Half of All Open COVID-19 Outbreak Investigations in LA County in Skilled Nursing Facilities; Highlights Need to Protect Older People

Although the number of open outbreak investigations across Los Angeles County is near an all-time low, skilled nursing facilities continue to experience a high proportion of outbreaks when compared to other sectors. Given the vulnerability of skilled nursing facility residents associated with advanced age and serious health conditions, preventing the spread of COVID-19 remains of paramount importance.

The highest number of new outbreaks at skilled nursing facilities occurred at the end of 2021, with 94 outbreak investigations initiated the week of Dec. 26, 2021, coinciding with the dominance of the first Omicron strain. This number has been steadily declining and over the past two months the number of new skilled nursing facilities outbreaks opened within a one-week period has ranged from one to 10.

Cumulatively, over the course of the pandemic, there have been more than 70,000 COVID-19 cases at skilled nursing facilities, nearly evenly divided between residents and staff; more than 4,000 deaths have been reported among residents highlighting the vulnerability of individuals receiving care at the sites. The proportion of COVID deaths among skilled nursing facility residents has dropped steadily since vaccinations became available.  In the summer of 2020, 58% of COVID deaths were among skilled nursing facility residents; in June of 2023, this number declined to 11%.

Currently, half of the 30 open outbreaks being investigated by Public Health are at skilled nursing facilities across the county.  Data on COVID-19 in skilled nursing facilities is reported regularly at ph.lacounty.gov/SNFdashboard.

One of the reasons for the significant declines in deaths is the significant number of residents and staff who are vaccinated: 89% of residents and 98% of staff at skilled nursing facilities completed the initial series. Currently, 70 percent of all residents and 48 percent of staff are up-to-date on their vaccines, meaning they have received the bivalent dose as well.

To help reduce transmission of COVID-19 among people living and working in skilled nursing facilities, Public Health is continuing to implement equity-driven strategies, with public health measures in place to help prevent COVID-19 infection. Whenever a resident or staff member tests positive for COVID-19, testing is required for anyone with close contact with that person. That may range from a small group of close contacts or everyone in the facility if there is a high level of exposure. Facilities are required to provide education about COVID-19 vaccines and offer all staff and residents the most recent COVID-19 vaccine recommended by the U.S. Centers for Disease Control and Prevention (CDC). A Los Angeles County Health Officer Order requires that all health care workers are vaccinated against COVID-19, including one booster.

Local reporting requirements mandate that a skilled nursing facility report any suspected outbreak within 24 hours by calling 888-397-3993 or 213-240-7821, or by filling out an online form. This allows Public Health to track cases, help with investigations, and provide resources.

Visitors to skilled nursing facilities are no longer required by Public Health to be vaccinated or test negative prior to visiting residents. However, individual facilities are granted the discretion to have these requirements as part of their policy to protect residents and staff.

To provide support, Public Health’s mobile vaccine teams regularly hold clinics at skilled nursing facilities to administer the bivalent COVID-19 vaccine to residents and staff. Public Health also distributes free COVID-19 test kits to facilities on a bi-weekly basis. To date, over 8.4 million tests have been distributed to County skilled nursing facilities. This summer, Public Health will offer free educational forums about infection prevention and control for skilled nursing facility staff.

Family members and friends should also take steps to prevent infection when visiting loved ones at skilled nursing facilities. If a person has any signs of respiratory illness, including coughing, sore throat, fever or headache, they should delay their visit until symptoms have passed. Taking a COVID-19 home test before a visit can provide extra assurance. The bivalent vaccine provides an additional layer of protection.

Free tests are available throughout Los Angeles County, including at libraries, through community based organizations, and for each person in a household covered by insurance, eight free tests are available per month at pharmacies. More information is available at ph.lacounty.gov/COVIDTests. If a person has a question about testing, possible symptoms, or has tested positive and needs telehealth services for treatment, the Public Health Call Center is available 7 days a week, from 8 a.m. to 8:30 p.m. at 1-833-540-0473.

“I would like to extend my deepest condolences to those who have lost a loved one to COVID-19. May you feel compassion surround you and find strength in your community during this difficult time,” said Dr. Barbara Ferrer, Ph.D., M.P.H., M.Ed., Director of the Los Angeles County Department of Public Health. “While I share in the relief that we are in a much less dangerous phase of the pandemic, I remain acutely aware that each day very vulnerable residents still die from COVID-19. I worry that some people think that COVID is gone and that common-sense precautions are no longer helpful.  Unfortunately, for some of our residents, particularly those residing in skilled nursing and long-term care facilities, sensible protections remain critically important to keep the risk of transmission low.  By taking advantage of the abundant access to personal protective equipment, tests, vaccines, and treatment, we can all do our part to making sure that our vulnerable family and friends can also enjoy the summer with less worry and lower risk.”

The CDC has replaced COVID-19 Community Levels with Hospital Admission Levels, which can help individuals and communities decide which prevention actions they can take based on the most recent information. Los Angeles County is in the Low Hospital Admission Level with 2.7 weekly COVID-19 hospital admissions per 100,000 people, reported on June 26 for the seven-day period ending June 21.

Public Health reports COVID-19 data weekly. The following table shows case, wastewater, emergency department, hospitalization, and death data in Los Angeles County over the past four weeks.   All metrics remain stable at levels of low concern.

Metric		Date of Weekly Report
	6/28/2023	6/21/2023	6/14/2023	6/7/2023
Weekly cases reported1,2	1,794	1,817	1,716	1,902
SARS-CoV-2 wastewater concentration as a percentage of the Winter 20222023 peak concentration value3	8%	10%	17%	10%
7-day average of the percent of Emergency Department (ED) encounters classified as coronavirusrelated3,4	2.4%	2.6%	2.7%	2.5%
7-day average number of COVIDpositive hospitalizations3,4	233	228	212	228
Weekly deaths reported2	28	25	36	46

• Case counts are an underrepresentation of the true number of infections, largely due to home tests which are not reported to DPH. Despite this, the trend in reported case counts from week to week is still an indicator of overall trends in transmission.
• Weekly case and death counts represent the number of cases and deaths reported for the week ending each Tuesday. The date a case/death is reported by DPH is not the same as the date of testing or death.
• Time periods covered by each metric: wastewater = week ending each Saturday, with a one-week lag; ED data = week ending each Sunday; hospitalizations = week ending each Saturday.  4) Data for past weeks is subject to change in future reports.

A wide range of data and dashboards on COVID-19 from the Los Angeles County Department of Public Health are available on the Public Health website at http://www.publichealth.lacounty.gov/COVIDdata including:

• COVID-19 Locations & Demographics (data by demographic characteristics and geography, active outbreaks, and citations)
• COVID–19 Response Plan
• COVID–19 Vaccinations
• Skilled Nursing Facility Metrics

Always check with trusted sources for the latest accurate information about novel coronavirus:

• Los Angeles County Department of Public Health:

http://publichealth.lacounty.gov/media/Coronavirus/

• California Department of Public Health: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/nCOV2019.aspx
• Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019https://www.cdc.gov/coronavirus/2019-ncov/index.htmlncov/index.html
• CDC Spanish https://espanol.cdc.gov/enes/coronavirus/2019–ncov/index.html
• World Health Organization https://www.who.int/health–topics/coronavirus
• LA County residents can also call 2-1-1

Cases through 12:00pm 6/26/2023
	Total Cases	NEW
Laboratory Confirmed Cases	3,755,601	1794
— Los Angeles County (excl. LB and Pas)	3,550,608	1664
— Long Beach	164,578	79
— Pasadena	40,415	51
Deaths	36,510	28
— Los Angeles County (excl. LB and Pas)	34,637	26
— Long Beach	1,420	0
— Pasadena	453	2
Age Group (Los Angeles County Cases Only-excl LB and Pas)
– 0 to 4	112,292
– 5 to 11	283,330
– 12 to 17	278,022
– 18 to 29	760,161
– 30 to 49	1,137,482
– 50 to 64	616,850
– 65 to 79	266,107
–  over 80	93,804
–  Under Investigation	2,560
Gender (Los Angeles County Cases Only-excl LB and Pas)
–  Female	1,832,680
–  Male	1,626,978
–  Other	1,852
–  Under Investigation	89,098
Race/Ethnicity (Los Angeles County Cases Only-excl LB and Pas)
–  American Indian/Alaska Native	6,729
–  Asian	264,727
–  Black	186,770
–  Hispanic/Latino	1,516,426
–  Native Hawaiian/Pacific Islander	17,778
–  White	493,366
–  Other	408,268
–  Under Investigation	656,544
Hospitalization (Los Angeles County Cases Only-excl LB and Pas)
–  Hospitalized (Ever)	178,721
Deaths Race/Ethnicity (Los Angeles County Cases Only-excl LB and Pas)
–  American Indian/Alaska Native	80
–  Asian	4,515
–  Black	3,254
–  Hispanic/Latino	16,914
–  Native Hawaiian/Pacific Islander	121
–  White	9,244
–  Other	419
–  Under Investigation	90