Bay Area COVID-19 Outbreaks Worsen, Spread in Long-Term Care Homes

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In Contra Costa County, the Orinda Care Center now counts at least 51 cases* of coronavirus, including a death.  Outbreaks have been reported in San Francisco and South Bay county senior care homes, too.

Local health departments always advise these facilities about controlling infections; infectious disease like influenza is common. Now coronavirus is forcing them to adapt and challenging response.

Contra Costa Deputy Health Officer Dr. Louise McNitt says last year they followed 20 such flu outbreaks, with an 'outbreak' defined by the California Department of Public Health as one confirmed case with the identification of a second confirmed case within 72 hours.

But counties don’t regulate assisted living and nursing homes where these outbreaks happen; that’s the work of the Department of Social Services and CDPH, respectively. Most care homes don’t have infection control specialists on staff, as hospitals do. As of last year, federal regulations require infection control specialists at skilled nursing facilities. Not long after that regulation took effect, the Trump administration began consideration of a modification to the rule that would loosen that requirement.

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That means the county’s best weapon for public health is often the phone.

Counties, including Contra Costa, provide guidance online. McNitt says she stays in more active touch remotely, calling to dispense practical local versions of the advice handed down by the state and the Centers for Disease Control and Prevention. For the past several weeks, the best advice she can offer, on topics like how to use space in facilities, screening staff and controlling exposure there, who needs masks, and why -- all of it keeps changing.

“You give people a certain set of guidance, you kind of feel like, you know, like a tiny little sigh of relief, okay, we got that done, and then the very next day, it's like, okay, now there's new guidance, and now we have to kind of start all over again,” McNitt says.

McNitt’s goal is to stay on top of the risks rippling out of these outbreaks, and out of existing stresses in the long-term care system.

Staffers paid lower wages may try to keep working, even if they’re ill. McNitt worries about care home workers who move among several part-time jobs, and might carry the virus without knowing it.

“Residents in more than one facility could be exposed because they often will work at one place during the week and another place on the weekends,” McNitt says.

Care homes with outbreaks now need equipment from counties. Santa Clara County is providing protective gear to Canyon Springs Post-Acute in San Jose after an outbreak there. In Contra Costa, McNitt’s boss, Health Officer Dr. Chris Farnitano, says the health department has requested protective gear for Orinda Care Center from the county’s emergency operations center.

“We’ve already delivered a large supply of that equipment and will continue to support the ongoing needs of this facility for...personal protective equipment,” he said, last Friday.

It’s not clear how long local stockpiles of gear can last. As health departments investigate more outbreaks in elder care homes, the safest guarantee specialists like Louise McNitt can offer is more phone calls.

*This story has been updated to include a breakdown of the number of cases, so far, at Orinda Care, 51: this includes 27 patients, 22 staffers and 2 people who have been sent to hospital. In addition, this story has been updated to reflect the fact that infection control specialists are required at skilled nursing facilities.

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