Kaiser San Jose fined $43K in outbreak

Could an inflatable tree really have infected at least 60 people, causing the death of one?

SAN JOSE >> As multiple agencies investigate the source of the coronavirus outbreak among at least 60 Kaiser Permanente San Jose workers that now has led to a $ 43,000 fine against the hospital, everyone wants to know: Could all this suffering really have been caused by one employee in a Christmas costume trying to spread holiday cheer?

“We want to support the Christmas tree person,” said a San Jose man, whose 87-year- old mother tested positive for the coronavirus little more than a week after she fell down and was taken to the south San Jose emergency room on Christmas Day.

Although sympathies may lie with the well-intentioned woman who bounced through the emergency department that morning in a battery- operated, inflatable tree costume with a big, red nose, coronavirus experts say that though there are many factors to consider, it’s entirely possible she could have been a superspreader. Not only was the woman probably at her most contagious just before she showed symptoms, and ultimately tested positive, but the fan in the ventilated costume likely spread the virus farther.

Still, the woman in the costume had to contract the virus somewhere, at Kaiser or elsewhere.

“Some of the people may have been incubating already,” UC San Francisco epidemiologist Dr. George Rutherford said of other hospital employees who were infected. “This may not all be laid at this poor woman’s feet.”

Numerous questions remain — including why Kaiser didn’t immediately notify the Santa Clara County Health Department of the outbreak. The department said Thursday that it found out after Kaiser issued a news release Sunday. The hospital has been fined $1,000 for each of the initial cases, County Executive Jeff Smith said Thursday.

“There are reports that people felt symptoms very early in the process — it’s a little surprising to hear that,” Smith said, noting that some hospital workers felt sick beginning Dec. 27 and a hospital receptionist died a week later. “It’s also a question mark that if everyone was wearing PPE, why did it spread so fast?”

Not only are Kaiser and the Santa Clara County Public Health Department investigating, but so is the state Department of Public Health, which is trying to determine whether there is more than one source of the outbreak.

“There are investigations going on right now including gene tracing,” Smith said, “trackers of the particular virus to see where it looks like it came from.”

Investigators also are interviewing employees and getting a variety of accounts that are difficult to verify, he said. Some workers say they had symptoms earlier than would be expected, he said. Others suggested Covid patients in the emergency department were not properly isolated. Kaiser did not immediately respond to a question about isolation protocols or about the fine levied against it.

Kaiser acknowledged that before the outbreak, tests were available to employees but were optional. Since the outbreak, however, “Our infectious disease specialists are strongly recommending that employees get tested,” Kaiser said in a statement this week.

The hospital, which said in a statement early this week that the tree costume is a possible cause, is contacting the 70 patients who were in the emergency department Christmas Day to let them know they were exposed. No one has confirmed whether any were sickened because of it.

The San Jose man whose elderly mom tested positive for COVID-19 said he was contacted Sunday by a Kaiser employee who said his mom had been exposed Christmas Day. But he’s doubtful she acquired it there. He said she was discharged Dec. 26 and taken directly to a skilled nursing facility, where at least nine, including his mother’s roommate, were infected. Because his mother didn’t test positive until Tuesday — and had tested negative Dec. 31 — he is confident she was infected by her rehab roommate. The son didn’t want his name used because his mother is still a Kaiser patient and he is happy with her care.

Patients and nurses, most of whom wanted to remain anonymous, also said this week that other factors may have been at play.

Snookie Montford, 68, of San Jose said she is confident she got the virus at Kaiser’s emergency department when she arrived by ambulance for a broken pelvis Dec. 23, even though she was discharged Dec. 24.

“Looking back, maybe they should have kept my door shut, but the thing is, I had not been around anyone, so basically I know I got COVID from being in the ER, but it wasn’t having to do with the Christmas tree thing because that was the following day,” Montfort said.

Kaiser wouldn’t comment on her case, citing patient confidentiality and the ongoing investigation.

A traveling nurse who worked on a higher floor of the hospital on Christmas Day and came down with COVID-19 symptoms — although she has tested negative — said she wouldn’t be surprised if the virus spread in hospital break rooms despite efforts to socially distance.

“We don’t wear masks in the break room. Everyone wants to rip them off after eight to 10 hours,” she said. “We take our masks off to eat. They’re small rooms. Everyone’s hungry and tired, and that’s where it all happens.”

A county order issued last weekend requires all company break rooms, including hospitals, to close. The order was not directly related to the Kaiser outbreak, Smith said.

Rutherford, the UCSF epidemiologist, said “it makes a lot of sense to me” that the woman in the costume may have been the source of the outbreak. “This is consis

tent with superspreading events,” he said. “This is just aided by the aerosol-generating device.”

Although a fan blew air inside the costume, he added, “The air has to go out of these things or it will continue to blow up and explode.”

Dr. Brian Schwartz, a UCSF infectious disease specialist, said the Kaiser outbreak reminded him of another superspreader event early in the pandemic when a diner at a restaurant in Guangzhou, China, who was infected but not yet showing symptoms sat in front of an air conditioner that spewed

the virus across the room. Nine other diners were infected.

Still, he said, most infections don’t take hold until about five days after exposure. For a group of sickened workers to complain of symptoms within two days is “very unlikely.”

As the investigation continues, friends and coworkers of the unidentified woman in the tree costume are coming to her aid on social media. “She needs our support like everyone else,” one woman wrote on Facebook.