A nasty respiratory illness had been spreading through the Life Care Center nursing home in Kirkland, Wash., for at least nine days when a sick resident was taken to a hospital on Feb. 19.

The resident, and another hospitalized Feb. 24, were later diagnosed with covid-19, the illness caused by the coronavirus, according to the facility. They were two of the earliest cases in the country’s deadliest cluster to date in the pandemic.

But the home’s managers had believed since early February that they were facing a surge of influenza, which was common for the facility, said a spokesman for the Life Care Center.

Their focus on flu had persisted even though their region had been on high alert since the Jan. 21 announcement of the first U.S. case of the coronavirus in a neighboring county.

The assumption of flu had held as the managers introduced a policy on Feb. 10 discouraging visitors due to the spike in illness.

And it had continued after a senior state health official, in a Feb. 21 letter, urged all nursing homes to prepare for the coronavirus by checking hygiene and infection controls, according to a copy of the letter obtained by The Washington Post.

Records, interviews and a close examination of information released by the nursing home and authorities point to a series of missed opportunities to limit exposure to the spreading coronavirus at the Kirkland home.

Life Care was legally required to report any suspected flu outbreak to county authorities within 24 hours. King County said it received notice of an “increase in respiratory illness,” with few details from the home, late on Feb. 27. At that point, 17 days had passed since visits to the facility had been discouraged by managers.

On Feb. 29, Life Care received word of two coronavirus cases, believed at the time to be the home’s first. A bar to visitors was implemented that day, according to Life Care, but some relatives said in interviews they were still allowed inside for several days afterward.

As of Monday, 29 covid-19 deaths had been associated with the home, according to the county. Life Care said Monday that 30 of the 43 remaining residents, and 46 of the home’s 180 employees, had tested positive.

The coronavirus outbreak at the home unfolded under a facility leader newly licensed in Washington state, licensing records show.

Confirmation of the first coronavirus case was met with a disjointed response inside, according to emergency calls released under a public records act request from The Post. A 911 operator trying to confirm arrangements for an ambulance crew to pick up a sick resident had to make repeated calls to the home.

Even as the assumption of ongoing influenza cases persisted at the facility, new patients were admitted and events were held, including a Mardi Gras party where residents sat “wheelchair to wheelchair,” said Cheri Chandler, 58, whose parents attended.

Some who visited now say that Life Care Centers of America, the Cleveland, Tenn.-based company that owns the home, should have been quicker to suspect the coronavirus was inside — and to properly lock down the home once the virus was confirmed.

“Everybody just moved too slow to recognize this virus,” said Mike Weatherill, whose 85-year-old mother, Louise, died March 4 of hypoxia, pneumonia and “epidemic covid-19 exposure,” according to a county record.

Tim Killian, a public liaison for the Life Care Center, said in an interview that the home’s staff did the best they could with the information available to them at the time, and that the response by public authorities was slow and inadequate.

“I can’t say everything was done perfectly, but I can say it was done within a range of normal operating procedure,” Killian said.

Novel coronavirus takes hold

On Jan. 21, as concerns grew globally about the spread of the coronavirus from Wuhan, China, authorities said that a 35-year-old man who had traveled from the region to Snohomish County, Wash., was the first known case in the United States. He has since recovered.

Officials in neighboring King County activated an emergency command and began briefing health care facilities, they told county political leaders.

Containment was the priority, state health secretary John Wiesman said at an event in King County on Jan. 29, “and the way that we contain this is to identify folks who may have symptoms, get them tested.”

Killian, the Life Care center spokesman, said a respiratory illness took hold from “early February,” flaring badly enough to prompt staff to discourage visits starting on Feb. 10. He said staff mentioned the illness to visitors when they arrived and that signs were placed on walls under what he called a “soft discourage” policy.

Staff had a “heightened awareness, of course” of the coronavirus, according to Killian, but they presumed they were up against influenza, which has similar symptoms and has afflicted the home several times in recent years.

“They didn’t see any medical difference” between what they observed in sick residents and past flu cases, he said.

Washington state law requires nursing homes to report “outbreaks or suspected outbreaks” of influenza to their county. King County requires the report within 24 hours if two residents have “acute febrile respiratory illness” in one week.

Killian said Life Care reported an outbreak to a state health department official in a voice mail on Feb. 26, and left two more messages the following day, before eventually sending a fax that they confirmed was received.

Washington’s two state health agencies said they had no record of this, and that they would expect any such report to go to the county.

King County did receive a “standard notice” late on Feb. 27 with “no details about the number of people ill or the status of illness,” Brent Champaco, a county spokesman, said in an email. “There was nothing in the original notice from Life Care that this was an unusual type of illness, or unusual in any way or manner.”

When county officials called Life Care the following morning, Champaco said, they “learned that approximately 20 residents were ill, and that their flu tests were coming back negative. Investigation ensued.”

Killian said Life Care was “not saying that it’s not possible that we should have called sooner.” But he said the “relatively slow” response by authorities deserved more attention.

“Even once we report it, it’s not like they marched out a team over to the facility,” he said.

Life Care Centers of America is the nation’s largest privately owned nursing home firm, with about 40,000 employees and more than 200 facilities across 28 states, according to Forbes, which estimates the company’s annual revenue at $3.2 billion.

In the spring of 2019, the Kirkland home was found to have problems with hygiene measures that government inspectors said “placed residents at risk for harm and transmitting/acquiring infections.” Some residents told the inspectors they were not being bathed as frequently as they were supposed to be.

By June, inspectors had returned and reported that Life Care had fixed its shortcomings. The home currently has a five-star rating for overall care from federal regulators and an “average” rating for health inspections.

As the respiratory illness at the Kirkland home gained a grip in February, Life Care continued holding communal events involving outsiders.

On Feb. 17, residents gathered to pet rabbits and guinea pigs from Animal Encounters, an Issaquah, Wash.-based company that brings animals to classrooms, centers for the elderly and birthday parties. John Connolly, who co-owns the firm, said the employee and animals involved had not visited other clients since then and no one at the firm was sick.

“The shocking thing for us is that you’re the first person who’s contacted us,” Connolly told The Post.

Killian said the home did not have enough staff to alert past visitors to the outbreak.

On Feb. 19, a sick resident was hospitalized. Life Care now says this was its first known coronavirus case, and that it was told only of the diagnosis more than 10 days after the hospitalization. Killian said Life Care did not know the current health of the resident.

Just as with social visitors, first responders called out for the home’s ill were also unknowingly exposed to the coronavirus. The city of Kirkland said on March 10 that a firefighter had tested positive. Five remain quarantined.

New residents continued being admitted even as visits were being gently discouraged. Chuck Sedlacek, who needed rehabilitation after breaking an ankle, entered on Feb. 20, his family said. Sedlacek, 86, has since tested positive for covid-19. So has his 64-year-old son, Scott.

“If they were so concerned about this respiratory outbreak, why were they taking new patients?” Sedlacek’s daughter, Seri, asked as she stood outside the facility. After confirmation of the coronavirus outbreak, “no other rehab center will take him,” she said.

Scott Sedlacek, who was wearing a face mask, said he has since recovered. “We had just the horrid luck of being in the wrong place at the wrong time,” he said.

In a Feb. 21 letter, Washington’s director of residential care services urged the state’s nursing homes to prepare for the coronavirus by reviewing emergency plans and checking infection and hygiene controls.

Killian said he did not know whether Life Care received that letter but said: “Was there an awareness of an alert? Sure.”

On Feb. 24, singer-organist Gary Lee Hood played an hour-long set of old favorites for two dozen residents enjoying a tea party. “I didn’t notice any precautions going on,” Hood said. “Nobody was wearing a mask.” Hood said he always cleaned his hands with sanitizer after shows and has not become ill.

A few days later, residents at Life Care gathered for a long-planned Mardi Gras party on Feb. 26. Hot hors d’oeuvres and cake were passed as a local swing band played. The band’s leader declined to discuss the event or band members’ health.

“I wish we had canceled that, but we only could make the decision on the information we had,” Killian said of the party.

Nursing students and staff from Kirkland’s Lake Washington Institute of Technology were also at the home that day and the next. The college said March 4 they were quarantining for 14 days from their visit. It said one staffer tested positive for covid-19 but did not say if this was linked to the Kirkland home. It closed the college until March 20.

Two recent residents of Life Care — an 86-year-old woman and a man in his mid-50s who were no longer at the Kirkland facility — died Feb. 26 from covid-19, according to a March 3 announcement from the county.

Authorities announced on Feb. 28 what was then King County’s first known coronavirus case — a woman in her 50s, who had traveled from South Korea. No link has been established between that woman and Life Care.

How the virus entered the home has still not been established, Killian said.

From inside, calls to 911

Washington regulators issued a nursing home administrator’s license to Ellie Basham, the new executive director of Kirkland Life Care, on Feb. 28, according to state records. Basham had arrived in January from a home in Augusta, Ga.

Washington allows administrators arriving in the state to transfer existing licenses issued by states that it deems to have comparable requirements. Georgia is not one of them, according to the state health department’s guide for applicants.

Basham referred a request for comment to Life Care.

Killian said Basham was classified as an “administrator in training” between joining the home and gaining her license. He said this had no impact on the home’s handling of the outbreak.

A profile for Basham that had been accessible until Saturday on LinkedIn, the professional networking site, said she had a nursing degree from the University of Phoenix and an MBA from Grand Canyon University.

Also on Feb. 28, Carmen Gray visited her mother, Susan Hailey, at Life Care. Hailey, 76, was there after knee-replacement surgery and had been expected to leave weeks earlier but broke an ankle in a fall at the home, her daughter said.

Hailey tested positive for covid-19 last week. Her family said she was experiencing shortness of breath and a cough.

“It angers me. This shouldn’t be happening,” Gray said of her ill mother. “There’s no excuse for this. She should have been home in January.”

Gray said she noticed a warning sign about the respiratory illness during the visit, but said she was told by a staff member that it was not coronavirus. So she sat with her mother in her room, and they watched a Glenn Close movie.

The following day, county officials announced what were then the first known coronavirus cases tied to Life Care — a health-care worker in her 40s and a resident in her 70s. Killian said Life Care was told early Feb. 29 that the resident had tested positive.

The full extent of the problem at the nursing home was becoming clear.

“Over 50 individuals associated with [Life Care] are reportedly ill with respiratory symptoms or hospitalized with pneumonia or other respiratory conditions of unknown cause and are being tested for covid-19,” the county announcement detailed. “Additional positive cases are expected.”

Life Care was abruptly thrust to the center of the coronavirus crisis within the United States. Recordings of 911 calls on Feb. 29 from the nursing home, obtained by The Post under a public records law, point to a disjointed early response inside the facility.

That afternoon, a nurse called to report a female resident in her 70s previously diagnosed with pneumonia who had a high temperature and tested negative for flu.

“We think she might . . . this is the place that sent the coronavirus, you know, to Evergreen Hospital,” the nurse told the 911 operator, who said a crew would head out.

But the operator had to phone back three times to try to get a message to staff that the patient needed to be moved outdoors and have on a mask to reduce the risks to the responding emergency personnel.

The 911 operator’s three return calls lasted nine minutes in all, the recordings show.

A Life Care phone receptionist first directed the operator’s return call to another staffer’s voice mail, then repeatedly placed the operator on hold, then transferred her to a different nurse.

When the audibly frustrated operator reached the Life Center receptionist a third time and explained that the operator needed to reach the nurse to pass along instructions for preparing the patient, the receptionist told her to hold on. “No, not ‘hold on’! ” an unidentified person at the call center was heard exclaiming in the background.

That day, the home implemented a firm ban on visitors, according to Killian. Yet relatives of two residents who had not been diagnosed with covid-19 said that during the days that followed, they were allowed inside the home.

Colleen Mallory said that although she knew visitors were not supposed to be admitted, she visited her 89-year-old mother, who has severe dementia, on March 2.

“I went to the door, and they did let me in,” she told reporters at a press briefing. “It was very eerie in there.”

Mallory’s sister-in-law, Annissa Walsh, said they had been self-quarantining at home and were not sick.

Mallory said she learned that her mother’s roommate, who days earlier had been suffering pneumonia-like symptoms and receiving oxygen, had been removed from the room, but that staff declined to explain why, citing privacy rules.

Killian said Life Care lacked legal authority to fully block relatives entering or residents leaving and had provided protective clothing to visitors. “We’re not a jail or a prison,” he said.

Following the Kirkland outbreak, the Trump administration issued tougher guidance limiting visits to facilities where the coronavirus has been detected.

Anxious families await news

As the death toll rose, the response from Life Care Centers and the authorities underwhelmed the anxious families of residents still inside. Life Care Centers dispatched Todd Fletcher, head of its northwestern operations, to take charge. Fletcher had worked 18-hour days since then to lead the response, Killian said, adding: “I count the staff as heroes.”

Killian said Life Care was unable for a week to obtain coronavirus tests for residents and staff, amid a shortage noted nationwide.

Debbie de los Angeles, whose mother Twilla Morin died on March 4, said she appreciated Life Care’s nurses, but wondered how the virus was allowed to spread. A medical examiner said her mother, who would have turned 85 in June, tested positive for covid-19, she said.

“When things were really getting out of hand in the beginning and so many people were sick, and they were dying by the day in there, why didn’t they get more help?” de los Angeles said to The Post, then paused. “I guess I don’t know if it really would have helped. Just like my mom, it went fast.”

Speaking to reporters March 5, Kevin Connolly, whose father-in-law Jerry Wall is a resident, complained that the nursing home still was not properly secured.

“There is no quarantine here,” Connolly said. “This disease is running rampant.”

That day, Life Care’s president, Beecher Hunter, issued a statement expressing sympathy for the relatives of those who died and thanking staff.

“We grieve with the families who have lost loved ones,” Hunter said.

By the end of that week, a “strike team” of doctors and nurses from the U.S. Public Health Service Commissioned Corps, which reports to the Surgeon General, had arrived to help tackle the outbreak.

On Sunday, more than two weeks after coronavirus was confirmed at the home, Killian said the government response was deficient.

“We’re still under triage, and we’re still asking for help, and still feel like the amount of help we’re getting is inadequate,” he said.

Nate Jones, Julie Tate, Dalton Bennett and Jay Greene contributed to this report.