San Francisco, CA — Mayor London N. Breed and Director of Health Dr. Grant Colfax today announced the next phase in the City’s expansion of coronavirus testing that will focus on and protect San Francisco’s most vulnerable populations during the ongoing pandemic. The new directive will require all residents and staff working at the 21 skilled nursing facilities (SNFs) in San Francisco be tested for the COVID-19 virus. The City will begin testing all residents and staff at SNFs next week, with a goal of creating a two-week testing cycle after the first round of tests are completed. 

Universal testing is one of a series of resources that the Department of Public Health (DPH) is providing to the City’s SNFs. DPH resources for SNFs include guidance on the prevention and management of COVID-19 in long‑term care facilities as well as a new set of protocols on outbreak preparedness and response. The testing program and these resources build on the lessons learned from the swift response to the outbreak at Laguna Honda, and the expert support and guidance from the Centers for Disease Control and Prevention and the California Department of Public Health.

The SNF testing program will be detailed in an upcoming Health Order. It is consistent with new testing guidelines issued by the California Department of Public Health that include screening of asymptomatic residents and workers of congregate living facilities such as skilled nursing facilities.

“Since this public health emergency began, protecting vulnerable populations living in skilled nursing facilities has been one of our top priorities,” said Mayor Breed. “We responded quickly to the outbreak at Laguna Honda, and we’ve learned a lot during our ongoing response that can help the other skilled nursing facilities in the city. Complete testing of staff and residents in all of San Francisco’s skilled nursing facilities is the next step in our commitment to vulnerable populations and universal access to testing.”

“Our vision is to have universal access to testing for all in San Francisco,” said Dr. Colfax. “To get there, we have continually expanded testing, based on where the need is greatest, and the availability of resources. We have focused first on mitigating outbreaks, protecting vulnerable populations, following case contact investigations and testing of frontline workers. As we have made progress in those areas, we grew to test everyone with symptoms, and we are expanding again. Testing asymptomatic residents and staff of skilled nursing facilities is a decisive move to protect these most vulnerable people, and their care givers, who are at high risk of an outbreak.”

Skilled Nursing Facilities are among the top priorities in the City’s efforts to mitigate and respond to COVID-19 outbreaks. There are 21 SNFs in San Francisco, including Laguna Honda Hospital, a SNF unit at Zuckerberg San Francisco General Hospital, and the VA Hospital. All SNFs serve some of San Francisco’s most vulnerable populations including older adults and residents with underlying health conditions. Additionally, the congregate nature of these facilities means residents are living near each other and have extensive casual and close contact with fellow inhabitants and facility staff. Once introduced into a facility, COVID-19 can spread rapidly, and residents are at high risk of becoming seriously ill, or even dying, if they become sick. Early on, the City issued a Health Order restricting all non-essential visitors from skilled nursing facilities in order to protect the residents and staff from exposure.

As the City works toward its goal of universal testing access, the next step will be testing people without symptoms, starting with residents and staff of all SNFs. The City will continue to add other congregate settings, such as shelters. The City will also test asymptomatic health care workers, frontline workers and essential workers. Lastly, the City will continue conducting testing in geographic and cultural communities that are affected by disparities in the spread of the coronavirus.

As long as COVID-19 is circulating in the community, residents and staff of skilled nursing facilities remain at risk. Testing determines on a certain date who is COVID-19 positive and allows SNFs to immediately implement protocols, including isolation and quarantine, screening, testing and infection control procedures. Surveillance and monitoring remain central to containing the coronavirus and are not replaced by this new testing program.

Although testing is a critical tool to find and confirm asymptomatic COVID-19 positive cases, it is just one aspect of being prepared and able to respond. DPH has created a new set of outbreak protocols in a “tool kit” for SNFs that offers an array of strategies to mitigate outbreaks and transmission. Testing is one piece of a larger strategy that also includes prevention, such as social distancing, frequent hand washing, appropriate use of personal protective equipment, and other recommended precautions.

The first round of complete SNF testing will take approximately one month and will primarily be administered by DPH staff. Testing starts on Monday, May 4^th at Laguna Honda Hospital. During the first round of citywide testing, DPH will train personnel at other facilities as needed so that they can begin administering the tests on their own. Once all facilities have been tested, the goal is to establish a regular testing cycle about every two weeks, based on what is currently known about the virus’s incubation period. Testing science and technology is rapidly evolving and will continue to inform our response and testing strategy. As more information becomes available about the virus, the testing schedule may adjust.

San Francisco began local COVID-19 testing in the Public Health Lab on March 2, 2020, and has been continually expanding testing capacity. As of today, 20,433 people in San Francisco have been tested, and an average of 9% have tested positive.

Below are a few examples of the City’s testing expansion to date:

• The City opened two CityTestSF sites for health care workers, frontline workers, essential workers and other San Franciscans with symptoms.
• DPH has opened test sites in the community at Zuckerberg San Francisco General Hospital, Castro-Mission Health Center, Southeast Health Center and Maxine Hall Health Center. In addition, DPH Jail Health Services tests all people coming into the jail who will be housed in jail.
• Those DPH test sites are part of a growing capability including 26 testing sites across the city, at UCSF, NEMS, One Medical, Kaiser, Sutter, Chinese Hospital, and Dignity Health.
• The City is working with partners, such as UCSF and the Chan Zuckerberg Initiative, on COVID-19 testing. There is research underway that uses testing to help us learn more about the prevalence of the virus in the community.

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