San Francisco Chronicle
Variant worse than thought
Hospitals affected: Inoculated staff at S.F. General, UCSF get COVID
Dozens of fully vaccinated staff members at two San Francisco hospitals have developed COVID19 over the past six weeks, almost all of them infected in the community — not on the job — as the delta-fueled fourth surge took off across the city.
Thirtyfive staff members at San Francisco General Hospital are out sick after testing positive for the coronavirus, said Dr. Luke Day, chief medical officer. Threequarters of them are fully vaccinated. Though that number makes
up a small portion of the staff of 7,000, it’s about as many staff infections as were reported during the peak of the winter surge.
At UCSF, about 140 staff members — out of 35,000 total employees — have been infected since mid June, said Dr. Ralph Gonzalez, chief innovation officer for UCSF Health. About 80% of those who tested positive were fully vaccinated.
None of the infected staff members have been so sick they needed to be hospitalized. Both hospitals say they have plans in place to cover those who are out sick or who aren’t able to work because of a COVID exposure.
But administrators are concerned about potential staffing shortages as this surge builds. And with increasing evidence that the delta variant can more easily infect even those who are vaccinated, and can spread among that group, too, they are pleading with the public to wear masks again and resume some of the other social distancing precautions they largely abandoned six weeks ago when the state dropped most public health mandates.
“All the people who are working in health care know how hard this is. We were all feeling like we were finally going to take a breather from this pandemic,” said Dr. Lisa Winston, medical director for infection control at San Francisco General. “My hope is that if we can keep getting vaccine rates higher, and wear our masks when we’re in public places and maybe distance a little bit. The more we can all do, the better our chances at avoiding the things that are more painful.”
The cases among hospital staff are reflective of what’s happening in the broader community, as people dropped their masks and started gathering again when the state reopened June 15, just as the highly infectious delta variant was silently starting to dominate.
Cases have been doubling every two weeks or so across the Bay Area since then, and though rates of infection are much higher among people who are not vaccinated, postvaccination breakthrough cases appear to be more common than health experts had anticipated.
But it’s clear the vaccines are still preventing most infections, Gonzalez said.
“We’re still seeing a strong vaccine protective effect,” he said. “Instead of 140 cases (among staff ), it would be 600 or 700 if you use the unvaccinated rate of infection.”
And Day said the vaccines are working “remarkably well” at preventing serious illness.
“People can still get COVID with the vaccines,” he said. “But the cases are much milder, you don’t get hospitalized and you don’t die from it, and that’s the goal of the vaccine.”
Hospitalizations for COVID have been climbing at San Francisco General and other Bay Area medical centers. As of Thursday, more than 600 people were hospitalized with COVID in the Bay Area, a nearly fourfold increase since June 15. Hospitalizations have increased fivefold in San Francisco, from just 16 six weeks ago to 83 patients on Thursday.
At San Francisco General, 17 people were hospitalized with COVID as of Thursday afternoon — far below the winter peak, when up to 70 people were hospitalized and 1 in 4 patients there had COVID. But just six weeks ago only one person was hospitalized with COVID, Day said.
“Just over the last week and a half, we’ve seen our numbers increase by 100%,” he said.
Both San Francisco General and UCSF have dusted off their surge plans and reinstated policies to preserve hospital capacity. They have resumed coronavirus testing of every patient admitted to the hospital, regardless of vaccination status.
Gonzalez at UCSF said the climbing infection rates among staff were an early signal that a fourth surge may be building in San Francisco. In late June, less than two weeks after the state reopened, the hospital saw an uptick in staff requesting coronavirus tests because they had symptoms of COVID.
Now, he said, they’ve had to add staff to the occupational safety team to keep up with demand for testing and case investigation in the hospital.
Cases at both hospitals have been reported among all types of staff, including doctors and nurses. Almost everyone was infected in the community — from going to bars or restaurants, shopping, traveling or gathering with friends. Like everyone else in this pandemic, hospital staff took advantage of the state’s reopening to remove their masks and reengage with friends and family.
“We encouraged staff to take some time off and take vacations to recharge,” Day said. “We’re part of our communities, we’re not immune to this, and even with best practices and best intentions you can contract this virus.”
Dr. Marissa RaymondFlesch, a pediatrician specializing in adolescent care at UCSF, fell ill with COVID in midJuly, shortly after taking a week off work and vacationing at home in San Francisco. Her husband and 2yearold son were infected, too.
RaymondFlesch and her husband are both fully vaccinated, “and I’m so grateful I was vaccinated,” she said. “I think that being vaccinated likely kept me out of the hospital, because I had a surprisingly symptomatic infection.”
She was not hospitalized but experienced “terrible” muscle aches and fatigue, and she lost her sense of taste and smell. Her husband had a bad cough and some breathing problems. Her son had mild symptoms, “which I’m very, very grateful for. He had a bad cold and was very tired, and had some lowgrade fevers.”
“Now he mostly keeps asking, ‘Mama, can we get fresh air?’ ” RaymondFlesch said.
She said that after more than a year of taking extreme care not to be infected — for her own protection and to keep her family safe — it was upsetting to test positive, and in turn to watch her husband and son get sick, too.
“We’ve been so so cautious — it’s hard for me to emphasize that enough. We are a family that has never really gone outdoors without masks,” she said. “We were just starting to get out in the world a little bit more. We had gone to the zoo. We started having small, small gettogethers with vaccinated friends.”
Hospital administrators and staff said in some ways it’s especially difficult for health care workers to be facing yet another surge, after being on the front lines and treating the sickest patients for so long. But they recognize this is a challenging time for everyone after getting a taste of what felt like postpandemic freedom.
“We need to shift back to the things we know how to do. We know how to mask, we know how to socially distance. We know how to work on Zoom,” RaymondFlesch said. “And that’s hard, it is really hard to shift back to those places. And not to know how long we’re going to need to do that for. I’m feeling it now, too.”