By Catherine Ho, San Francisco Chronicle, November 12 2020
Coronavirus cases are starting to surge again in California nursing homes amid a third deadly wave of the virus. The spike is reigniting worries that accelerating community spread is spilling over to settings where residents are most vulnerable to dying from COVID-19.
The number of new daily coronavirus cases at the state’s skilled nursing facilities has more than doubled since the start of November — from 42 on Nov. 1 to 101 on Nov. 10 — after a relatively steady decrease since August, according to state data. The figures are seven-day averages of new daily cases. One Bay Area facility, San Tomas Convalescent Hospital in San Jose, appears to be part of this wave, reporting 30 new cases among residents on Nov. 4, according to state data.
The rise coincides with — and is steeper than — a statewide uptick in new infections. Over the same period, new daily cases in California increased from about 4,100 to 7,500, according to state data.
While it is difficult to pinpoint the source of outbreaks at nursing homes, experts say health care workers or visitors may be bringing the virus into many facilities. Unlike the residents, they are coming and going and could be exposed while out in the community. Staffing shortages also make it harder to manage infection control measures.
“As the cases in the community rise, the workers are exposed and they can take the virus in,” said Charlene Harrington, a professor emeritus at UCSF School of Nursing who has studied staffing levels at nursing homes. “By now the nursing homes should have the protocols worked out so they’re testing all the workers every week, or even more often if necessary, and that they’re able to put the infection control into place. So I think it’s some breakdown in the testing.”
Most of the new clusters of cases are at facilities in Southern California, the Central Valley and Sacramento, according to data reported by the facilities to the California Department of Public Health.
But the San Tomas hospital in San Jose has also been part of the recent spike, with 102 total cases reported among residents and 59 cases among health care workers since the start of the pandemic. Seventeen residents with a history of COVID have died. That figure includes residents who had COVID, recovered and later died from other reasons, the facility’s management team said in an email Thursday.
The 130-bed facility saw its first case in May. It declined to say whether it was a worker or resident, citing confidentiality. It currently has 32 confirmed cases among residents, who are in an isolated COVID unit with their own nurses who do not enter other parts of the facility.
Eight staff members are now unable to work because they have tested positive for the virus. The facility has conducted twice-a-week testing for employees and weekly testing for residents since October, it said in a written statement posted on its website.
In October, three complaints were filed regarding the facility’s infection control, according to the California Department of Public Health database. The details of those complaints and who filed them are unclear.
“We currently are in compliance with the CDPH and have been working with their office daily to ensure we are using best practices,” the facility’s management team said.
Elsewhere in the Bay Area, the new wave is similarly seeping into nursing homes. In Solano County, it is almost always introduced by someone at a family gathering, said county Health Officer Dr. Bela Matyas.
“We have a lot of disease in congregate living facilities, about a dozen outbreaks we’re tracking now,” he said.
He said one upside is that the county has improved surveillance in nursing homes and is catching new infections before they can spread widely within a facility.
“We have some control in congregate facilities if we do a lot of surveillance,” he said. “We’re catching them when there’s one or two in the environment instead of an outbreak.”
The coronavirus has been particularly deadly in skilled nursing facilities, where residents are older and live in relatively close quarters. Nearly 4,800 residents and 154 staff at skilled nursing homes in California have died from COVID-19, representing 27% of the state’s overall COVID-19 deaths. That is down from 40% in May.
It’s unclear if nursing home deaths statewide are also increasing, as the California Department of Public Health has not reported those figures regularly since Oct. 1 — possibly because the number is less than 11, the reporting threshold.
“I figure we have another bad three months, four months ahead of us,” said Mike Dark, an attorney for the California Advocates for Nursing Home Reform. “And the time for putting together an effective response to prevent the kinds of outbreaks we’re seeing, that window is closing. We’re likely to see some of the worst months of the pandemic in California long-term care facilities over the next few months.”
San Francisco Chronicle staff writer Erin Allday contributed to this report.