By Martin Wisckol, Orange County Register, May 24 2020
While Orange County Public Health Officer Nichole Quick said the county is doing everything possible to contain the burgeoning number of COVID-19 cases and deaths in nursing homes, advocates for the elderly are calling for more ardent efforts and ask that the county emulate steps taken in other places with large, vulnerable populations.
On Wednesday and Thursday, 18 of the 24 coronavirus deaths in county struck residents of nursing homes and other long-term care facilities, according to county data. By Friday, the county was reporting a total of 118 deaths, with nursing home residents accounting for 45.
Nursing home residents make up less than 1% of the state’s population, according to a recent report by the Public Policy Institute of California.
But nursing homes and other long-term care facilities account for a far larger share of the county’s COVID-19 cases and deaths, with those percentages growing weekly.
At the end of April, long-term care residents and staff accounted for 14% of all county infections. They now account for 19%. And at April’s end, those residents accounted for 27% of all county coronavirus deaths, a share that had reached 38% by Friday. There’s been a single related staff death, according to county data.
“Please know that we are doing everything we can,” Quick said of nursing home infections at a press teleconference Thursday.
She listed a number of initiatives the county has undertaken to stem the rising number of nursing home infections and deaths, including a team of “infection preventionists who conduct an on-site assessment within 24 to 48 hours for any facility that has more than one resident testing positive for COVID-19.”
Additionally, the county has contracted with nursing registries to help fill staffing gaps at the facilities, has established an ambulance strike team for potential evacuations and has taken several other steps to support efforts at long-term care facilities, Quick said.
But while nursing home advocates applaud any improvements, they say far more needs to be done. That’s particularly true given the spiking numbers in Orange County, where there are now at least 21 facilities in the county with outbreaks — defined as more than one infected resident — up from nine at the end of April.
“We’re going to continue to see this kind of pace of infections and deaths for a few months,” said Michael Dark, an attorney for California Advocates for Nursing Home Reform. “We still haven’t started comprehensive testing of every resident and staff member. And until we do, we’re not going to know the extent of the problem.”
Fixing the problem
While long-term care facilities tend to be densely populated by older people vulnerable to illness, that doesn’t mean they’re predestined to be hot beds of COVID-19 infection, according to Dark.
“At community acute-care hospitals, there are a lot of infected people but you don’t see the same rate of spread,” he said. “The problem in nursing homes is poor infection control and understaffing. You can have a nursing assistant see 10 or 15 residents an hour. It’s hard to take proper infection control measures at that pace.”
As for testing patients and staff at nursing homes, some counties have been more aggressive than Orange County.
By the end of April, Orange County had begun testing all residents at any nursing home that had two or more infections among residents. It offered voluntary testing to staff that wanted it.
But by the time Orange County began mandatory resident testing, Los Angeles County was already underway with a more stringent policy requiring testing of all residents and staff at any long-term care facility with a single infection.
While Dark wants to see mandatory testing of all residents and staff at all long-term care facilities — even where there are no known infections — he said at very least, a single positive test should trigger mandatory testing of all residents and staff at a facility.
“There’s no such thing as a single resident infection,” he said. “They either got it from another resident or from a staff member.”
He noted that visitors, including family members, have been largely banned from nursing homes since the start of the pandemic.
Libby Anderson of the Council on Aging, who serves as ombudsman to nursing home residents in Orange County, also is pushing for universal testing of everyone in the facilities.
“If you have one infected staff member who’s asymptomatic, they can infect one resident after another,” she said.
Help on the way
Statewide, the percentage of COVID-19 deaths in long-term care facilities is even greater than in Orange County, at nearly 50%. But Orange County’s rates are increasingly more rapidly than those statewide.
Helping in efforts to slow the spread of infections in nursing homes is a joint collaboration between UC Irvine and CalOptima, which provides health-care services for the indigent. The effort is being led by Susan Huang, medical director of the UCI Health Epidemiology and Infection Prevention program, and funded with $629,000 each from CalOptima and the county Health Care Agency.
The program is focusing on infection prevention training at 12 county nursing homes that have high numbers of CalOptima patients. It also will develop a training program for 55 other nursing homes. The year-long intensive training began on May 8 and is underway at three facilities so far, with three more about to begin.
“The actual viral outbreaks in nursing homes are being addressed by a (Health Care Agency) response team,” said Emily Fonda, CalOptima’s deputy chief medical officer. “The OC Nursing Home COVID Prevention Program is a separate effort directed at training staff to manage current outbreaks and the expected resurgence of the virus in the fall.”