange and red. Those who go into red zones may not set foot in green zones and the orange zone is the nursing unit floor where the string of infections originated. Three of the staff who worked there have tested positive, Miscovich said.

It was one nurse’s diagnosis last Friday that triggered testing of dozens of employees, which was conducted by the Hawaii Department of Health. Those results all turned up negative. It wasn’t until a patient became symptomatic on Monday that a follow-up test at a hospital was positive.

That’s when Miscovich got in touch with Hale Nani administrators, who were looking to conduct blanket testing. Once a facility-wide weekly testing plan was approved by Avalon Health Care, which owns Hale Nani, Miscovich says Hale Nani alerted DOH of the plan by telephone.

“This was not ordered at the direction of the Department of Health. I’m working with Dr. Sarah Kemble and three other individuals with the Department of Health, and they’re very cooperative and supportive of our plans,” he said.

Miscovich, a private physician, has worked with dozens of health care workers to spearhead the Premier Medical Group Hawaii’s COVID Command Mobile Unit. They have conducted more than 10,000 tests statewide.

Other nursing homes have recently moved to conduct a baseline testing of all staff and residents, based on dated federal guidance.

Arcadia Family of Companies, which operates Arcadia and 15 Craigside, conducted a mass testing of all residents and staff at their two facilities earlier this month, also led by the Premier Medical Group. The results were negative.

Denise Mackey, the administrator of Hale Ho‘ola Hamakua on the Big Island, which is home to 60 residents, noted nearly all long-term care facilities in Hawaii have been recommended by the Healthcare Association of Hawaii to pre-test all new admissions 72 hours before they enter the campus.

Hale Ho‘ola Hamakua administrators have also made the decision to test new admissions seven to 10 days into their mandatory 14-day quarantines.

“We keep them on the 14-day quarantine regardless of any of these results,” Mackey said. “Once we pass the 14 days and we have two negative Covid tests within about a 10-day period, we’re feeling relatively confident that we’ve reduced the possibility of a resident or new resident patient bringing covid into this building. Then they’re eligible to mix in with the rest of the long-term care population.”

Hale Ho‘ola Hamakua is part of the East Hawaii Region of Hawaii Health Systems Corporation, which plans to implement a randomized surveillance testing of staff across the region.

In addition, the Big Island facility conducted baseline diagnostic testing of all staff and residents on June 4, the results of which returned negative. Mackey said the decision was made based on federal recommendations to do so, despite the advice being directed more to mainland nursing homes that are located in areas with more severe outbreaks.

For Hale Ho‘ola Hamakua, there are no plans to do another round of blanket testing of everyone unless there’s cause for concern in the community and more activity in other long-term care homes.

“In the industry we’re all very supportive of each other because we’re well aware it could really happen anywhere,” Mackey said. “I have lots of mainland associates who are in pretty big hot zones with this, and it seems like quite honestly no matter what precautions some of these facilities take, something can happen. Nothing is foolproof.”