Are/Were You Ready for Your First COVID-19 Case(s)?

SNFs are now required to report patients under investigation for COVID-19 (PUIs) and actual COVID 19 cases among their residents and HCWs (Health Care Workers).  The report is updated every working day ( ) and indicates that over 20% of our SNFs have one or more cases associated with their facility.  

In Sonoma County, we have 20 SNFs and so far have had only one asymptomatic HCW, detected in the first PHD (Public Health Department) SNF surveillance.  As the emeritus Medical Director of a CCRC, I am helping them with their COVID-19 preparedness.  In addition, our county PHD has convened a weekly virtual workgroup of SNFs and area health care leaders for providing the latest guidance on COVID mitigation and for discovering innovative ways to implement that expert guidance locally.  At a recent workgroup, some participants questioned the wisdom of taking PUI (persons under investigation) or known COVID cases where transmission precautions are still necessary, given the bad outcomes of COVID seen so far in SNFs in geographic epicenters.  

In my CCRC, we decided to prepare for accepting these admissions according to CDC guidance that should protect our residents and HCWs (  At this time, this unit is functioning as an Observation Unit in a closed wing with private rooms, closed doors, PPE, and designated staff for this unit that doesn’t commingle with other staff.  This has allowed us to take admissions from acute hospitals with “No clinical concern for COVID-19” while protecting our other residents and staff from asymptomatic transmission from these new admissions.  In addition, it has allowed us to transfer residents with COC (change of condition) where COVID 19 hasn’t been excluded, to this unit.  These clinical opportunities have helped us improve our adherence to the CDC IP guidance and have prepared us to provide on-site safe care for COVID-19, should that be necessary.  Our county and SNF work group are committed to providing tangible support for SNFs which do take or develop COVID cases.

Our county Board of Supervisors has listened to our concerns and has funded an alternative site care at Sonoma State University for PUIs and proven COVID cases who still require quarantine.  At this time, we have not yet had an outbreak of COVID in our SNFs, or Senior Living Communities, so the alternative site is not yet operational. 

Our workgroup has been joined by Marin County’s similar partnership.  Their KP (Kaiser Permanente) team developed 3 interventions for their Senior Living Communities that includes:  MATT (Mobile Assessment Triage Teams), ECBT (Education Capacity Building Teams), and LCPT (Life Care Planning Teams).  These have worked well in the 4 senior living communities with COVID-19  and have recently intervened on behalf of a Marin County SNF with an early symptomatic HCW.  At this facility, the partnership was able to test all HCWs and residents in one day and helped them develop a functional COVID unit where the one pre-symptomatic resident was identified.  Five pre-symptomatic HCWs were identified in this one day screening.  No further cases have been identified, but further surveillance is planned. 

Importantly, the PHD and their licensing division were able to help this facility with PPE and staffing up to cover the other identified +HCWs’ absences due to quarantine.  This quick partnership action may have prevented further spread of COVID at that facility, where no further COVID case has been identified.  In Sonoma County and in 5 other Northern California counties, KP is helping us and the other counties develop similar surge capacity.    

On April 24, CDPH AFL 20-33,1 was published on Interim Guidance for Transfer of Residents with Suspected or Confirmed COVID 19 ( ).  This letter clarified the expectation that all CA SNFs should be prepared to accept suspected and confirmed COVID cases including those still requiring transmission-based precautions.  SNFs may not require a negative COVID test as criteria for admission or readmission of hospitalized patients considered low risk for COVID—although they can certainly ask for it, and with increased testing availability and quicker turnaround times, it is not an unreasonable request.  

Because of this, SNFs are encouraged to follow CDC guidance for safely managing this patient category’s residual small risk of COVID transmission. If the potential admission is a suspected COVID or a COVID patient who still requires transmission-based precautions, the referring hospital should first consult the local health department to insure that a safe site of SNF care has been identified.  For more information about this well-written and important ALF, see link.  

At a local level, each of our communities and facilities need to evolve models of care commensurate with the potential COVID threat and available resources.  Are you ready?

Share this post:

Comments on "Are/Were You Ready for Your First COVID-19 Case(s)?"

Comments 0-5 of 0

Please login to comment