By Sarah Ravani, San Franscisco Chronicle, June 23 2020
Debra Plummer learned with horror while watching TV this week that 14 residents and at least one health care worker at the San Miguel Villa nursing home in Concord have died of COVID-19, and 75 more have been infected with the coronavirus.
Plummer’s mother was among the infected. She has Alzheimer’s disease and tested positive for the virus three weeks ago before recovering and emerging from isolation. Since the start of the pandemic, Plummer said, San Miguel administrators wouldn’t tell her how many people had tested positive at the nursing home, although they report the figures to the state.
“It’s really scary,” Plummer said. “Sometimes we feel extremely depressed. Last night I was awake from 3:30 to 5:30 wondering if she is OK. It is very emotional. There is not a whole lot we can do.”
The news out of the Concord nursing home came as California saw sudden surges in the number of new cases — surpassing 6,000 for a second straight day — even as the state reopened restaurants, bars, gyms and salons.
Nursing home deaths account for more than 40% of all COVID-19 deaths in California, and are on the rise even though it’s clear that isolation, proper equipment and frequent testing slow the spread of the coronavirus.
“We are still not on top of the problem,” said Charlene Harrington, a professor in the UCSF School of Nursing. “How can this happen right under everybody’s nose? It can only happen if there is nobody out there monitoring the facilities.”
At nursing homes across California, little oversight and few penalties by state and county health departments — and a lack of testing and supplies — are driving the spread of the virus, say eldercare experts and advocates for residents. And it’s nearly impossible for families or the public to get information directly from nursing homes. Administrators rarely respond to press calls. And even those with public relations companies representing them don’t always respond. By comparison, San Quentin State Prison in Marin County, where 10% of the inmates and 30 guards are infected with the coronavirus, updates the stats on its website daily.
Details on what happened at San Miguel Villa — and why — were not forthcoming Tuesday. The nursing home ignored eight phone calls from The Chronicle over two days.
San Miguel Villa is the 125th nursing home in the Bay Area to experience a coronavirus outbreak since the start of the pandemic. Throughout the Bay Area, at least 96 nursing home residents and workers have died, according to state data. And at least 1,500 have been infected.
On May 22, the Contra Costa County public health department requested help from the state to assess San Miguel Villa’s infection control and prevention practices after identifying a coronavirus outbreak, said Will Harper, a spokesman for the department.
The state Health Services Department said Tuesday that a team of infection-prevention specialists was sent to San Miguel. They worked with the county to manage the outbreak and determine what was needed to prevent another one, the state’s department said.
Working with Kaiser Permanente, the county tested all residents and staff each week and provided personal protective equipment to the facility, Harper said.
“Our outbreak investigation team continues to have daily calls with the facility to assess the ongoing situation,” he said.
San Miguel Villa is a 190-bed home with a “much above average” rating, according to its nursing home profile from Medicaid.
But the facility had seven health citations in its last inspection on April 5, 2019, including failure to ensure food was served under sanitary conditions, leaving residents at risk for foodborne illnesses.
Staff also twice failed to follow infection-control practices. In one case, a nurse did not wash his hands before inserting a resident’s gastrointestinal tube. In the other, staff members used bare hands to turn off faucets after washing, rather than using a paper towel. This left them at risk of recontaminating their hands.
Nursing homes are uniquely vulnerable to the virus, said John Swartzberg, an infectious disease expert at UC Berkeley. Staff go in and out of the building, and due to low wages, often work in multiple facilities. This makes them more susceptible to contracting and sharing the virus with residents.
“Somebody has to be bringing the virus into the nursing home, otherwise it wouldn’t happen,” Swartzberg said. “Once it’s brought into the nursing home, then it can perpetuate itself into the nursing home by internal transmission.”
The California Department of Public Health mandated that all skilled nursing homes complete an infection mitigation plan that includes a schedule for testing residents and workers for the coronavirus. All did so, as required, by the end of May, the department said.
The state said baseline testing must be completed by June 30. But testing has still lagged in many facilities, said Harrington of UCSF.
“A lot of the nursing homes haven’t even done testing yet,” she said. “That just makes everybody vulnerable.”
Nursing homes submit the test results to the state, which publishes them on its website.
State officials said they were reviewing the plans and doing site visits in June and July. Regular visits will happen every six to eight weeks to ensure nursing homes are abiding by the mandate, they said. If they don’t, nursing homes could be subject to unspecified enforcement actions.
Despite the order, nursing homes remain vulnerable to coronavirus outbreaks because they don’t test often enough and are short on staff and personal protective equipment, said Patricia McGinnis, director of California Advocates For Nursing Home Reform.
“Nursing home residents aren’t a priority in this state,” McGinnis said. “Nobody is watching anything. The nurse facilities and the nurse evaluators aren’t coming in. Family members aren’t allowed in (during the pandemic). Nobody is watching anything in these facilities while the deaths pile up and the infections pile up. It’s just very sad.”