They are the outliers.
Since the COVID-19 pandemic began in late winter, 29 Massachusetts nursing homes have found a way to do the improbable: Keep the virus out.
The state provided the Globe with a list of facilities with no cases in patients or staff as of last Friday. The Globe identified several others with a dozen or fewer cases and no fatalities.
It’s a track record that some of the facilities’ operators assess with unease. They know their COVID-free days could end at any moment. A single case could propel patients and workers into a fight for their lives.
The map of nursing homes that have eluded the virus so far is something of a puzzle. At least six belong to chains with other facilities that experienced devastating outbreaks. Some are located near nursing homes that lost scores of patients.
No one is willing to declare victory.
“We are aware that things could change in a heartbeat,” said Jerry Shaffer, executive director of Gardner Rehabilitation and Nursing Center in Gardner.
On Friday, Shaffer’s facility marked 77 days without the virus breaching its walls. It’s a remarkable feat in a state where 78 percent of all nursing and rest homes have at least one probable or confirmed case of the virus, and 62percent of the 7,085 people who have died from COVID-19 were long-term care patients, according to state figures released Tuesday.
But Shaffer said Gardner Rehabilitation and Nursing Center feels the strain of what could happen.
“We have colleagues and we would talk to them on Monday and they would be COVID-free and then by Thursday they would have 46 cases,” he said. “It’s there but for the grace of God go I.”
Interviews with leaders at facilities with few or no cases revealed some common threads.
None are located in Boston, Worcester, or Springfield, the state’s largest cities. Most — all but three — accept payments from Medicaid or Medicare.
Of the 26 facilities that receive government funding, most have fewer residents per day than the average nursing home in Massachusetts. On government ratings scored on a five-star scale, the average score for the 26 facilities was three stars, about average for the state.
Half of the nursing homes are located west of Worcester; one is on Martha’s Vineyard, and another on Nantucket.
Several leaders at facilities interviewed by the Globe said they stopped accepting new patients or dramatically reduced new admissions during the pandemic, a strategy that differed from some nursing homes. When patients were admitted, they were quarantined for 14 days.
Keeping infected workers out, a crucial hurdle, was one of the hardest to clear because the industry is built on the labor of low-wage employees who work several jobs. Still, some of the nursing homes persuaded their workers to commit to one facility until the crisis abates.
Workers at South Cove Manor at Quincy Point received a $5 hourly pay raise, new admissions stopped, and all patients and employees were tested for the virus in March, said Bill Graves, the facility’s president and chief executive. Two workers contracted the virus, but recovered, he said.
The nursing home was established 35years ago in Chinatown (the facility was later relocated to the South Shore) by a group of activists who wanted better care for the region’s Asian population. Its residents and workers remain overwhelmingly Asian, Graves said, and many have family and friends in China, where the virus originated last December.
“They took this more seriously than others early on,” said Graves.
Employees balked at early US government guidance suggesting that masks only be worn by the sick, he said. Within three or four days, everyone at the 141-bed facility was wearing a mask, Graves said.
“They were so adamant,” he said. “They knew that this was the right thing to do.”
Charities seeking to help Asian communities weather the crisis donated personal protective equipment in large quantities, making it possible for South Cove Manor to maintain adequate supplies, Graves said.
Leaders across the globe have taken notice of how parts of Asia have kept the virus from ravaging facilities that provide long-term care.
In May, public health experts briefed a parliamentary committee in the United Kingdom about COVID-19 in Hong Kong, South Korea, and Singapore, where no deaths have been reported in “care homes,” another term for a long-term care facility.
Professor Terry Lum, head of social care policy at Hong Kong University, testified that officials relied on their experience treating SARS, the lethal virus that erupted in Asia in 2003, and isolated all COVID-19 patients in hospitals for up to three months.
The World Health Organization noted the positive outcomes in Hong Kong and South Korea in guidance it issued on May 21for preventing and managing the pandemic in European long-term care facilities.
"COVID-19 spread is not inevitable among [long-term care] services,” the WHO wrote.
Isolating infections appeared to work at Campion Health and Wellness, a rest home and nursing facility for Jesuit priests in Weston.
A priest who lives in the rest home and a dozen workers contracted the virus, but recovered, said Nick Gilbert, the executive director.
All 54 priests at the facility have private rooms, which Gilbert believes helped contain COVID-19.
“Any time anyone coughed or sneezed, I was worried about it,” he said. "We have very old, vulnerable men here. If they get this virus they can’t fight it. They have no immunity.”
Inside chains where some facilities had large outbreaks while others didn’t record a single case, managers said the vastly different outcomes haven’t produced a road map for keeping the virus out.
Berkshire Healthcare operates 15 nursing homes, including Williamstown Commons in Williamstown and Hunt Nursing and Rehabilitation Center in Danvers. Each site recorded more than 20 patient deaths from COVID-19.
The organization also runs nursing homes in Northampton, Pittsfield, and North Adams that haven’t recorded any cases, state records show. The North Adams nursing home is a 10-minute drive from Williamstown Commons.
But all the facilities followed the same government guidance and internal policies for COVID-19, said Lisa Gaudet, spokeswoman for the nonprofit chain.
“There’s no silver bullet. There’s no smoking gun,” she said.
Michael Medeiros, director of operations in Massachusetts for Athena Health Care Systems, said luck plays a role. The organization’s nursing home system includes Plymouth Rehabilitation & Health Care Center, a 186-bed facility with no COVID-19 cases, and Marlborough Hills Rehabilitation & Health Care Center, where a licensed practical nurse and 22 patients have died from the virus.
“I think at any given moment, any facility could be affected," he said. "But every facility is prepared.”
Farren Care Center in Montague tested its 248 workers and patients in phases and found no infections, said Edin Thompson, the administrator.
The only facility of its kind in the state, Farren Care Center treats patients who have mental and medical illnesses, and turnover among among residents is low.
Still, Thompson said she expected testing would reveal asymptomatic transmission of the virus that has been detected in many nursing homes. It didn’t. But she does not intend to let her guard down.
“We act," she said, "as though we already have it.”