SAN JOSE, Calif. — To Dr. Mehrdad Ayati, it became clear in early March that nursing homes were about to explode as major incubators of coronavirus outbreaks.
The geriatric care specialist who teaches at Stanford and his colleagues were fielding desperate questions from skilled nursing facilities asking how they could protect patients and staff from getting COVID-19.
Where could they find personal protective equipment such as masks, gowns and gloves for their staff? If their mostly elderly patients started showing COVID-19 symptoms, should they keep them inside or transfer them to hospitals?
“Nobody paid attention to the skilled nursing homes,” Ayati said about those earlier days of the coronavirus pandemic, when the nation’s eyes were riveted on cruise ships, stay-home orders, ventilator and N-95 mask shortages, and video footage of increasingly overwhelmed hospitals.
A deadly outbreak at a Washington state nursing home perhaps should have raised concerns, but collectively, “we kind of abandoned skilled nursing homes and assisted living facilities,” Ayati said.
But then tidbits of information began trickling out of some San Francisco Bay Area nursing homes and assisted living facilities that a few patients here and some employees there had been infected by the coronavirus.
Suddenly, more facilities began confirming cases of patients and health care workers infected with COVID-19, and the numbers became staggering, including the revelation last week that nine of at least 66 people who contracted the virus at Gateway Care and Rehabilitation Center in Hayward had died.
At the Orinda Care Center, meanwhile, Contra Costa County health officials reported that three of the 51 people inside there who tested positive so far have died.
In San Jose, outbreaks at The Ridge (formerly Mt. Pleasant Nursing Center) and Canyon Springs Post-Acute Care Center have included dozens of patients and staff diagnoses.
In response, California Gov. Gavin Newsom promised Friday to send “SWAT teams of infectious disease specialists” into the growing number of infected facilities in an effort to stem the tide of infections and deaths.
Those SWAT teams likely will encounter very chaotic scenes. But how did the problem reach such epic proportions?
Experts say it starts with chronically understaffed facilities whose employees seldom are trained to handle medical emergencies, much less how to put on some of the protective equipment and masks needed to deal with a pandemic. Low pay — some certified nurse assistants make little more than minimum wage — requires many to work multiple jobs across multiple facilities, potentially carrying disease as they go.
“Some of it was sort of built into the structure of the way nursing homes are run and made them sort of perfect places for this disease to spread,” said Dr. Marina Martin, section chief of geriatric medicine at Stanford University’s School of Medicine. “There have often been 20 patients per nurse — before the pandemic.
“Given how little money goes to nursing home care, they’re always short-staffed,” she said. As the staff circulates, “they serve as the perfect vector — going from patient to patient to patient.”
Those problems were compounded by the failure of state regulatory agencies to take charge of the dire situation early, though the homes are now clearly on the radar. In his daily news conference Friday, Newsom said the state is monitoring 191 of the 1,224 skilled nursing facilities in California where 1,266 patients and workers have tested positive.
Although the early focus after shelter-in-place orders went into effect was to keep family members outside the front door of nursing homes to prevent them from possibly infecting patients, the employees are now suspected of having introduced the virus through the back door.
What happens inside some of the facilities might frighten families even more.
“We heard from folks in San Jose, two nights ago, that some of them were using plastic bags on their hands” when they ran out of gloves, said Arnulfo De La Cruz, executive vice president of SEIU 2015, the California long-term care workers union.
The employees are working longer hours than ever while administrators call for reinforcements from staffing agencies and local health departments to step in for those stricken by the virus.
“Balancing the care they’ve given to their clients and making sure they and their family and community is safe, you can imagine they’re under an enormous amount of pressure,” De La Cruz said. “Their stories are examples of where they’re still going to work, running out of masks, or their masks are getting soiled and have to wait a day or two to get a new batch. The issue of PPE is constant.”
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