‘Whole hospital felt relief ’
COVID cases plummet at nursing facilities
Laguna Honda resident Bernadette Yee, who has been vaccinated, gets a push from activity therapy supervisor Yaffa Alter.
The coronavirus pandemic has been hard on Bernadette Yee, who lives at Laguna Honda, San Francisco’s largest skilled nursing facility.
Her sister used to visit every day, but for months they’ve spoken only by FaceTime or WhatsApp. Yee, 65, has yet to meet one of her grandnieces, who was born last May. She stays in her room for meals and hasn’t been able to leave the facility to get massages that help her manage muscle stiffness from sitting in a wheelchair most of the day — the result of a stroke five years ago that left her partially paralyzed on her left side. December 2019 was the last time she was able to go to a cafe with her
“Some people think the goal (of vaccines) is nobody get it, but a more realistic goal is you get it but it’s no big deal.” Dr. Louise Aronson, UCSF geriatrician and clinical lead for the seniors hub at the San Francisco COVID Command Center
sister for their Saturday afternoon catchups.
“I cannot think about it because when I do that, I start counting days,” Yee said. “I miss everything. I don’t want to dwell on things because it makes me sad when I do that. I just keep moving, keep busy . ... If I keep thinking about bad things and feel sorry for myself, I’ll be so sad.”
Yee and the roughly 700 other residents at Laguna Honda, which houses about a third of San Francisco’s skilled nursing resident population, may soon have reason for hope. In a trend that mirrors what’s happening at many other nursing homes in the state and nation, new cases among residents and staff have plummeted over the past several weeks, from 66 in December, to 53 in January and 4 in February.
No Laguna Honda residents have tested positive for the virus since Jan. 18, and the last patient in the COVID unit was discharged last weekend — marking the first time since October that it was empty.
“It was a party for us when that one patient left,” said Dr. Wilmie Hathaway, Laguna Honda’s chief medical officer. “The whole hospital felt this relief, this breath we all took when it was official.”
It is a marked improvement from less than two months ago, when Laguna Honda was in the darkest days of the pandemic. More than a third of the total cases among residents and staff occurred in December, as did the first COVID-19 deaths. In total, 63 residents and 169 staffers tested positive since the start of the pandemic. Six residents have died — four in December and two in January, with the last death recorded Jan. 5.
The hospital is continuing to require staff and encourage residents to physically distance and wear masks. But now, with cases so low — there have been no new resident infections since Jan. 18, though there are five current staff infections — administrators are planning to allow family and friends to resume visiting residents starting March 3. Those visits will be mostly outdoors and are being scheduled now, Laguna Honda officials said. And the hospital is preparing to bring back some outpatient clinical services they had suspended during the worst of the surge, including gastroenterology, endocrinology, pulmonary and cardiology care.
“We have to slowly reopen,” Hathaway said.
It is difficult to pinpoint whether the decline in cases is because of vaccines, infection control measures like masking and distancing, or because cases are declining in the community overall after the holidays; San Francisco as a whole has seen a similar, steep drop in new infections since midJanuary.
“I think it’s a combination of all of the above,” Hathaway said.
About 90% of residents have gotten their first shot and 85% have been fully vaccinated with both shots; 84% of clinical staff have gotten their first shot and 80% have been fully vaccinated. Two staffers tested positive for the virus after receiving two shots, though both were asymptomatic, with the cases detected by routine testing.
The facility’s high vaccination rates, coupled with the fact that no one who’s been immunized developed COVID-19 symptoms, even if they did contract the virus, is encouraging, experts said. It suggests, albeit anecdotally, that the vaccines appear to work in the real world the way the clinical trials indicated they would: They are very effective at preventing people from getting serious COVID-19 symptoms, even though they may not be foolproof at preventing people from contracting the virus.
“Some people think the goal (of vaccines) is nobody get it, but a more realistic goal is you get it but it’s no big deal, like the common cold,” said Dr. Louise Aronson, a UCSF geriatrician and clinical lead for the seniors hub at the San Francisco COVID Command Center. “If some people are carrying (the virus) but not getting sick, and other people get it and don’t get sick, then it’s OK. Then we potentially live with it.”
There are other signs around the region and state indicating vaccinations are helping lower infection rates at congregate care facilities. Cases are down tenfold at Marin County longterm care facilities, from an average of 60 active cases in January to four active cases in February. The steep decline began two to three weeks after residents and staff got second doses of vaccine, which is in line with when the vaccine is considered effective, the county said. It takes about two weeks to build immunity after getting the second shot.
“This is one of our earliest and most highly vaccinated groups, and we’re seeing clear signs of protection,” county health officer Dr. Matt Willis said in a statement. “The vaccine is already saving lives in Marin.”
At least 90% of Marin County skilled nursing facility residents and at least 82% of staff have been fully vaccinated.
Statewide, new cases and deaths at skilled nursing homes are at their lowest levels since late March, according to state data. As of Wednesday, the most recent day for which data was available, there were 29 new cases a day on average, and less than 11 deaths.
For Yee, daytoday life has not changed much since getting vaccinated. She continues to keep her distance from other residents, washes her hands often and wears a mask. But she feels safer.
“I just feel much better around the nurses and the aides because I feel more protected,” Yee said.
She is looking forward to the hospital one day reopening the communal wellness center so she can resume physical therapy sessions there, and to being able to see her sister again.
“Hopefully things will get better,” she said.