County weighs lessons of norovirus outbreak 

Health Department resources were pushed to the limit last month by an outbreak at the Bonnie Brae senior living facility of a highly contagious stomach flu that sent a handful of residents to the hospital for dehydration.

About 30 percent of the Health Department’s nurses were called into action when 90 people contracted the illness, known as norovirus, at the 164-unit Belmont facility in early December. The virus then spread quickly to other senior living and nursing facilities in the county, requiring visitor restrictions on many until Dec. 15, officials said.

About six Bonnie Brae residents were treated and released for severe vomiting, fever, diarrhea and dehydration, said Sarah Lambert, executive director of the Lesley Foundation, which manages Bonnie Brae and three other facilities in the county.

While health officials were able to respond quickly and effectively to the December outbreak, a second concurrent outbreak of comparable proportion would have been beyond the county’s capacity to handle, Morrow said. "That’s very concerning to me," county health officer Dr. Scott Morrow said, regarding the personnel "strain" the outbreak caused for his department.

"It’s a big deal," Morrow said.

In fact, the outbreak at Bonnie Brae — the largest serious outbreak at that type of facility — has exposed a serious weakness in the county’s "become self-sufficient" approach for facilities to treat communicable outbreaks.

It has also raised questions about how health officials would respond to such facilities in the event of a pandemic, Morrow said.

Unlike nursing homes, the dozens of facilities like Bonnie Brae in the county — essentially apartment complexes for seniors with communal dining and activity areas — are prevented from providing medical services on-site, Morrow said. Responsibility for such facilities — about 1,000 in the county, by Morrow’s estimate — thus falls to the county Health Department, which could be overrun if a large number of residents at several facilities fell ill, officials said.

Looking for ways to solve the gap, health officials have begun an institutional infection control program studying how local institutions and the county can better respond to similar outbreaks, Morrow said.

The county plans to publish a complete report this spring on Bonnie Brae and connected outbreaks, focusing on what worked and what needs improvement, Morrow said.

An apparent increase in the number and severity of norovirus outbreaks — including among 300 passengers and crew on the cruise ship Queen Elizabeth 2, which docked in San Francisco on Wednesday — has federal health officials looking into the cause, health officials said.

Riding out the symptoms is often the only method of recovery, which can be particularly tough on the young and elderly, according to Beverly Thames, spokeswoman for the county Health Department.

And worse, contracting the virus once does not make a person immune to it in the future, said Michelle Mussuto, spokeswoman for thestate Department of Health.

Facilities asked to report illnesses

Under new protocols issued by health officials following the norovirus outbreak at Bonnie Brae, senior living facilities have been asked to report resident illnesses to the county for the first time.

While not required to monitor or report illness among their tenants, they intend to do what they can, according to Sarah Lambert, executive director of the Lesley Foundation, which manages Bonnie Brae and three other facilities in the county. That will include checking in on residents who don’t show up for dinner or who their friends report not feeling well, Lambert said.

"The Health Department has asked us to notify them if we have more than two cases of gastroenteritis, flu or anything potentially contagious," Lambert said.

To prevent similar outbreaks in the future, health officials have also asked Bonnie Brae to institute regular bleach cleanings of doorknobs, kitchen counters and all common areas, according to health officials.

Additionally, the facility ordered dozens more meal trays and sufficient utensils for all residents so that meals can be carted door-to-door rather than requiring communal dining that could spread disease, Lambert said.

ecarpenter@examiner.com

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