S.F.’s Laguna Honda was a model for coronavirus control. Now, 3 are dead in new outbreak - San Francisco Chronicle

Three Laguna Honda residents have died of COVID-19 this month as the San Francisco skilled nursing facility, the largest in the state, faces its first deadly outbreak of the pandemic.

The city has been praised for months for keeping the virus largely at bay at Laguna Honda and preventing deaths among its 715 vulnerable residents. The new outbreak, which has led to more than 50 cases among staff and residents this month, unfolded with heartbreaking timing: Laguna Honda starts vaccinating residents next week.

“It would have been ideal if we’d been able to vaccinate a month ago, but the vaccines weren’t approved then,” said Michelle Fouts, director of pharmacy at Laguna Honda. “We can’t get it done soon enough at this point.”

Since the start of the pandemic, Laguna Honda has had 163 coronavirus cases: 122 staff and 41 residents. But nearly a third of all cases have been in December. And the current outbreak is still growing, with 10 new cases reported in the past 48 hours.

The three deaths were among residents in a memory care unit. They were all men age 75 and older.

Laguna Honda, which is run by the San Francisco Department of Public Health, was recognized early in the pandemic as particularly at risk of life-threatening outbreaks if the virus got a foothold in the facility. It’s home to hundreds of frail and elderly San Franciscans, some of whom have lived there for years.

A concerted effort by local public health authorities, along with on-site guidance from experts with the Centers for Disease Control and Prevention, largely held off the virus. There were some outbreaks, the worst in July when 25 staff and residents were infected, but they were quickly corralled and no one died. Policies put in place at Laguna Honda helped guide preventive efforts at nursing homes across the state, San Francisco officials said.

In fact, that the facility had never experienced a large outbreak or resident deaths often was cited as one explanation for San Francisco’s remarkably low fatality rates overall. Nursing home residents have made up distressingly high proportions of COVID-19 deaths in the United States, by some counts as many as 40% nationwide. Until this month, no one had died at Laguna Honda.

But the fall and winter surge that swept across the state led to increased coronavirus cases among Laguna Honda workers, followed by associated clusters among other staff and residents.

“The month of December has been one of the most challenging months throughout this pandemic response,” said Nawzaneen Talai, chief quality officer for Laguna Honda. “We mirror what happens in the community. Just as this surge has been tremendous in the community, it’s hit us hard too.”

Outbreaks at nursing homes almost always start when an infected staff member, who usually does not have symptoms, unknowingly carries the virus into the facility and passes it to co-workers and residents. Early in the pandemic, nursing homes were instructed to conduct frequent testing of staff members to prevent those outbreaks, but with the virus so widespread it’s been a challenge for many places to keep up.

At Laguna Honda, in response to the current spike in cases, officials have increased testing — from once a week for all staff who interact with residents to twice a week. Also, all staff are required to wear N95 masks and face shields instead of simple surgical masks. Visitations from friends and family of the residents were stopped about a month ago to further prevent new cases.

The memory care unit that housed the three residents who died was identified early on as especially vulnerable to outbreaks, Talai said. The North Mezzanine, as it’s known, is a secure unit because residents suffer severe cognitive issues and are prone to wandering off. They also have trouble wearing face coverings and avoiding contact with others.

The first resident died Dec. 11, the second Dec. 22, and the third on Tuesday. The hospital sent letters to staff and residents and their families informing them of each death.

“The first resident death was very emotional,” Talai said. “There was this moment of defeat, when really it’s not. The staff has done an incredible job. There’s a reason we were so vigilant about this particular unit — this outcome was always highly plausible.”

That these deaths occurred just as Laguna Honda starts vaccinating staff and residents is tragic, hospital officials said. More than 900 staff members have been vaccinated over the past two weeks. Residents will begin getting vaccinated on Monday; hospital officials expect to give a first dose to about 80% of them over two days.

But the unfortunate timing is a sober reminder that the pandemic will rage on even as more people are immunized, and that containment policies are as important now as ever, hospital officials said.

“It’s not ideal to be vaccinating in the midst of such a big surge,” Fouts said. “But it also re-emphasizes just how important this vaccination campaign is.”

Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com Twitter: @erinallday

December 31, 2020 at 10:06AM
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S.F.’s Laguna Honda was a model for coronavirus control. Now, 3 are dead in new outbreak - San Francisco Chronicle

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