SF officials are bracing for worst-case coronavirus scenario at Laguna Honda nursing home

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By Cynthia Dizikes Jason Fagone and Trisha Thadani San Francisco Chronicle, March 30, 2020

Laguna Honda Hospital on Friday, March 20, 2020, in San Francisco, Calif.
Laguna Honda Hospital on Friday, March 20, 2020, in San Francisco, Calif. Photo: Santiago Mejia, The Chronicle

San Francisco officials are begging state and federal officials for more help in averting a looming disaster at the city’s 780-bed nursing home, where a coronavirus outbreak is growing.

On Monday, city officials admitted San Francisco is not equipped to handle a surge of cases at Laguna Honda hospital on its own. The city has requested over 100 additional staff and more equipment from the state and federal governments. Officials are still waiting for some replies.

“Please respond,” Supervisor Norman Yee implored state and federal officials, as he looked squarely into the camera during a Monday morning press conference. “We need your help.”

At least two patients and nine staff members at the facility — where the majority of the residents are elderly with underlying health issues — have tested positive for COVID-19, with more tests still pending. Since March 26, 158 staff members and 54 residents have been tested for the virus. Dozens of tests are still pending, and some frontline staff members complain they cannot access a test unless they show symptoms.

As the cases continue to climb, experts worry Laguna Honda could mirror the rampant outbreak at a nursing home in Kirkland, Washington, where the coronavirus raced through the facility in a matter of weeks, ultimately killing more than 30 people.

Other nursing homes in California and across the country have also struggled to combat the virus. The Centers for Medicare and Medicaid Services reported last week that 147 nursing homes across 27 states have at least one resident with COVID-19.

But few are as large as Laguna Honda.

In the last week, San Francisco has placed two units with several confirmed cases on quarantine, prevented residents from leaving the facility and ramped up testing of staff and residents. Six infection control nurses from the California Department of Public Health and infectious disease physicians and epidemiologists from the Centers for Disease Control and Prevention also began working at Laguna Honda’s campus as of Monday. It is unclear how long they will be stationed at the hospital.

Still, residents, frontline health care workers and experts say the city’s response may have been too little, too late.

Going forward, even if the city throws all of its resources at the facility, hundreds of people could be infected and hospitalized and dozens could die if the crisis unfolds as it did in Kirkland, said Dr. Terry Hill, medical director of Laguna Honda from 1999 to 2004. That’s largely because those who live in nursing homes are particularly vulnerable to the virus and also require close and constant attention and contact with medical personnel for everyday needs — like walking, eating and bathing.

“It could be staggering,” said Hill, who is currently the COVID-19 medical director for the Alameda-Contra Costa Medical Association and helping manage the East Bay’s response to the pandemic. “We could be faced with weeks of one death after another, which is extraordinarily hard on families and staff.”

“This is a wake-up call for the Bay Area,” he said.

In a letter Friday to the U.S. Department of Health and Human Services, Mayor London Breed made several requests, including four infection control nurses, 25 testing staff, 40,000 swabs for testing, five doctors and 30 nurses.

“What we have seen from outbreaks in similar facilities, such as in Washington State, will only be magnified at Laguna Honda Hospital,” Breed wrote.

San Francisco and its public health department have received widespread praise from health experts for being among the first in the country to shut down businesses and tell people to stay home. Some have said that the city’s early shelter in place order, which went into effect March 16, may be starting to “flatten the curve” of new coronavirus cases, as intended.

Still, the amount of confirmed cases in the city more than doubled within a week, to 378 cases as of Monday. The city also does not have a full picture of the virus’ spread due to lags in testing across the state.

Peter Chin-Hong, professor of medicine and an infectious diseases specialist at UCSF, said the city acted responsibly, and he is “cautiously hopeful” about San Francisco’s relatively low case counts compared to other parts of the country. But he is still worried about the situation at Laguna Honda.

An outbreak there, he said, could cause a “mini-surge” of sick patients who are at high risk of dying and need treatment at local hospitals, which is what happened during the Kirkland nursing home crisis.

“We are just basically worried about a Kirkland part two,” said Chin-Hong.

Breed and Department of Public Health Director Dr. Grant Colfax repeatedly said Monday that they expect the number of cases to increase in the coming days and they are preparing for a worst-case scenario. It marks a dramatic change in tone from just a week ago, when officials did not mention at a press briefing that staff members at the nursing home were infected until prompted by reporters.

Over the last two weeks, several employees at Laguna Honda have sounded the alarm to The Chronicle, saying the nursing home was unprepared to face the threat of the virus. The workers said they had trouble finding N-95 masks, face shields and basic cleaning supplies.

City officials maintain there is enough equipment, but it had been moved to a new “centralized” location and had to be requested via managers.

Meanwhile, even after the first staff members tested positive for the virus the hospital said last week that it was only testing people with symptoms — despite the fact that some people with the virus are asymptomatic. Then, the department abruptly changed course late last week, saying it planned to test about 150 staff members who may have been infected.

But those tests have been slow in coming, and one health care worker told The Chronicle on Monday that the city still isn’t allowing them to get tested unless they show symptoms. The department is facing the same problem that hospitals and doctors are facing: a severe shortage of tests.

“I know of staff and residents who want to be tested, but that would not occur unless you ‘have symptoms,’” said a resident, who feared retaliation and whom The Chronicle agreed not to name in accordance with its anonymous sources policy.

Comprehensive testing, as well as tracking known contacts of infected people, are critical to stopping the spread of the coronavirus within medical facilities like Laguna Honda, said Dr. Lee Riley, chair of the Division of Infectious Diseases and Vaccinology at UC Berkeley’s school of public health.

“Depending on how quickly they are able to do this, they may be able to curtail the bad outcomes,” said Riley, noting that delays in getting diagnoses just gives the virus more time to spread.

“The incubation period could be up to two weeks,” Riley said. “So the next two weeks are going to be critical for Laguna Honda and San Francisco.”Trisha Thadani, Cynthia Dizikes and Jason Fagone are San Francisco Chronicle staff writers. Email: tthadani@sfchronicle.comcdizikes@sfchronicle.comjfagone@sfchronicle.com