Hale Nani Rehabilitation and Nursing Center has confirmed a small outbreak at the state’s largest nursing home with at least four residents and one staff member now testing positive for the coronavirus.

The company confirmed the news in a letter posted on the website of its parent company Avalon Health Care Group.

“Despite our best efforts to prevent COVID-19 from being introduced into our facility, we can confirm that we had a total of one staff member and four residents test positive for COVID-19,” the notice said. The staff member, who had been exposed to a COVID-19 case outside Hale Nani, was first confirmed positive on June 12 and the residents are all on the same unit where the employee worked.

The residents and their caregivers initially tested negative, but one of the residents later developed symptoms and was taken to the hospital, testing positive on June 14. That resident is still hospitalized, while the others have been placed in isolation at the facility. Two residents tested positive via 15-minute rapid COVID-19 tests, but active virus must still be confirmed by nasal swabbing tests.

“Thank God all the infected individuals are completely asymptomatic and are stable,” said Dr. Scott Miscovich, owner of Premier Medical Group Hawaii, which is conducting the tests for about 250 residents and roughly 550 staff. “This further emphasizes the importance of testing asymptomatic individuals in cluster settings.”

Hale Nani began testing all residents and staff for the virus on June 16. Tests will be repeated a week and two weeks later until all are negative, Miscovich said. In the meantime, if any employee or resident develops symptoms, they will be immediately retested.

“The outbreak so far is confined to one ward that has 17 total residents. You keep on testing weekly until no positives are found so that you know this facility is disease-free,” he said. “This is a respiratory virus that bodies have never seen. Until we develop a vaccine, this will continue to spread. People should not be listening to any myths that the summer or change in weather will lessen our exposure.”

The Department of Health said it is working on a surveillance plan and has been working with all 48 long term care facilities over the past five months on coronavirus infection control and mitigation strategies.

“The most important thing we can do to prevent COVID-19 outbreaks in nursing homes is to ensure facilities are implementing proven infection control procedures,” including the wearing of medical masks, as well as the screening of residents and staff for symptoms, frequent disinfecting and minimizing floating of health care workers, said DOH spokeswoman Janice Okubo. “Unfortunately, not all clusters are avoidable, but having sound infection control strategies in place can minimize the frequency and extent of clusters of COVID-19 in nursing homes.”

Hale Nani said it is screening all individuals before they enter the facility. If they report any signs of the coronavirus, they are sent home. The facility is only allowing essential visitors or vendors to enter on a case-by-case basis.

In addition, all staff and visitors are required to wear personal protective equipment.

“We are working diligently to limit the spread of the virus to other residents of the facility,” the administration wrote. “We will continue to implement the guidance that has been provided to us by the Centers for Disease Prevention and Control, the Centers for Medicare and Medicaid Services and the state Health Departments as we fight to keep our residents and staff safe.”

Meanwhile, Maunalani Nursing & Rehabilitation Center said one COVID-19-positive employee not involved in patient care is at home with no respiratory issues. The center is requiring a negative coronavirus test result before the individual may return to work. All employees and residents in the 100-bed facility were offered free COVID-19 testing, and all returned negative, said Sai Chantavy, CEO of Maunalani. The DOH was also investigating two positive cases among workers at another Oahu long-term care facility, Kalakaua Gardens.

“Testing will not prevent the virus from walking in the door,” Chantavy said. “The facility cautions their staff as well as the community that everyone is vulnerable during this pandemic.”

Hawaii recorded five new coronavirus cases Wednesday — four on Oahu and one on the Big Island — bringing the statewide total of infections since the start of the outbreak to 744. The state’s count of new COVID-19 cases so far in June at 96 has already doubled the 45 total new cases recorded in May. Of the more than 63,243 coronavirus tests conducted so far by state and clinical laboratories, about 1.2% have been positive.

As of today, 88 infections in Hawaii are active cases with a total of 639 patients now considered recovered since the start of the outbreak in February. The state’s coronavirus death toll remains unchanged at 17.