COVID prepared long-term care facilities for norovirus threat

Five years after COVID-19 devastated California’s long-term care homes, experts say safety measures born out of the pandemic are shaping how facilities respond as a new virus variant spreads this winter.

By February 2021, residents of California long-term care facilities accounted for more than a quarter of all COVID-19 deaths. Vaccines and treatments have since eased the dangers posed by the pandemic, but viral threats have not disappeared.

A new norovirus strain, known as GII.17, spiked throughout the Bay Area last winter, according to wastewater monitoring that tracks disease trends. Experts say the strain spreads more efficiently than earlier versions of the so-called winter vomiting disease. Older adults are especially vulnerable, facing complications such as dehydration from gastrointestinal illnesses. As winter returns, the virus is again circulating, with high concentrations reported in the East Bay and on the Peninsula.

Experts say COVID-era safety provisions — including increased communication between facilities and health officials, updated inspections, changes in outbreak response and a more prominent role for infection prevention staff — are now central to how long-term care homes manage infectious disease.

Changing how facilities respond to suspected infections is critical because the close quarters of senior living centers make them uniquely vulnerable to outbreaks, said Dr. James Deardoff, a geriatrician at the San Francisco Campus for Jewish Living.

“One of the biggest shifts since COVID is that we’re much more proactive and much more standardized in our protocols,” Deardoff said. Residents with suspected infectious symptoms, for example, are now isolated and tested earlier than in the past.

The pandemic also underscored the need to balance infection control with residents’ quality of life. Strict room isolation helped prevent the spread of disease but caused social and emotional harm, a lesson that continues to inform policy decisions.

“There’s always a balance between resident rights and public health,” Deardoff said. “Even though people are living in a facility, they can still make certain choices.”

Along with many other facilities, Deardoff’s workplace now uses cohorting — grouping infected residents rather than isolating them individually — to limit spread while reducing isolation. Other strategies include staggered dining schedules, spacing tables farther apart and eliminating shared items.

Facilities have also become more cautious when transferring residents with symptoms such as vomiting or diarrhea between buildings.

At the height of the pandemic, public health officials began sending monthly updates and hosting statewide calls to share guidance with health care providers, said DeAnn Walters, director of clinical affairs and quality improvement at the California Association of Health Facilities. Those communications continue, she said, including updates on emerging viruses.

To ensure guidance is followed, Theresa Mier, a spokesperson for the California Department of Social Services, said reviews of infection-control practices — including masking and handwashing — are now part of every annual inspection.

Five years after the height of the pandemic, many facilities employ dedicated infection preventionists to monitor outbreaks, audit hygiene and protective-equipment use, and ensure protocols are followed, Deardoff said.

“Before COVID, we had people in that role, but it often wasn’t their main job,” he said. “Now it’s a much more prominent, defined position.”