Jason Fagone and Trisha Thadani San Francisco Chronicle, April 6, 2020
Miles LeBoeuf, a supply clerk at Laguna Honda, San Francisco’s biggest nursing home, wasn’t concerned about the new coronavirus when he first read about it in January. There were only a few cases in the country at the time, he’s a healthy 43-year-old, and everything at the nursing home seemed normal.
But as the weeks went on, and he delivered nursing supplies throughout the sprawling facility, he started to notice strange and troubling things, he said. His job gave him a unique vantage point on Laguna Honda, and it seemed to him that the facility was dangerously unprepared for what might be coming. And this was even before staffers and residents started testing positive for the virus, sparking a desperate scramble by the city to contain the spread of infection at one of the most vulnerable spots in the Bay Area.
Since the start of the pandemic, the prospect of an outbreak at Laguna Honda has been a worst-case scenario for San Francisco’s Department of Public Health, which owns and operates the nursing home. Most of the home’s 750 residents are frail and elderly, and the virus has taken a particularly heavy toll on people who are older and have compromised immune systems.
Over the last two weeks, The Chronicle interviewed a dozen people with connections to the home, including medical professionals who work there, other employees, residents and their loved ones. We agreed not to name several sources who told us they were not authorized by their employer to speak or feared retaliation, in accordance with The Chronicle’s anonymous source policy.
They said the city’s response to the crisis has been spotty, fuzzy, secretive and slow, leaving the facility porous to the outside world for weeks and dangerously unprepared for disaster. While the city has significantly ramped up its response in the past week, many worry that early missteps and delays may have caused irreversible damage.
Nursing homes and long-term care facilities nationwide have become hot spots for the virus. In February, 35 people died at a Kirkland, Wash., nursing home; Laguna Honda has six times as many residents as that facility. On Friday, a 47-bed nursing home in Orinda reported that 27 residents and staffers have tested positive.
On March 5, a porter working at Laguna Honda decided to quarantine himself on suspicion he was infected, and he tested positive. Eighteen days later, on March 23, the city publicly confirmed that the first health care staffer had tested positive there. That day, Dr. Grant Colfax, the city’s health director, indicated to Supervisor Aaron Peskin that he was horrified at the possibility of a wider outbreak at Laguna Honda, recalls Peskin, who discussed the danger with him at the city’s Emergency Operations Center.
A few days later, the health department announced a flurry of steps to halt the contagion. Two residential units in Laguna Honda’s South tower, housing 60 people each, were placed under quarantine. All residents were prevented from leaving the facility. The department tested more staff members and residents. A handful of experts from the CDC and state health department parachuted in to give advice, and Mayor London Breed and Sen. Dianne Feinstein wrote separate letters to federal agencies, pleading for 100 additional support personnel.
From the outside, it seemed like the city was taking control of the situation. But people inside Laguna Honda said they have experienced a different and more upsetting reality.
The sources said there has not been enough protective equipment for doctors and nurses, potentially exposing front-line workers to the virus. Some employees have been entering the building without being given masks and without being screened for symptoms of COVID-19, the respiratory disease caused by the virus. Residents supposed to be on quarantine had been mingling with non-quarantined people in a communal smoking area, one resident said Tuesday, and social distancing wasn’t being strictly enforced.
In response, the department maintained that there is enough protective equipment. A spokeswoman for the Department of Emergency Management said that all staff members are screened at the beginning of their shifts, and residents in the quarantined units are “restricted to their neighborhoods and have been provided a __cpLocation to smoke and access to fresh air.”
As of Sunday, 11 Laguna Honda staff and three residents tested positive for the new coronavirus, according to the Department of Emergency Management. But because of delays caused by a national shortage of tests, most residents and employees still haven’t been tested.
The department responded that it is “identifying and testing those staff and residents they are most concerned about for COVID-19 exposure throughout the hospital.”
“I pray I’m not an asymptomatic carrier spreading the virus throughout the hospital,” LeBoeuf told The Chronicle in one of several emails over the past two weeks. “Without testing, there is no way to know.” He stressed that he was speaking only for himself, not for the city or the nursing home.
In the communal parlance of Laguna Honda, LeBoeuf is a storekeeper.
The most important part of his job is making daily deliveries of nursing supplies across the facility, including protective equipment, peroxide wipes, hand sanitizer, gauzes and tapes, needles and catheters. He stocks the two residential towers, North and South, and brings parcels to a third, older building used for administration.
He likes his job — people on his team, materials management, tend to stay until retirement — and believes in the facility’s mission. Part nursing home, part hospital and part old-fashioned almshouse, Laguna Honda serves those with nowhere else to turn. The setting is peaceful, a lush wooded campus near Forest Hill. On his breaks, LeBoeuf would go for hikes, spotting coyotes, hawks and deer.
In late February, he started to worry when he noticed that personal protective equipment, or PPE, was going missing from supply cabinets. These are the masks and gowns and other gear that doctors and nurses need to protect them from airborne virus particles. LeBoeuf realized that the stockpiles were being depleted faster than he could refill them. He couldn’t tell whether the gear was being used for medical purposes or if it were being stolen or hoarded. In either case, it was a problem.
“My direct manager is now working seven days a week,” LeBoeuf emailed, “heroically and desperately trying to keep ahead of demand for supplies, using every purchasing trick she can think of to get PPE from any and every source possible. It’s too much.”
Deirdre Hussey, an acting spokeswoman for the hospital, said late last month that there was enough PPE for the frontline workers. She said the equipment had been moved from its regular supply cabinet to a “centralized” __cpLocation and staff members had to request it through a manager.
But two unions representing doctors, nurses and other workers at Laguna Honda have said that PPE supplies are inadequate. The week of March 23, the unions demanded that the city provide a detailed inventory of masks and other gear, but no inventory has been released.
“By no means do we have plenty of PPE,” said a Laguna Honda medical professional. “Right now there’s still not enough, and it just makes me so angry to hear people say, ‘Oh, there’s plenty of PPE supplies.’ How could they say that when they’re not working on the ground at Laguna Honda?”
LeBoeuf was also alarmed by another problem that seemed to fester throughout March: The facility didn’t seem to be taking basic precautions to contain the virus.
On March 6, one day after the porter quarantined himself, the health department suspended visitors from entering Laguna Honda. But the facility remained porous, LeBoeuf said, with hundreds of employees coming and going every day through multiple entrances. No one was consistently checking the staff for fevers or asking about their health, he said.
Meanwhile, more employees tested positive. On March 25, the city disclosed that five staff members had contracted the new coronavirus, and two units where those employees worked, South 5 and South 4, were placed under quarantine. More front-line workers started staying home, fearing they could either contract or spread the virus at work, said Brandon Dawkins, an activities therapist at the facility and the San Francisco County representative for the labor union SEIU 1021.
According to a Laguna Honda resident who said he lives in South 4, understaffing has meant that vulnerable residents can come into close contact with others.
“You have older patients wandering around the unit, and going through drawers, going through places where they shouldn’t be,” the resident said. “They’re allowed to mingle without wearing masks.”
The resident said that in the shared dayroom in his unit, residents are allowed to watch TV and eat in close contact without wearing masks, and until about a week ago, maskless residents in South 5 — the first unit to be quarantined — were taking breaks in a communal smoking area frequented by residents from other parts of the hospital.
“A lot of patients could have the virus,” the resident said. “I told staff, I said, ‘Wouldn’t it be better if we just test everybody?’ And they said they’ll just wait for symptoms.”
Contacted via text message on Saturday afternoon, he said he still hasn’t been tested. He and his fellow residents haven’t been given masks, either, he said.
According to the Laguna Honda medical professional who spoke to The Chronicle, employees have been pushing administrators to test all residents in South 4 immediately, but testing has lagged. As of Saturday, 278 out of some 1,600 Laguna Honda staffers have been tested, and 94 residents of a total 750.
In an ideal world, officials have said, everyone inside the facility would be tested immediately. But due to pervasive failures by federal, state and local governments to build testing and lab capacity, there aren’t enough test kits to go around. Using its public health laboratory, the city health department can perform only 150 tests per day. So the department has rationed the tests, reserving them for people who show symptoms of COVID-19 or who came into contact with a known infected person.
Dr. George Rutherford, a UCSF infectious disease specialist, said the department’s hands are tied when it comes to the amount of available tests, and officials are doing the right thing by testing only people who display symptoms.
“This is the most efficient way to do it,” he said in an interview Thursday. “Unless you’re going to go through and commandeer all of the city’s testing capacity, this is the way that makes the most sense.”
But will that work? If the experience of the Kirkland nursing home is any guide, the answer may be no.
Officials in Kirkland tried to stop the outbreak by checking the symptoms of staff and residents. That strategy failed because the outbreak was at least partly driven by residents who were infected but lacked symptoms, according to a Centers for Disease Control and Prevention paper released last week.
“If we’re going to wait for someone who is outwardly showing symptoms, then we are really behind the curve,” said San Francisco Board of Supervisors President Norman Yee, whose district includes Laguna Honda.
Dawkins, the activities therapist at the facility, said he was finally able to get tested Thursday after several days of waiting. He said the hospital asked him to get tested because he “may” have come in contact with someone who was infected. His test came back negative.
While Dawkins said it was a tremendous relief to know that he was not spreading the virus to others, he wishes other colleagues could get tested, too, because they are “terrified” of coming to work without knowing their status.
“Folks want to know where they stand,” he said. “They want to know what they are carrying.”
LeBoeuf, the storekeeper, says he would get tested immediately if he could.
Meanwhile, he has continued to work, not knowing whether he is a carrier.
On March 24, the day after the first worker tested positive, LeBoeuf’s manager began taking the temperatures of people on his team once per shift, but only “after we’ve already entered the facility, made our coffee runs to the cafeteria (where residents are also grabbing drinks and snacks), and begun work,” he emailed.
Last Saturday morning, March 28, LeBoeuf arrived at work and saw a new sign at the door. It said not to enter without a mask, and if you don’t have a mask, to get one at the administration entrance. He went to the entrance but there was no one posted in the lobby, there were no masks and there was no one taking people’s temperatures, he said.
“So I walked through to my department and am about to begin work,” LeBoeuf emailed. “I have an ear-loop mask on to protect others from myself, and am washing my hands between floors.” He spent the rest of his shift delivering supplies, traveling via elevator, and needing to touch numerous buttons, door handles and cabinets along the way.
Then, on Saturday morning, April 4, he arrived at work, and for the first time, he says, he was stopped and asked whether he had any COVID-19 symptoms. An employee also took his temperature.
“My temperature read low because I’d walked downhill in the cold morning air,” he emailed. “I was not allowed into the building until my temperature was back within a normal range.”
LeBoeuf felt relieved. Nearly two weeks after the first staffer at the nursing home tested positive — and almost a month after the porter quarantined himself — the storekeeper was finally screened at the start of his shift.
“This is a great change,” he said.
Jason Fagone and Trisha Thadani are San Francisco Chronicle staff writers. Email: email@example.com, firstname.lastname@example.org Twitter: @jfagone, @TrishaThadani