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COVID-19 in health care facilities a growing concern

With stricter shutdown orders looming across the state due to increased COVID-19 cases and deaths stretching hospital capacities, some skilled nursing facilities in Nevada County are already feeling the strain of staffing and supply constraints.

This week, Gov. Gavin Newsom announced regions with hospital intensive care unit capacity falling below 15% would be placed on additional stay-at-home restrictions, including shutting down some businesses like personal care services, salons and barbers. The Greater Sacramento region, which includes Nevada County, is currently at 76% of hospital ICU capacity and is expected to exceed it by Christmas Eve, according to state data.

According to Public Health Director Jill Blake, last month the county saw more COVID-19 cases (over 700) than all previous month combined. In just the first few days of December, the county has already added 200 cases and six additional deaths.



County officials say the spike has been fueled by continued social gatherings and workplace transmission, particularly in congregate living facilities.

“What we have witnessed more than once is people going to work with mild symptoms, and when their symptoms worsen, they then decide to stay home,” Blake said at a county meeting on the dramatic case increase.



During the first week of November, the state averaged 95 new cases in skilled nursing facilities per week and less than 11 deaths. During the final week of November that jumped to 288 new cases per week and 18 deaths at skilled nursing facilities, higher than it’s ever been.

According to state public health data, four Nevada County skilled nursing facilities — Spring Hill Manor Convalescent Home, Golden Empire Nursing and Rehab, Wolf Creek Care Center and Tahoe Forest Hospital SNF — have active cases among residents. Golden Empire and Spring Hill Manor are the only facilities reporting deaths among residents.

Spring Hill Manor has had 40 cumulative residents with COVID-19, Golden Empire has had 29, and Wolf Creek Care Center and Tahoe Forest have both had less than 11 cases.

Administrators for the skilled nursing facilities were not available to comment Friday.

STAFFING ISSUES

County officials declined to give further demographic information on the recent deaths in skilled nursing facilities or their circumstances, but said the virus was not introduced by a transfer of a COVID-19 positive patient.

“When community transmission becomes widespread, as it very much has in Nevada County, outbreaks in our vulnerable settings such as SNFs become more and more likely,” County Public information Officer Taylor Wolfe said in an email.

According to state documentation, Golden Empire has indicated an “urgent need” for staffing and supplies and has been referred to the state’s Healthcare-Associated Infections program.

Similarly, Wolf Creek Care Center was granted a request to dip below state-mandated staffing ratios due to decreased availability of staff. According to state documents, the facility has asked personnel to work extra hours and substituted some Certified Nursing Assistant hours with Licensed Nurses.

“As testing becomes more widely available, more and more staff members who work in skilled nursing facilities are testing positive and becoming unavailable to work,” the request states. “Others are scared away by the situation.”

Heidi Steinecker, deputy director of the state’s Center for Health Care Quality, said Healthcare-Associated Infections data has shown 70% of hospitals have some kind of health care professional-related outbreak, leading the agency to recommend weekly testing of staff in the coming weeks.

“Hospital outbreaks have involved various combinations of nurses, respiratory therapists, physicians and techs, but also non-clinical personnel such as security staff. And, of course, patients have acquired COVID while in the hospital for another condition,” Steinecker said in a weekly facility meeting.

The surge has led to the county prioritizing contact tracing for those most recent and most vulnerable cases, and now the county is asking residents prioritize testing for those showing COVID-19 symptoms.

“During this pandemic we’ve seen essentially all the hospitals are asking for more help from temporary workers from traveler, nurses, etc., and so there haven’t been enough to go around in some cases. And then we’re also seeing part of the health care workforce getting sick and needing to go out,” Sierra Nevada Memorial Hospital CEO Brian Evans said. “The number one thing that everybody could do for these health care workers is do not get COVID and don’t give anybody COVID,”

To contact Staff Writer John Orona, email jorona@theunion.com or call 530-477-4229.


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