By Sarah Ravani, San Francisco Chronicle, Updated April 30, 2020
As coronavirus infections increase in nursing homes throughout the state, Santa Clara County made the chilling discovery this month that dozens of staff members with no symptoms of the coronavirus had unknowingly infected the very people they cared for at three facilities experiencing big outbreaks.
The revelation raises questions about what Bay Area county public health departments — which oversee testing at nursing homes — are doing to prevent outbreaks. Many do not require workers to be tested before they interact with patients.
“We’ve been arguing for a long time now that the state needs to make nursing homes the No. 1 priority for testing because they are the most vulnerable group, but it still hasn’t happened,” said Dr. Charlene Harrington, a professor in the UCSF School of Nursing. “We can’t protect people otherwise. There are just way too many asymptomatic people.”
Unless workers are screened for the coronavirus before entering a nursing home, Harrington and other medical experts warn, the virus will continue to spread through those facilities at alarming rates — which is what happened in Santa Clara County.
During the first week of April, reports of positive cases emerged from three facilities there: Canyon Springs Post-Acute Care Skilled Nursing and Ridge Post-Acute Care Skilled Nursing Facility, both in San Jose, and Valley House Rehabilitation Center in Santa Clara.
This prompted county officials to test workers there as well. The results showed that one-third of all COVID-19 cases at the three facilities were from staff members, said Dr. Jennifer Tong, who works with the county’s public health department. And most had no symptoms.
They “were contributing to the spread of infection within the facilities without realizing that they themselves were of risk to the vulnerable residents there,” Tong said at last week’s county Board of Supervisors meeting.
But the nursing home operators shouldn’t have been surprised.
“The experts in long-term-care medicine and geriatrics have been warning government officials about this for a couple months now,” said Dr. Michael Wasserman, president of the California Association of Long Term Care Medicine.
Nearly 33% of coronavirus deaths in California occur in nursing homes — residents and staff members, according to state figures, which are probably an undercount because the state relies on data from facilities, which often lag in reporting.
At the end of April, coronavirus infections among nursing home residents across California stand at nearly 4,000. In Santa Clara County alone, nearly 18% of 2,134 confirmed coronavirus cases are in nursing homes. And almost 35% of the county’s 107 coronavirus deaths have occurred in nursing homes.
Workers are also sick. State data show that 2,594 nursing home workers have been infected with the coronavirus.
Although there are no data to prove it, it is unlikely that most of those workers were tested for the coronavirus before going to work. Most Bay Area facilities say they take staff members’ temperature before they enter the premises.
But medical experts say temperature checks aren’t good enough in determining someone’s coronavirus status, since so many are asymptomatic. Scientists believe that 20% to 50% of people with the coronavirus never show symptoms.
This month, scientists said asymptomatic transmission of the virus is driving the pandemic.
Without proper intervention, that silent threat is especially dangerous at “chronically understaffed” nursing homes, said Teresa Palmer, a retired San Francisco geriatrician.
“Nursing homes are like cruise ships. They are just totally sitting ducks,” she said. “The progress from being sick to death can be very rapid in nursing home patients. You want early warning on someone who is delicate so they can be very closely monitored, and you’re not going to get that if you’re not testing asymptomatic staff to get a lead on where a hot spot in a nursing home might be.”
In response to revelations that asymptomatic workers were transmitting the virus in the three facilities, county and state workers, residents and staff at all three of the Santa Clara County facilities in question are now tested on an ongoing basis, said Tong of the county public health department.
But county officials say that even after the discovery about asymptomatic staff, widespread testing at nursing homes isn’t an option. They often blame a shortage of testing swabs and chemical reagents needed to process the tests.
“The major limiting factor is the availability of reagent for the testing and swabs,” said Jeffrey Smith, the Santa Clara County executive. “So we’ve, until now, had to focus on sick people entering the system, but we are considering swabbing everyone.”
The outbreaks at the three facilities have been significant.
At Canyon Springs Post-Acute Care Skilled Nursing, a spokesman said that 99 people have tested positive for the coronavirus, and five patients have died. Ridge Post-Acute Care Skilled Nursing Facility has reported 40 infected residents and 14 infected staff. And Valley House Rehabilitation Center has 38 residents and “fewer than 11” staff testing positive. (For privacy, the state won’t specify any number below 11.)
On April 17, the Service Employees International Union, which represents county health care workers, filed a complaint with Cal/OSHA alleging that county health care workers represented by the union had direct contact with infected patients without proper masks or isolation practices at Canyon Springs and Ridge Post-Acute.
Addressing the virus in nursing facilities has been an “enormous challenge,” Smith said. The county created a strike team to monitor the long-term-care facilities in the county, he said. So far, 21 skilled nursing homes have reported at least one coronavirus-positive patient, according to the county’s figures.
So far, only one county in the state has called for testing of all residents and staff at nursing homes even if no symptoms are present: Los Angeles. On April 22, Barbara Ferrer, the county’s public health director, said that nursing homes are advised to test everyone.
Experts throughout the state say they hope Santa Clara County will implement more testing at nursing homes.
“Santa Clara County is trying to make some good decisions right now,” said Wasserman, of the California Association of Long Term Care Medicine. “It behooves us to focus a significant amount of our efforts on nursing homes, assisted living and group homes, and that means readily available testing.”