The novel coronavirus is taking root inside the Washington region’s nursing homes and assisted-living communities for the elderly, with at least 142 of those sites now affected and two of the nation’s largest outbreaks happening in Virginia and Maryland.

Amid a national scramble for respirator masks and other protective gear, caregivers, worried families and industry leaders all warn that the country’s premier network of care for a growing segment of society may soon be overwhelmed.

Caregivers for the elderly have launched large-scale safety measures, stretching their budgets to keep buildings clean and residents safe in hopes of avoiding another major outbreak after the deaths of 40 infected residents from a long-term care facility in the Richmond area and 18 residents in a nursing home in Maryland’s Carroll County.

As the tally of cases grows, some facilities are worried they soon won’t have enough workers to help their residents — either because of coronavirus infections in those ranks or because they are choosing to avoid the risk of coming in.

“There are some days I’m getting texts all night as we’re trying to cobble together the staff that we need for the next day,” said Barbara Brannon, chief executive of Falcons Landing in Virginia’s Loudoun County, where three residents have died, 16 residents and members are also infected and 32 employees are under quarantine as they await test results.

“We have a lot of people who are out,” Brannon said, noting that several employees have someone at home with health-care problems. “I suspect some of them are just afraid. It’s been a real struggle.”

The industry is made up of nursing homes for elderly patients with serious health problems — requiring regular medical attention from the nurses and doctors on site — and assisted-living facilities where residents live in independent apartments or houses but need help with medication or daily tasks like bathing. Nursing homes are more heavily regulated.

Maryland’s elderly care facilities have been hit the hardest, with 125 of those communities reporting at least one infection as of late Friday, state officials said. Among them is the Pleasant View Nursing Home in Carroll County, where 18 residents have died and another 112 residents and staff have been infected.

Virginia health officials said the state has 20 facilities with at least two infections. The District says seven of those communities have had cases of covid-19, the disease caused by the novel coronavirus.

Maryland Gov. Larry Hogan (R) has so far taken the most aggressive steps to prevent the virus from spreading further inside the industry where elderly residents are already receiving care for a host of other ailments.

Earlier this month, Hogan mandated that workers in nursing homes wear protective masks when dealing with infected patients. That order, however, does not apply to assisted-living facilities, which, until recently, had not been as severely impacted.

Hogan also launched statewide “strike teams” that offer overburdened nursing homes medical help and supplies in hopes of sparing already straining hospitals from adding more patients. Earlier this week, Hogan included group homes for children with severe medical conditions in that initiative, with plans to also include assisted-living facilities.

Virginia has employed a similar strategy that includes all long-term care facilities, while District officials say they are mostly monitoring cases and advising on safety measures.

Some health-care givers for the elderly argue for more aggressive measures.

A group of 35 geriatric-care doctors, nurses and facility directors in Maryland criticized Hogan for not initially focusing on assisted-living communities. The group urged the governor to require that everyone inside long-term care be tested — regardless of whether they have symptoms — and that protective gear be widely distributed.

If half of the nearly 40,000 seniors living inside Maryland elderly care communities were to be hospitalized due to covid-19, that population alone would need more than double the state’s current supply of hospital beds, those health-care professionals predicted in a letter sent earlier this month to the governor.

That strain could lead to as many as 10,500 elderly patient deaths, the group said.

Roy Fried, a Montgomery County geriatric care doctor who wrote the letter, said people without symptoms inside those facilities should be a greater priority.

“In assisted living, you have certified nursing aides that help people with their activities of daily living — bathing, dressing, toileting — and you might have one aide taking care of 10 people,” Fried said. “They’re doing it with gloves, but they don’t have masks for everybody.”

With most sites now barring visitors, he said, “the only way [the novel coronavirus] comes in now is through the Trojan horses, which is the staff.”

That specter has loomed in an industry where many lower-paid certified nursing assistants and custodians typically supplement their income in the expensive Washington region by stringing together shifts at multiple sites.

State and local health officials have urged elderly care facilities to require their workers to commit to one work site, which many have done but with sporadic success.

In Virginia, the company that owns the Kensington Falls Church (home to at least two covid-19 cases, so far) has offered to make up the difference in lost pay for workers who commit to working there alone. The Kensington is also allowing those workers to live on site with some grocery services provided, the company said in a statement.

Of the 45 employees who usually work at more than one location, 27 have taken up the company’s offer, the company said. The other 18 are working on an on-call or part-time basis.

In the Richmond area — where one of the country’s largest outbreaks at the Canterbury Rehabilitation & Healthcare Center has so far led to 40 deaths and 148 residents and employees infected — the top local health official has pressed Gov. Ralph Northam’s administration to bar staff from working at more than one site.

“Despite the best efforts of the medical staff, the testing community, of everybody involved, we’re still seeing really significant spread,” said Danny Avula, director of the Richmond and Henrico County health districts.

Avula said other facilities in the area have stopped accepting Canterbury staff who were pulling shifts elsewhere. But, he added, he couldn’t say for sure if all facilities in his region have stopped.

James Wright, Canterbury’s medical director, was bitter after so much grief at his center, saying they are short workers.

Though he wouldn’t share specific numbers, Wright said Canterbury has lost so many workers to illness and fear that, at one point, he was personally changing beds and helping patients. His wife took a leave from the hospital where she works to help him for about a week, Wright said.

“A publicly funded nursing home is a virus’s dream,” Wright said, blaming society’s willingness to “warehouse” the elderly in such institutions.

Avula is encouraging facilities to start testing asymptomatic residents and separate any who test positive but show no signs of illness from those who are symptomatic or negative.

Norman Oliver, Virginia’s health commissioner, said Avula’s points — about testing asymptomatic nursing home patients and restricting staff from working in multiple facilities — are “very well taken.”

But he stopped short of saying there would be a public health order along those lines. The state is “intensifying” its efforts to protect residents in long-term care facilities, Oliver said.

As for nursing home staff, he said the workers have little choice but to work multiple jobs because they are so low paid.

Northam (D), who earlier this week appointed a “czar” to oversee the state’s response to covid-19 cases in elderly care facilities, said the lack of enough protective gear at Canterbury and similar facilities “really ties our hands.”

“I will tell you it’s a real challenge for us, but we’re doing everything we can to keep them safe,” the governor said.

Lori Porter, executive director of the National Association of Healthcare Assistants, said those workers should be receiving hazard pay during the crisis.

“We wipe the noses,” she said. “We are an inch away from these people’s breathing and every intimate thing that’s being done. Somebody is going to have to do something big, and it can’t be just one company.”

Industry leaders agree.

James Balda, director of an Alexandria-based umbrella group for 12,000 senior living communities in the country, called Argentum, said his organization has pressed the Trump administration for $20 billion in economic aid to cover the extra costs of labor and supplies.

Many smaller facilities are financially strapped as they pay higher prices for protective gear and add extra services to keep residents safe, Balda said.

“In a lot of cases, communal dining has been restricted and so you need to almost triple your food service staff to be able to deliver meals three times a day to everybody’s room,” he said. “Supply costs are going up almost over 100 percent.”

Some of the facilities owned by large parent companies have been able to leverage their spending power to keep everyone comfortable so far.

At Riderwood Senior Living Community in Silver Spring, where three residents and five staff members have tested positive, the 2,530-resident facility’s parent company has furnished the 1,400 workers there with protective gear from its bulk supply.

“We are uniquely equipped to manage an effective response to covid-19,” said Dan Dunne, director of external communications for Erikson Living, which owns Riderwood and charges residents a minimum of between $140,000 and $850,000 to move in, followed by monthly service fees of at least $2,100.

The situation is different at Falcons Landing in Loudoun, home to about 550 military veterans, their spouses and other former federal employees.

Brannon, the chief executive, said her staff has had to procure masks from local dentists’ offices and use supplies donated by other elderly care facilities that have not yet been hit.

“We have a resident’s son who dropped off 50 3-D printer face shields to our gate for us,” she said. “They are not the ones we’d normally used, but they will work and they will be effective.”

Brannon said the virus’s “insidious” way of spreading through her community, despite all the efforts to stop it, has been the hardest to deal with.

The community’s first case was a woman in her 90s who died in a hospital a few hours after she tested positive in late March. Eleven days later, 10 more residents and five employees had tested positive, with two more male residents in their late 80s to early 90s also dying.

All those cases have been inside the typically more isolated health centers on campus, but Brannon said she learned in late March that three outside contractors who had been providing physical and cognitive therapy to other residents had also tested positive.

“It’s heartbreaking,” Brannon said, about the fatalities. “You hope against all hope that they can rally, but with a group like this it is more difficult.”

Meanwhile, notice after notice about new coronavirus infections have been rolling out to families of residents across the region, with the companies trying to preserve a sense of calm.

At Sunrise in McLean, six people have been infected, local health officials said. Sunrise Assisted Living, that community’s parent company, also notified families of “the presence of covid-19” in two Arlington County facilities and another one in Chevy Chase.

At the Brooke Grove Retirement Village in Sandy Spring, there were five cases as of Thursday. In a statement posted to its website, the company said that until its first case last week, workers there had been using cloth face masks.

Shelley Slade, whose mother lives inside the Rockville Nursing Home, where two cases have been reported, said a nurse also shared her worries over a lack of protective gear.

“It’s just crazy to me not to have testing for all employees, once it is clear that it is in the building despite them taking all the precautions they could,” Slade said. A Rockville Nursing Home spokesperson did not return messages for comment.

Others are lost in the fog of an expanding crisis where the effort to control it has been in constant flux.

The Dulles Health & Rehab Center in Herndon recently notified family members it would stop testing residents after its tally of confirmed cases reached 11, with one fatality.

In a letter to family members, the facility cited now-outdated guidance from Fairfax County’s health department that said testing was not necessary after five cases are confirmed in one location, what was then an effort to manage a limited capacity for testing in Virginia.

Fairfax — home to 690 covid-19 cases as of Thursday, with 79 percent of those residents 65 or older — has since opened its own testing lab, while commercial labs have ramped up their efforts.

“As testing capacity has increased, we are testing any symptomatic individuals for covid-19 in long-term care facilities,” said John Silcox, the county’s health department spokesman. A Dulles Health & Rehab Center official did not respond to messages for comment.

Robyne Edley Kenton, whose mother with advanced dementia lives at the Herndon facility, said she wants her to be tested. Edley Kenton said she’s worried her mother is at higher risk for infection because her condition makes her unaware that a deadly virus has begun its march through her community.

“She’s all alone,” Edley Kenton said. “She doesn’t know where she is because she can’t remember.”

A few days later, her mother, Joan Edley, 78, had developed a fever and, though she hadn’t been tested, was being treated as if she had covid-19.

Rachel Chason, Ovetta Wiggins, Darran Simon and Gregory S. Schneider contributed to this report.