SF to mandate universal coronavirus testing at nursing homes

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By Dominic Fracassa and Sarah Ravani, San Francisco Chronicle, May 1 2020

A bird is seen flying above Laguna Honda Hospital in San Francisco, Calif. on Tuesday March 31, 2020.Photo: Nick Otto / Special to The Chronicle

San Francisco health officials are preparing to issue a new health order next week that will mandate regular, universal coronavirus testing for residents and staff in the city’s 21 skilled nursing facilities.

The order, which will be handed down next week, requires both public and private nursing homes to test their residents and staff. It marks the newest milestone toward the city’s goal of eventually providing universal testing for the novel coronavirus while mitigating outbreaks among at-risk populations.

Patients at skilled nursing facilities, which are regulated by the state health department, are among the most in danger of serious illness and death, given that most are older, living in close quarters with one another and have underlying health conditions. Many also require close, intensive attention from medical staff who enter and leave the facilities, creating a porous environment and raising the risk of transmission.

Visitors have been prohibited at Bay Area nursing homes since early March.

The testing mandate follows an ongoing expansion of San Francisco’s testing capacity and a shoring up of the supply chain that brings in critical equipment to conduct testing, like swabs. There are about 2,500 residents in San Francisco nursing homes, according to the city’s health department, and 2,500 to 4,500 staffers.

Universal testing for both patients and staff at nursing homes represents a “background surveillance system to catch and treat people, and prevent a chain of transmission from going through the facility,” said San Francisco Public Health Director Dr. Grant Colfax.

Testing alone will not prevent outbreaks, but “this will likely help us greatly improve our management of outbreaks across these very vulnerable systems,” he said. “When you look at the mortality rate at nursing homes, we have to do this now.”

Across the Bay Area, nursing homes have been ravaged by COVID-19. Santa Clara County has been the locus of one of the largest nursing home outbreaks in the region. Recently, an investigation by county officials prompted by a rash of positive cases at three nursing homes in San Jose and Santa Clara found that a third of infections had been spread by staffers — most of whom were asymptomatic.

At the end of April, there were nearly 4,000 confirmed COVID-19 cases at California nursing homes. State data show that 2,697 nursing home workers have also been infected. Nearly 35% of deaths in Santa Clara County — 41 in total to date — have occurred in such facilities.

If the additional testing for nursing home employees yields more infections, it could create potential staffing issues for operations at the facilities.

Most Bay Area counties don’t have testing mandates at nursing homes. In Alameda and Contra Costa counties, testing for COVID-19 isn’t required unless an outbreak is suspected.

Michael Dark, a staff attorney for the California Advocates for Nursing Home Reform, said that counties throughout the state have waited so long to institute testing in these facilities that the priority is no longer to stop the virus.

Still, testing is “crucial” at nursing homes, he said.

“The virus is likely already spread widely through San Francisco facilities,” Dark said. “So we are not testing anymore to stop the virus, we are testing to find out just how bad it’s really gotten.

“It’s crucial for us to know how to allocate resources and how to protect people who are still COVID-naive.” Testing staff at these facilities is a top priority, Dark said.

City health officials expect the first round of testing to take roughly a month and will mostly be administered by health department staff. Over time, they hope to see testing performed once every two weeks, a cadence corresponding with the virus’ 14-day incubation period.

Teresa Palmer, a retired San Francisco geriatrician, said she spends most of her days sending emails to public officials urging them to require testing at skilled nursing facilities.

Palmer applauded San Francisco’s new mandate.

“That’s great,” she said. “Finally. It has to be done. It’s a huge potential reservoir of infection and, of course, nursing home patients die quickly. If you wait until someone has symptoms, you’ve lost precious time and you’re going to get an outbreak and more people are going to be infected.”

Palmer’s 102-year-old mother lives at the Jewish Home. She said she constantly worries of her mother’s health and whether the staff were putting her at risk because of the lack of testing.

“I’m chronically anxious,” Palmer said. “I don’t want to lose her to this. She has a few more years, she is very vibrant. This fear of loss shadows my days.”

Testing will begin Monday at Laguna Honda Hospital in San Francisco, a 780-bed skilled nursing facility run by the city that has already endured an outbreak that required assistance from the federal government. To date, 21 cases have been confirmed at Laguna Honda — 16 staff members and five residents, all of whom are in good condition, according to the health department.

“As someone whose grandmother was in Laguna Honda for years, I know how important it is to keep everyone in these skilled nursing facilities safe,” Mayor London Breed said. “This includes both the residents and the staff, who are working hard every day to provide care during the challenging times.”

Along with the mandate for testing, the city’s health department is also rolling out a set of protocols meant to create a uniform approach to managing outbreaks and stopping transmission of the coronavirus at all nursing homes.

“For the most part, the city will be supplying the test kits for the first round of testing,” said Rachael Kagan, a health department spokeswoman. Some skilled nursing facilities can already administer tests on their own, she said.

“As the process matures and skilled nursing facilities start doing their own testing, they may be responsible for the kits, as well, when they have adequate supply,” Kagan said.

Dominic Fracassa and Sarah Ravani are San Francisco Chronicle staff writers. Email: dfracassa@sfchronicle.com sravani@sfchronicle.com Twitter: @dominicfracassa @SarRavani