Jason Fagone and Cynthia Dizikes San Francisco Chronicle March 21, 2020
Employees at Laguna Honda Hospital say they worry the hospital could be quickly overwhelmed by a surge of cases if and when COVID-19 strikes the facility.Photo: Santiago Mejia / The Chronicle
Laguna Honda Hospital on Friday, March 20, 2020, in San Francisco, Calif.Photo: Santiago Mejia / The Chronicle
If the new coronavirus takes hold inside San Francisco’s largest nursing home, what’s the plan to save patients’ lives and protect doctors and nurses from exposure?
No one seems to know, but staff at the city-run Laguna Honda Hospital and Rehabilitation Center say they haven’t been given enough tools to stop the spread of infection — and they worry that the sprawling facility that cares for 750 seniors and other especially vulnerable people could quickly be overwhelmed by a surge of COVID-19 cases, if and when residents of Laguna Honda start to test positive.
So far, no instances of the dangerous respiratory virus have been reported at Laguna Honda. But medical professionals who work there said they are afraid they will get their first positive test result any day now.
According to two doctors and a nurse, the situation is precarious. Nurses can’t find masks or other protective equipment. Doctors are treating patients suspected of COVID-19 without recommended “face shields.” There are only five or so isolation rooms out of 780 total beds. Although some patients have already exhibited symptoms of possible coronavirus infection, and doctors started asking for tests weeks ago, the facility only began ordering tests on Monday, according to one doctor who spoke on condition of anonymity because he was not authorized to speak publicly.
The San Francisco Department of Public Health owns and operates Laguna Honda. In a statement, department spokesman Brent Andrew said, “Laguna Honda leadership has worked actively and diligently to train staff on COVID-19 procedures, including the use of personal protective equipment (PPE), thorough cleaning of common spaces and resident rooms, and other prevention techniques.”
Other hospitals in the region and the country face similar obstacles, struggling to find enough tests and scrounging for masks. Laguna Honda may be especially vulnerable to the pandemic because it serves some of the most disenfranchised people in the city, providing long-term care to the poor, the sick and the elderly.
According to the Centers for Disease Control, older people who contract the virus are more likely to die of it. The most recent annual report for Laguna Honda shows that 61% of its residents are 65 or older, and 20% are 85 or older. Dementia, Alzheimer’s disease and HIV are among their most common diagnoses.
“It’s a powder keg,” said Tim Jenkins, senior representative for the Union of American Physicians and Dentists, which represents doctors at the hospital. “It’s a giant nursing home, and we’ve seen what’s happened in these other nursing homes.”
This week, a long-term care facility in Burlingame reported that three residents tested positive, and last month the virus raced through a nursing home in the Seattle area, infecting 129 people and killing 23.
A report the CDC released Wednesday warned that nursing homes could become coronavirus hot zones if more aggressive measures aren’t taken.
“Once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members, and visitors,” the report’s authors wrote.
Staff members at Laguna Honda said that their facility, one of the largest of its kind in the United States, with a 62-acre campus, doesn’t seem prepared for what might be coming.
“Just like all others, am concerned about our preparedness personally and as a group to face what is ahead,” one doctor wrote to a colleague on Sunday in an email obtained by The Chronicle. If the virus gets loose inside, Laguna Honda “is going to become a sick town with 780 pts [patients] plus staff,” the doctor wrote.
The Laguna Honda doctor who spoke to The Chronicle anonymously said, “I’m not confident that there are good plans for if things get worse rapidly, which they could so easily do.”
The doctor added that Laguna Honda only has five isolation rooms where patients with COVID-19 symptoms can be kept apart from the rest of the population and treated safely. “If we start to have more [COVID-19] cases than there are isolation rooms, I have no idea what we’re going to do,” the physician said.
“This would definitely be a wildfire,” said Theresa Rutherford, a Laguna Honda nurse assistant and the regional vice president for SEIU Local 1021, which represents nurses at the facility as well as food-service employees and workers tasked with disinfection. “We need more personal protective equipment. We need more training. And we need to ensure that frontline workers are protected.”
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At a press conference Thursday, San Francisco’s public health director, Dr. Grant Colfax, said the city was taking aggressive steps to prepare “for a potential surge in coronavirus patients.” Colfax said the city’s medical facilities have enough protective equipment “for now” and claimed that “health care workers who need the protection are getting the protection they need as of this time.”
According to the Laguna Honda employees, this isn’t true. Right now, they said, their facility doesn’t have enough N95 masks, worn over the nose and mouth to stop airborne transmission, and many nurses haven’t been “fit-tested” for the dwindling supply of masks that do exist, meaning the masks may fail. Nurses are told they can find N95 masks at the nursing station, and when they go to the station, it’s empty.
Even basic protective items are hard to come by, like cleaning supplies and disposable shoe covers, Laguna Honda staff said.
The doctor who spoke to The Chronicle was recently preparing to treat a patient suspected of having COVID-19. When the doctor looked for a plastic face shield, a key piece of protective equipment, none were available in the hospital. So the doctor treated the patient without the face shield.
The doctor also said that Laguna Honda only started testing patients for COVID-19 on Monday. Some patients had dry coughs and shortness of breath, and doctors wanted to order coronavirus tests. But the city said no, according to the doctor: “The reason we were given was that DPH [department of health] just didn’t have enough tests.”
At that point, the doctors asked if they could send samples to Quest Diagnostics or LabCorp, private companies that were offering coronavirus tests. The answer was no: Testing had to be done by the health department.
It is unclear how many Laguna Honda patients have been tested to date. As of Thursday night, the doctor said, all completed tests had come back negative; some are still pending.
The doctor also expressed concern for the health of colleagues who might be exposed. Some doctors and nurses struggle with their own health issues, and there’s no clear plan for what they should do if they get exposed to coronavirus and develop symptoms. All they’ve been told is that if they feel sick, they should stay home from work.
“I have been rather sick a lot this flu season already so cannot imagine what else I can endure,” wrote the other Laguna Honda physician in the Sunday email.
On March 6, the health department put a halt to visits from family members and others at Laguna Honda, citing concerns about viral transmission. Department spokesman Andrew said the decision “was purposefully and carefully designed to protect the institution, its residents and staff.”
Andy Chan, whose 80-year-old mother Teresa has lived at Laguna Honda for three years, said it has been frustrating not to see her, but “it’s better safe than sorry.” Teresa suffers from dementia and uses a wheelchair. Chan said that while the facility has done a good job caring for her, he doesn’t have a sense of how Laguna Honda is preparing for COVID-19. He said he hasn’t received any emails or letters about coronavirus from the hospital, and he worries about widely reported shortages of supplies.
“That lack of everything, whether it’s the respirator, sanitizer, gloves, anything that facilities need — it’s actually quite surprising,” Chan said. “This is the greatest country in the world, and we can’t address this.” He said the president and the federal government need to use their power to provide supplies quickly.
According to Rutherford, the nurse and union representative, the SEIU asked the city earlier this month to hire more nurses and build physical barriers to stop airborne virus droplets from spreading. This week at Laguna Honda and Zuckerberg San Francisco General Hospital, she said, the city installed glass screens at the entrances, where hospital vendors and members of the public go in and out, and the city agreed to hire 170 additional nurses across all its facilities.
Colfax, the city health director, said on Thursday that the department recently hired 70 nurses and hoped to hire 50 more at a recruiting fair this weekend: “We are making offers on the spot.”
Chronicle staff writer Dominic Fracassa contributed to this story.Jason Fagone and Cynthia Dizikes are San Francisco Chronicle staff writers. Email: jason.fagone@sfchronicle.com, cdizikes@sfchronicle.com Twitter: @jfagone, @cdizikes
