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January 12, 2021
Don Juan's Other Reckless Daughter
Mayor's Reckless Nursing Home COVID Reporting
by Patrick Monette-Shaw
As I wrote last November, Mayor London Breed — aided and abetted by Dr. Grant Colfax and the Department of Public Health — has failed miserably when it came to reporting COVID cases in San Francisco’s skilled nursing facilities (SNF’s), which data is more robustly publicly available elsewhere. It should be easily and readily available on local government web sites.
To repeat, it took until November 6 — fully eight months after Breed shut down Laguna Honda Hospital to visitors and then issued her first COVID-19 Shelter-in-Place order — before DPH under Breed’s reckless watch began publicly reporting data about COVID cases in San Francisco’s SNF’s on DPH’s COVID Data Tracker web site.
When DPH did begin reporting limited local SNF COVID data on-line in November on its new “COVID-19 in Skilled Nursing Facilities (SNFs)” web page, DPH decided to present data only on the number of COVID cases among residents of the 19 SNF’s in the City, eliminating reporting cumulative case reporting for healthcare workers (staff) at the 19 facilities.
That was patently ridiculous, because on-line data published on both the federal Centers for Medicare and Medicaid Services (CMS) and California’s Department of Public Health (CADPH) web sites have been presenting data reporting COVID cases and deaths for both SNF residents and SNF staff all along.
For good measure, DPH decided to pad its SNF data by including COVID cases from the SNF operated by the VA Medical Center located on Clement Street near 40th Avenue. That’s ridiculous, first because those SNF beds are reserved only for armed services members who have received a service-related disability determination, and excludes those who have served in the military but do not have a documented service-related disability; and second, because that facility is not licensed as a SNF by the State of California since it is a federal facility, and is not included in COVID SNF reporting on either the CMS or CADPH web sites.
Reckless COVID Case Discrepancies
It’s crucial that members of the public, and families of patients in SNF’s, receive accurate and up-to-date information about COVID cases in local skilled nursing facilities, in part to decide whether the risk of acquiring COVID in a SNF warrants taking their relatives out of a problematic SNF for safety reasons.
Not only does DPH’s on-line “COVID-19 in Skilled Nursing Facilities” web page exclude reporting COVID cases among SNF staff, but it also reports resident cases in the 19 (to 20) SNF’s into a single aggregate summary.
Ideally, DPH should be releasing and publishing up-to-date resident and staff COVID cases for each individual SNF on-line, since each SNF is required to provide daily updates to DPH. Displaying public data for the 19 separate SNF’s is not rocket science and would not require very much effort by DPH staff to maintain and update daily.
As of Tuesday, January 12 DPH reported 487 cumulative COVID cases and 53 COVID-related deaths for residents across the 20 SNF’s, but the edited screen shot shown here indicates that data was for the period ending December 31, 2020 — fully 12 days ago. By contrast, CMS’ web site reported data through December 27 that became available on January 7 publicly reported there were 298 cumulative COVID cases among residents across the 19 SNF’s in San Francisco and 50 deaths.
The difference between CMS’ data ending December 27 vs. data DPH is itself reporting through December 31 represents an increase of three resident deaths, and a whopping 189 additional resident COVID cases across those four days. It will take some time before the CMS data reports the same data as DPH reported for December 31.
More than likely, the 487 COVID cases among SNF residents DPH reported on January 12 is now far higher, given the surge in cases now underway and the likelihood the British COVID variant has probably been long on the loose in the Bay Area.
The screen shot also misrepresents the percentage of deaths among SNF residents to all COVID deaths in San Francisco. The 24% reported appears to use a more recent denominator for the 53 SNF resident deaths as of December 31. In reality, there were actually 194 total COVID deaths in San Francisco, so using 194 as the denominator means that the 53 SNF deaths as of December 27 represented 27.3% of all COVID deaths in the City, not 24%. This is but one example of SFDPH fudging its numbers.
DPH claims the data it presents on its SNF page needs a seven-day lookback lag period — compared to just a three-day lag for most all other COVID reporting elsewhere on its larger COVID Data Tracker web site. For example, the data reported on January 12 for Sexual Orientation cases on SFDPH’s COVID Data Tracker web site is updated daily and only lags back to January 9. If DPH can use a three-day look back period for most of the subsets of data it updates daily, it should use the same three-day lookback for reporting SNF data, which should also be updated daily — not 12 days or longer and only updated twice a week, on Wednesday’s and Friday’s.
To the extent San Francisco’s Board of Supervisors mandated that DPH publish sexual identity data on DPH’s COVID Data Tracker web site, the Board of Supervisor should mandate that DPH list the data for each of the 19 SNF’s and be updated daily.
LHH's Family and Resident COVID Reporting
The federal CMS web site provides COVID data for each of the 15,000 SNF’s nationwide; CMS has an 11-day lag in case reporting. The most recent CMS data for the week ending December 27 became available for download on Thursday January 7, reporting there were 103 cumulative COVID cases among LHH staff, and 32 cumulative cases among residents.
However, LHH’s resident/family web page that I just inadvertently stumbled across, which had only recently become available, reported that as of January 8 there had been 149 staff and 53 resident cumulative cases. That represented an increase of 46 staff infections and 21 resident cases since the December 27 CMS report.
Four days later on January 12, the LHH resident/family web page reported that as of January 11 there were 157 cumulative staff COVID cases at LHH and 58 resident cases, another increase of eight more staff and five more residents across just three days since January 8. That’s an increase of 54 cumulative COVID staff cases and an increase of 26 cumulative resident cases since December 27.
To the extent LHH can update its resident/family COVID information web page daily, why is it the SFDPH only updates its SNF facility web site just twice a week, with an excessive lag in daily reporting?
I have to wonder how long it is going to take CMS to report updated LHH data for the week ending January 14.
So much for Breed’s reckless claim LHH was a national model on how to prevent the spread of COVID cases in SNF’s!
Monette-Shaw is a columnist for San Francisco’s Westside Observer newspaper, and a member of the California First Amendment Coalition (FAC) and the ACLU. He operates stopLHHdownsize.com. Contact him at email@example.com.
The day after this article was submitted for publication, SFDPH updated its “COVID-19 in Skilled Nursing Facilities (SNFs)” web page on January 13, reporting case data through January 5, 2021 — given the seven-day lag DPH claims is needed for data validation. DPH should have provided data through January 6. That web page only reports SNF resident cases, and excludes any mention about SNF staff infections.
CMS reported that through December 27, there was a cumulative total of 379 staff COVID infections across the 19 SNF’s. SFDPH’s COVID in SNF’s web page mentions nothing about staff infections at all.
The data through January 5 reported a total of 564 cumulative resident COVID cases among residents and 59 COVID-related resident deaths across the 20 SNF’s. The previous update dated December 31 had reported 487 cumulative cases and 53 resident deaths from COVID.
That means in the intervening five days between the two most-recent reports, there were 77 additional SNF patient COVID infections and six more patient COVID deaths.
Again, CMS had reported that as of the week ending December 27, there were just 298 cumulative resident COVID infections in the 19 SNF’s and 50 deaths. So, SFDPH’s January 5 data suggests that in the nine days between December 27 and January 5 there were an additional 266 resident COVID infections (to 564) and nine additional COVID patient deaths in San Francisco’s 19 SNF’s.
Five of the additional nine patient deaths appear to have been residents of LHH, because CMS’ data reported LHH had one COVID patient death as of December 27 and LHH’s new Resident/Family COVID-19 Information Page web page reported a total of six COVID patient deaths as of January 13.
The Board of Supervisors needs to rapidly mandate that SFDPH immediately address its recklessly anemic SNF data reporting on-line by improving data reported, including — at minimum — cumulative SNF staff infections by facility name, and resident cases and deaths by facility name, and do so daily, not twice a week.