By David Rosenfeld and Olga Grigoriyants | The Daily Breeze | April 22, 2020
New data released this week by the Los Angeles County Department of Public Health painted a troubling picture of coronavirus outbreaks at institutional settings and the potential for continued spreading there, particularly at long-term care facilities that house the elderly — among the most vulnerable to COVID-19.
That new data includes 270 of the 275 institutional settings — from nursing homes to state prisons — that have at least one case of COVID-19, the disease caused by the novel coronavirus. The county said it was investigating 3,115 cases — 1,826 among residents and 1,289 among staff — at those facilities, including 47 additional settings since Friday, April 17.
The new data came as health experts grapple with evolving evidence about COVID-19, with the county’s health director saying on Wednesday, April 22, that officials need new strategies now that they know asymptomatic people can spread the virus to others. That, officials have said, could have led to larger outbreaks at nursing homes, with staff passing the virus onto their patients.
The biggest outbreak, the data shows, has occurred at Brier Oak on Sunset, in Los Angeles, which had 68 staff members and 76 residents who have tested positive as of Wednesday. But underscoring how the virus can spread in enclosed facilities, the county also listed Brier as having another 42 probable cases. The Health Department defines a probable case as a person associated with an outbreak with clinical symptoms and has not been tested.
Countywide, close to 40% or 292 people who died after testing positive for COVID-19 came resided at an institutional setting, the vast majority of them at skilled nursing facilities. That’s far above the state average of about 20% of deaths from COVID-19 among nursing home residents.
A representative for Brier Oak said the facility was adapting to a rapidly evolving situation and doing everything it could to contain the outbreak, including restricting visitors and screening residents and staff members.
“I can assure you that we are working around the clock,” said Budgie Amparo, chief clinical officer at Brier Oak on Sunset, “doing everything in our power — and everything medical experts know as of at this time — to protect and keep our patients, residents and employees as healthy and as safe as possible.”
The next largest outbreak in the county, including both confirmed and probable cases, has occurred at the California State Prison in Lancaster, where 54 inmates and 15 staff members tested positive and another 42 inmates were presumed positive, according to the data.
A representative for the state prison could not be reached for comment.
But while correctional facilities, treatment centers, shelters and group homes also constitute the institutional settings, reported cases have predominantly consisted of skilled nursing and assisted living facilities.
The batch of data released from the county — which did not include deaths — also differs somewhat from a list of skilled nursing facilities put out by the state on Saturday, which showed 148 nursing homes had coronavirus outbreaks in L.A. County. The state’s list only includes the number of individuals at each site who tested positive and does not include probable cases for those who were showing symptoms but have not yet been tested.
Public Health Director Barbara Ferrer said Monday that the county has sought help from the U.S. Centers for Disease Control and Prevention to help contain certain outbreaks; officials have also worked with state health teams to supplement staffing at the worst-hit nursing homes.
“One of the biggest issues we’re having at the nursing homes is they have a lot of staff who are out because they are infected and they are sick,” Ferrer said. “So that creates an even worse situation at any one of these nursing facilitates with an outbreak because they have less staff.
“We’ve asked for help making sure that all of our nursing homes have enough staff,” she added. “We’ve arranged for relief staff so they can stay open and continue to care of their patients.”
Officials with The Kensington Redondo Beach, for example, said the facility — with 19 staff members and 23 residents testing positive, and another two staff members and a resident listed as probable — was working closely with county health officials. Four residents at the facility have died after testing positive for COVID-19, management confirmed previously.
“We have treated anyone that has any symptom, a runny nose or a sore throat, for example, in a very cautious way, asking them to self-isolate for 72 hours,” said Managing Partner David Faeder.
At the facility, 30 residents and 29 staff members tested negative who were initially listed as probable cases on the county’s list.
“We continue to have an outstanding and cooperative relationship with the L.A. Department of (Public) Health and appreciate all they have done with us,” said Kensington spokeswoman Andrea Obston. “We continue to perform all of the procedures and protocols we have previously instituted and will be practicing those for the foreseeable future.”
Nursing homes have been put in extremely difficult positions lately as they balance the needs to protect their residents and the right to privacy, according to Jason Belden, director of emergency preparedness with the California Association of Health Facilities, which represents 900 skilled nursing facilities and 450 intermediate care centers.
Skilled nursing facilities, in particular, had trouble securing enough personal protective equipment early on, Belden said. Up until about a week ago, guidance from the CDC stated that only those exhibiting symptoms of COVID-19 should wear a mask. That guidance could have exposed many residents for more than a month to staff members who were carrying the virus and didn’t know it because they showed no symptoms, Belden said.
“I’ve talked to enough of them to know they are personally devastated,” Belden said of facility administrators across the state. “They care deeply about the people in their buildings. There’s a general frustration. I don’t know that there is any blame for that. We were operating under the conditions they thought were most appropriate and balancing that with our ability to have PPE.”
Ferrer acknowledged this week that what public health officials now know about the virus has changed.
“It turns out, we were wrong,” Ferrer said Wednesday. “With new information, it has become clear that asymptomatic people are capable of spreading the virus.
“We have to change our strategies,” she added.
But the damage, in some cases, may have already been done — especially in long-term car facilities.
“We set up a system where workers can’t come in who are symptomatic,” Ferrer said on Tuesday. “That made it easier than anyone thought for employees to unknowingly and unwittingly spread the virus to those they were taking loving care of.”
Nursing home representatives and family members of some nursing home residents this week called for mandatory testing so that long-term care facilities know whether any of its staff or the people they tend to have COVID-19.
“It’s essential that testing becomes mandatory,” said Michael Dark, staff attorney for California Advocates for Nursing Home Reform. “If you’re a health care worker who is infected and you’re feeding by hand a resident who is 80 years-old with an underlying health condition, you just got that person sick.”
Laurie Spivak, whose 86-year-old father lives at Chatsworth Park Health Care Center, agreed.
“If testing is available,” she said, “why in the world they are not mandating testing in such dangerous places for elders?”
Spivak’s father recently had a stroke, making him even more vulnerable to severe COVID-19 symptoms. Earlier this month, she received a call from Chatsworth Park about a confirmed case there — and it left her wondering whether to pull her father out of the facility.
“I don’t understand why the testing of the staff once there’s a confirmed case it’s not a routine,” she said. “It seems like it would be the best way to protect staff from bringing it home as well as protecting people who are in these facilities.
But mandatory testing, based on statements from officials, seems unlikely — at least anytime soon.
Ferrer said as much during her Tuesday briefing, though she did acknowledge the need for increased testing at facilities with outbreaks.
“We agree that there should be widespread testing at every nursing home where there’re outbreaks,” Ferrer said. “We have been working with the state on helping us enhance our capacity to more easily be able to do that testing.”
But then there’s the response to containing an outbreak.
Across the state, for example, four facilities have required intervention from a state health team to assist with staffing. The teams represent a way to prevent a situation like what happened at the Magnolia Rehabilitation and Nursing Center in Riverside, where residents were evacuated after staff members refused to show up for work.
For Erica Montes, whose 81-year-old father resides at a nursing home now with two confirmed cases, the past month has been filled with anxiety. She has only been able to visit her father through a glass door as the entire facility, like many others, prohibits visitors.
“With no visitors, this still got around,” Montes said with surprise. “They don’t have enough PPEs there for the staff and I feel for them.”
For the full list of outbreaks visit Publichealth.LACounty.gov.