Of the 18 elderly residents of the Southeast Nursing and Rehabilitation Center who died of COVID-19 in recent weeks, Precious Jefferson had bathed, dressed, and fed more than half of them.

That was before she fell ill herself.

A certified nursing assistant, Jefferson worked a few shifts a week at the Southeast facility for nearly a year while also working at a smaller, privately run skilled nursing center – a job she has held for the past 10 years.

The spread of coronavirus at Southeast, first made public April 1, is one of the largest clusters of coronavirus cases in San Antonio. In all, 74 residents and 29 staff members have tested positive for the virus, with 56 of those not exhibiting any symptoms, according to Metro Health. Only the Bexar County jail, which has recorded 358 cases among inmates and staff as of Sunday, has experienced a larger localized outbreak.

On Friday, Metro Health confirmed an employee of the Southeast nursing home had died. Dorothy Davis, 60, spent more than a month in the hospital before her death Sunday, according to news reports.

“She was a hard-working woman … [but] she worked mainly overnight so I rarely saw or worked with her,” said Precious, adding that the two only came into contact when Davis worked extra shifts.

Nursing homes have emerged as one of the highest-risk environments for the spread of the coronavirus. The Centers for Disease Control has said those with the highest risk for severe illness from COVID-19 are people age 65 years and older and those who live in a nursing home or long-term care facility.

As of May 7, there were nearly 25,000 reported deaths due to COVID-19 in long-term care facilities (among residents and staff, where available) in 33 states that have publicly reported such data, according to an analysis by Kaiser Family Foundation (KFF). In Texas, 41 percent of all COVID-19 deaths have been residents or staff of long-term care facilities, according to the KFF analysis.

In San Antonio, Mayor Ron Nirenberg responded to the outbreak at the nursing home by forbidding nursing home staff to work in or visit more than one facility.

For Jefferson, the hard work of caring for elderly nursing home residents and patients makes her feel good. “Some of [the residents] are really fun to be around – you learn about history,” she said.

But depending on the day, Jefferson would care for 20 to 30 patients during an eight-hour shift. “It’s definitely not for the faint of heart,” she said.

Once residents began testing positive for COVID-19 in late March, she had her temperature taken every day upon entering the facilities. Jefferson was working at both nursing homes when the first patient at Southeast tested positive for the virus.

“I never had a fever,” she said, and besides a slight cough, she wasn’t feeling sick. But an administrator told her to self-quarantine starting March 24 because she had been working with a patient who tested positive for the virus.

Along with the other Southeast staff members who had contact with residents diagnosed with the virus, Jefferson was tested for the virus on March 29, after she had already started isolating herself. The test came back positive.

Sending her 14-year-old son, who has asthma, to live with a relative, Jefferson and her husband began a quarantine that lasted two weeks. “The symptoms weren’t that bad,” she said, and the facility administrator told her she could return to work when she was symptom-free.

On April 28, after being out of work without pay for about a month, she returned to Southeast to work a 2 p.m. to 10 p.m. shift. The following day, she woke up with a cough, body aches, fever, shortness of breath, and diarrhea.

Jefferson’s husband then became ill with the same symptoms. His virus test came back positive. Both are staying home and caring for one another, “and so far, so good,” she said.

The Southeast administrator responded to an email on Friday saying she would need some time to gather information about the nursing home’s policies and procedures for employees returning to work after being sick, and for ongoing monitoring of the staff and residents. As of Monday afternoon, she had not provided that information.

Jefferson said she believes she was exposed to the virus at Southeast. But she doesn’t have any complaints about the facility’s cleanliness or the care of the patients.

“I made sure that I kept my areas cleaned, and I made sure that the residents were taken care of,” Jefferson said. “I was doing my job. I wasn’t scared.”

But she wasn’t there more than a day or two a week, she added. “So you never really know. I went in and did what I was supposed to do and went home, basically.”

The Southeast Nursing and Rehabilitation Center has been scrutinized in past government inspections, resulting in a one-star review by Medicare. A Texas Department of Health and Human Services in October listed violations such as food safety issues and lack of proper sanitary measures and issued 17 health citations.

Now Jefferson is too scared to go back there and said she never will. “The second time around, it was the worst,” she said of the illness. “I want to go back to my other job. But I know I need to make sure I’m over this COVID first and then get retested again.”

Until then, she plans to stay quarantined and will wear a mask when she leaves the house. She worries that others aren’t taking the outbreak seriously enough and that the city is reopening too soon.

“It’s scary – you wake up gasping for air and you can’t breathe and then the body aches and the pain,” Jefferson said. “I think that a lot of people take it as a joke … And I think that also a lot of people wouldn’t be able to handle half the symptoms.

“I’m terrified of catching this again.”

Reporter Jackie Wang contributed to this report.

Shari Biediger has been covering business and development for the San Antonio Report since 2017. A graduate of St. Mary’s University, she has worked in the corporate and nonprofit worlds in San Antonio...