2019 Novel Coronavirus: Orange County Update
for Long Term Care Facilities (LTCFs)
May 14, 2020
Fifteen COVID-19 outbreaks have been identified in Orange County LTCFs over the past 4 weeks. These outbreaks have occurred despite good compliance with temperature and symptom screening of both staff and residents. Outbreaks can spread rapidly among residents and staff, and responding to and testing for these outbreaks strains resources. On Monday, 5/11/2020 the California Department of Public Health (CDPH) sent out an All Facilities Letter (AFL 20-52; https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-52.aspx ) requiring skilled nursing facilities to submit a COVID-19 Mitigation Plan to prevent and respond to possible outbreaks. OCHCA has been advising facilities with current outbreaks, and can offer assistance with these plans for facilities who have not yet handled COVID-19 cases.
Testing of Residents
CDPH has recommended that facilities perform regular COVID-19 testing of all residents. Such testing can detect clusters at an early stage, but resources are limited, and mass screening is labor intensive and can be very expensive if done on a regular basis. The Orange County Public Health Lab (OCPHL) can assist with testing of symptomatic residents, but cannot routinely assist with mass screenings. OCHCA is working with commercial labs that can assist with some degree of screening, but this process is still being operationalized. Screening of residents using your facility’s pre-existing lab contract can be done, with the cost potentially borne by resident’s insurance, but it is unclear if insurance will reimburse for repeated screenings. Facilities should investigate options for testing their patients using their insurance while OCHCA finalizes further guidance. Consideration can also be given to more targeted screening of particularly high risk residents, such as dialysis patients and others who leave the facility on a regular basis (e.g. radiation therapy or chemotherapy), and/or of mobile patients who interact with numerous residents and staff.
Testing of Staff
CDPH has recommended that facilities perform regular testing of all staff. Similar to testing of symptomatic residents, OCHCA can assist with rapid testing of symptomatic SNF staff; please call 714-834-8180 to report any staff PUIs and to schedule testing. For more large scale screening of staff, like the mass screening for residents, resources are limited, but staff have more options for screening, such as drive-up testing or testing at a private provider’s office. The state has set up 4 sites within Orange County that are prioritizing asymptomatic healthcare workers; these sites, run by OptumServe, are located in Orange, Buena Park, Santa Ana and San Juan Capistrano. They run Mon-Fri from 7 Am – 7 PM by appointment only; walk-ins are not accepted. Appointments can be made by calling 1-888-634-1123 or visiting https://lhi.care/covidtesting . Please note that phone registration will only be used for people without internet access. Although it is important for all staff to be tested, experience with the outbreaks to date showed that staff with the most direct patient care (e.g. CNAs) tend to be the ones most likely to have infection.  
Outbreaks and Staff Sharing
OCHCA is aware that staff at LTCF often work at multiple facilities; shared staff who become infected pose a significant risk of introducing COVID-19 to new facilities. OCHCA advises facilities experiencing an outbreak that whenever possible their staff should not work at other locations. Since the information on LTCF outbreaks is publicly available on the CDPH website at https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/SNFsCOVID_19.aspx , OCHCA will resume weekly updates to LTCFs to inform them of active outbreaks so that facility administrators can make decisions regarding staff that are shared with a facilities experiencing an outbreak.  
  Facility Response to COVID-19 Outbreaks
OCHCA has developed guidance for facility set up and patient cohorting in case an outbreaks occurs; click the button below to download a copy of the guidance.
  Infection Control Guidance
OCHCA has contracted with Expert Stewardship, Inc., a group of experienced infection prevention professionals, for assistance in the public health response to COVID-19 in skilled nursing facilities. Expert Stewardship staff will work in partnership with OCHCA staff to conduct onsite visits and provide ongoing infection control guidance for facilities experiencing outbreaks. Facilities who are not experiencing outbreaks but have questions about infection prevention/control issues may submit questions to their e-mail at ochca@expertstewardship.com or call the hotline 714-545-6113. Expert Stewardship may be able to help facilities not experiencing outbreaks with onsite trainings or assessments in the future as resources permit.
  Additional Resources
CDC guidance for COVID-19 in Long Term Care Facilities: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html
CDC infection control training modules for long-term care facilities: https://www.cdc.gov/longtermcare/

CDPH COVID-19 Guidance for California SNF webinar recording: https://youtu.be/gYNkUkrwu1c

CDPH COVID-19 webpage: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx
Contact Information
Please contact Communicable Disease Control Division at 714-834-8180 with questions or concerns. Please note that this number is now operational 24/7 for medical providers. Please do not share this number with patients.

Case Numbers are updated daily on our website at: www.ochealthinfo.com/novelcoronavirus
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