It took awhile for the LA County Health Department to begin sorting where all the COVID-19 deaths had occurred. And knowing what we know now, one might think it would be easy to see a pattern developing of where people were succumbing to the Wuhan virus and respond accordingly.
We now know that in its zeal to shut things down to save frontline medical professionals and old people, the LA County Health Department missed a big tell.
There have been reports of coronavirus deaths at nursing homes since last month. The clusters were developing at eleven separate nursing home-like facilities. But now we know that fully 40% of the Wuhan virus deaths were people in nursing homes and “institutional” facilities. The County reports that 3,115 cases occurred in nursing homes and similar facilities; 1,826 of the cases were residents and the rest were staff.
County Health Director Dr. Barbara Ferrer said Wednesday that 292 residents of these types of facilities have died. She admitted that they were wrong in how they dealt with asymptomatic workers co-mingling with patients.
… in the past, we have done a lot of our infection control protocols around an assumption that we needed to worry about people who were symptomatic and test people who were symptomatic… But it turns out that we were wrong, and with new information it’s become clear that asymptomatic people are capable of spreading the virus. And this is particularly true in a facility where all of the care for most of the residents happens — because employees are bathing people they’re feeding people, they’re moving people they’re in extraordinarily close contact with the people who reside there — and really helping to make sure that those people have what they need every single day. But in having what they need, it’s become clear that part of that is our obligation to make sure that we’re able to test all residents and employees for the virus, regardless of whether they show symptoms or they don’t.
Ferrer called for testing all employees and residents of nursing facilities. However, she still called for testing only symptomatic people in the wider community. So far 90,000 symptomatic people have been tested in LA County and 15% have tested positive.
Ferrer’s change of heart on pre-symptomatic or asymptomatic transmission of the virus comes after a USC and LA County Health Department study showed that as many as 442,000 people in LA County have already developed anti-bodies to COVID-19. That means they were exposed and never developed symptoms and it also means that the mortality rate from the disease is a lot lower than feared.
But the possibility that asymptomatic people could spread the disease was known earlier.
The CDC reported that based on the Kirkland, Wash., nursing home cases, Chinese data and cases in Singapore, there was a distinct possibility of passing the disease along without ever developing symptoms.
…asymptomatic transmissions have been reported in China (1,2) and possibly occurred in a nursing facility in King County, Washington (3). Examination of serial intervals (i.e., the number of days between symptom onsets in a primary case and a secondary case) in China suggested that 12.6% of transmission was presymptomatic (2). COVID-19 cases in Singapore were reviewed to determine whether presymptomatic transmission occurred among COVID-19 clusters.
Investigation of COVID-19 cases in Singapore identified seven clusters (clusters A–G) in which presymptomatic transmission likely occurred. These clusters occurred during January 19–March 12, and involved from two to five patients each (Figure). Ten of the cases within these clusters were attributed to presymptomatic transmission and accounted for 6.4% of the 157 locally acquired cases reported as of March 16.
To stop the disease from infiltrating the nursing homes, testing would have had to be done or, at the very least, proper garb should have been worn at every facility.
The county also reported that 100 homeless people have tested positive for the coronavirus, 55 of whom were in shelters.
The downtown LA Union Rescue Mission is a hotbed of cases.
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