By Anna Bauman San Francisco Chronicle April 3, 2020
20 Updated: April 3, 2020 9:56 p.m.Comments4
An investigation this week into a nursing home in Orinda revealed that the coronavirus swept through the 47-bed facility, infecting a total of 27 people in what is one of the largest reported outbreaks at a single location in California.
Health officials said Friday that they began investigating Orinda Care Center after receiving reports of a coronavirus outbreak at the skilled nursing facility. Officials initially found fives cases of COVID-19, including two residents who were hospitalized and three staff members. But more testing revealed a much more alarming situation: Results returned positive for 22 additional residents, or more than half of the people living there.
“Unfortunately, this does not come as a surprise,” said Dr. Chris Farnitano, the county’s health officer. “This is something we’ve been worried about and preparing for for quite some time.”
In addition to the Orinda Care Center outbreak, the county is investigating several other reports of COVID-19 at other sensitive places — nursing homes or other congregate settings, Dan Peddycord, the county’s public health director, said Friday.
“The situation is very serious, and we are deeply concerned about residents of our senior care facilities in Contra Costa County,” Farnitano said. “That is why we need everyone to follow the stay-at-home order, social distancing guidance and other measures in recent health orders — to protect the people in our community who are vulnerable to severe illness from COVID-19.”
More than 400 long-term care facilities in the U.S. have at least one case of COVID-19, the U.S. Centers for Disease Control and Prevention reported this week. That number nearly tripled since March 23, when the agency said 147 facilities had reported cases.
The California Department of Public Health declined to provide information about cases at long-term care facilities in the state. But plenty of evidence suggests the Orinda facility is not an outlier. There are at least 12 cases among residents and staff at Laguna Honda, San Francisco’s 780-bed nursing home. Canyon Springs Care, a San Jose skilled nursing and rehabilitation center, reported 11 cases of COVID-19 among residents and staff on Friday.
A Southern California nursing home in San Bernardino County reported 57 cases and two deaths earlier this week. Los Angeles County health officials reported there are 11 long-term care facilities with at least a single case. Bay Area county health officials have not released similar information.
The virus, which causes respiratory symptoms and fever, is most deadly to older adults and those with underlying health conditions. According to the CDC, 80% of people who have died in the U.S. from COVID-19 were 65 years or older.
This makes nursing home residents particularly vulnerable to severe symptoms if they catch the contagion.
“Once it gets in a facility, because the patients are so vulnerable, they’re so old, they have so many chronic conditions —it can spread very fast,” said Charlene Harrington, a retired nursing professor at the UCSF. “Even though the families haven’t been able to come in, you have the staff going out and getting exposed.”
The Centers for Medicare and Medicaid Services conducted targeted inspections to assess whether nursing homes were prepared to fight COVID-19. This week it found that 36% of facilities inspected in recent days did not follow proper hand-washing guidelines and 25% failed to demonstrate proper use of personal protective equipment.
After 37 deaths were linked to the LifeCare nursing home in Kirkland, Wash., nursing homes everywhere went on high alert. In mid-March, Bay Area county health officials ordered nursing homes to ban visitors, cancel group gatherings and follow strict health protocols.
“However, we were always aware that those steps were not a guarantee against an outbreak,” said Farnitano, the Contra Costa County health officer.
At the Orinda facility, 14 residents and staff had tested negative, some test results were still pending and some staff still needed to be tested by Friday afternoon.
Since learning of the outbreak, county health officials isolated the COVID-19 positive cases in a separate area of the facility. To preserve staffing, Farnitano said, some staff who test positive can care for COVID-19 positive residents if the staffers are asymptomatic. Those staff members would be required to wear personal protective equipment at all times and could not intermingle with the noninfected portion of the facility.
“As long as we keep them together, neither staff nor residents are placed at any additional risk,” Farnitano said.
Harrington, however, said she thought it would be dangerous for infected staff members to continue working and risk transmitting the virus to their family members at home.
Harrington called the outbreak an emergency and said it required the facility to bring in more staff, including an infectious control expert.
“I think most of them are gonna get it,” she said.
The county is training the facility’s staff on wearing protective gear, and officials have requested additional masks, gloves and gowns to meet the surging need.
No other infected people have been sent to the hospital because they all have mild symptoms, Farnitano said. He did not know the condition of the two who were hospitalized.
Health officials said they are monitoring residents and staff at the nursing home and that tests will be given to anyone who develops symptoms in coming days.
The CDC recommended this week that nursing homes designate separate units within a facility for COVID-19 patients, or create separate facilities entirely. In Massachusetts, a skilled nursing facility was converted into a COVID-19 care center. Elderly people from across the region who are discharged from hospitals with a known or suspected case of COVID-19 can go there instead of populating scattered homes. The centralized location prevents the virus from spreading to a host of facilities, health officials said.
In California, meanwhile, officials ordered nursing homes to accept COVID-19 patients from overflowing hospitals, which critics called a “death sentence.” Harrington said there are several nursing home advocacy groups that want California to adopt the centralized care approach like Massachusetts.
“We really want the state to set up special facilities to handle COVID-19,” Harrington said. “The typical nursing home, they don’t have the staff, the training and the expertise to handle these cases.”