Update: A third resident's death was reported on Sunday at the Southeast Nursing and Rehabilitation Center. The man was in his 60s with underlying health conditions.
A San Antonio nursing home has seen nearly 70 of its residents test positive for COVID-19. The outbreak at Southeast Nursing & Rehabilitation Center has sent shockwaves of alarm throughout local and county government and attracted national attention.
Eighty-four men and women live at the facility on East Southcross Boulevard. As of Friday night, 67 had tested positive, and as of Saturday, two had died. The nursing home also employs about 60 staff members, and twelve of them also tested positive for the virus. San Antonio Metro Health said it launched a 'multi-layered aggressive response' to protect nursing home residents and curb the spread.
The addition of 59 cases from the nursing home caused Bexar County's total COVID-19 cases to spike up to 342 on Friday night. By Saturday night, the number rose again to 384. The death toll stood at 11, including the two nursing home deaths.
"In case anyone in San Antonio needed a wakeup call about the seriousness of COVID-19 to our community, this is it," San Antonio Mayor Ron Nirenberg said Friday during a press conference at the city and county's emergency operations center. "COVID-19 is alarmingly contagious and very insidious."
When the residents were tested, 11 came back negative. Four were still pending and two were 'inconclusive.'
Nursing homes can be particularly vulnerable to the spread of disease, especially when proper precautions are not taken. It was not immediately clear what caused the virus to spread at Southeast Nursing. A contact investigation was underway.
Learning from other cities
The initial notable nursing home infection came from Life Care Center in Kirkland, Washington, a city near Seattle. Health officials connected 37 deaths to that outbreak during the early days of the coronavirus crisis in the U.S.
San Antonio Fire Chief Charles Hood said lessons learned from the Life Care Center outbreak helped San Antonio officials determine their response.
"We visited all nursing homes within our region," he explained. "Within San Antonio we have 68 nursing home facilities. Our fire companies went to each one of them and gave them information about potential spread of COVID-19. We worked with the responsible parties to make sure we had the best egress and ingress to those facilities to where we're not exposing our crews or the patients as far as moving patients out," Hood said.
A Southeast Nursing resident was transported to the hospital for the first time on March 21. Over the next ten days, five more patients were hospitalized, and one certified nursing assistant tested positive.
Part of the city's response included visiting all of the city's low-rated nursing homes.
"The San Antonio Fire Department and the San Antonio Metropolitan Health District are visiting all 34 of the lowest rated nursing homes in the community to conduct facility assessments in each of them, which includes evaluating their infection control and environmental health procedures," the city said in a statement. "Finally, the SAFD will visit all 68 nursing homes in the area again to notify them of the process for EMS transports from their facilities."
A coronavirus outbreak at a nursing home is not unique to San Antonio. At least 83 residents at the Resort at Texas City, near Houston, have tested positive, according to Houston Public Media.
Also, the Denton State Living Center near Dallas has seen an outbreak affecting at least 49 residents, according to KERA.
Containing the spread
Dr. Cherise Rohr-Allegrini is an epidemiologist and San Antonio program director with the Immunization Partnership. She said the situation in nursing homes is often very different than that among the general public. In some cases, nurses may care for multiple patients.
"That means that means a nurse or a staff member … that is potentially infected but not symptomatic or very mild symptoms that aren't noticeable could potentially see 10 or 20 patients," she explained, "and therefore spread it to that many people, which is not a normal environment."
She believed there are practices that nursing homes can employ to help mitigate the spread.
"Ideally, you would treat a nursing home like individual household units," she said. "So maybe you have two to three staff members who have a group of patients and they only see those patients, and the patients only see those staff members, so they're not sharing the virus between different groups of patients."
On Friday, Nirenberg issued a new public health emergency order prohibiting nursing home staff members across the city from working at multiple facilities.
"We have great concerns about the potential for infected staff members from Southeast Nursing center potentially exposing residents in other facilities where they might have also worked," he said.
Nirenberg admitted there was no federal guidance on nursing home staff working between different facilities.
"In this situation with a pandemic to manage, one glaring area that hadn't been previously regulated was the ability for workers to be vectors of infection in multiple locations," he said. "and that's the part that we now are taking it upon ourselves locally to manage."
Bexar County was expected to issue a similar public health order in the coming days.
Tracking down the employees
San Antonio Metro Health contacted each of the staff members who work at Southeast Nursing and ordered them to take a COVID-19 test.
On Friday, the city said they had determined the employees worked at seven different facilities based on conversations with those who had been tested. By Saturday night, almost all staff had been contacted. Officials did not yet have an updated number on how many facilities may have shared employees.
Nirenberg said a handful of staff members had not been contacted.
"There are seven that are not contacted yet because they are not able to be located but we are working through that process right now," he said. "As it stands today anybody who is positive is quarantined, and those folks who are under investigation are quarantined as well."
Rohr-Allegrini said it is possible the virus could spread to other nursing homes because of the nature of their populations.
"In a population like this where they're already medically fragile you're going to see more people getting more severely ill. Maybe we got lucky and nobody spread it to another nursing home. That's why it's really important they don't share staff but we won't know until they do all the testing," she said. "That's ideally what they'll do ... they'll test every nursing home that has been potentially exposed to any of the staff we know are positive."
Joey Palacios can be reached at Joey@TPR.org and on Twitter at @Joeycules.
