O F FI CE OF T H E M A Y OR
S A N F RA N C I S C O

L O ND O N N. B RE E D
MAYOR

March 27, 2020
Assistant Secretary for Preparedness and Response Robert Kadlec
U.S. Department of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Re: Requesting Support Containing and Investigating a COVID-19 Outbreak at
City and County of San Francisco Skilled Nursing Facility
Dear Assistant Secretary Kadlec,
In response to the novel coronavirus (COVID-19) pandemic, San Francisco has advanced
extraordinary measures to immediately expand health care capacity in our hospitals and facilities,
eliminate bureaucracy to fast track hiring practices, and develop programs to support our impacted
small businesses and our workforce. We have been in constant contact with our state, federal, and
private sector partners to secure whatever medical supplies we can find. Here in San Francisco, we
have declared a local State of Emergency and issued a Shelter In Place order. Yet, the work we are
doing locally to protect the public’s health and prepare for the expected patient surge is not enough.
The City and County of San Francisco owns and operates Laguna Honda Hospital, a 780-bed
skilled nursing facility, one of the largest in the country. As of today, March 27, six employees and
one skilled nursing resident have tested positive for COVID-19. We have taken immediate actions
to protect residents at Laguna Honda Hospital through investigation and containment strategies,
including mass testing of staff and patients on the affected unit. We have restricted non-essential
visitors, screened staff for illness at the start of each shift, and improved infection control. We have
also limited floating staff from one unit to another to reduce the opportunity for the virus to spread
and increased our health checks on residents. This week, our local Health Officer ordered a
protective quarantine, which prohibits residents from leaving campus. Despite these efforts, sadly,
we expect an outbreak at this location.
What we have seen from outbreaks in similar facilities, such as in Washington State, will only be
magnified at Laguna Honda Hospital. We urgently request the additional resources below in order
to accelerate our response to slow the spread of COVID-19 by protecting our vulnerable skilled
nursing residents and health care workers:
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Four Infection Control Nurses (must be Registered Nurses (RN) trained in infection control
with clinical or hospital background);
Ten public health professionals who are able to conduct contact tracing for outbreak
investigations. This role requires individuals who are professional and able to conduct
interviews with infected and exposed individuals. Ideally individuals should have prior
experience, but the San Francisco Department of Public Health is ready to provide necessary
training;

1 DR. CARLTON B. GOODLETT PLACE, ROOM 200
SAN FRANCISCO, CALIFORNIA 94102-4681
TELEPHONE: (415) 554-6141

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25 testing personnel, including five respiratory therapists and healthcare workers.
San Francisco Department of Public Health will provide staff with just-in-time training and
appropriate Personal Protective Equipment;
A surveillance team consisting of four epidemiologists and two laboratory staff to determine
prevalence and spread during the course of the outbreak;
40,000 flocked oropharyngeal and nasopharyngeal swabs and 10,000 vials;
Five Medical Doctors (MDs) who practice internal medicine or family medicine, and who are
clinically active and able to see patients;
30 Registered Nurses;
10 Licensed Vocational Nurses; and
20 Personal Care Aides.

Thank you for your attention to this pressing situation and we look forward to your partnership as
we come together to deal with this unprecedented health crisis. Urgent action is needed now to save
lives. If you have further questions, please contact Dr. Grant Colfax, Director of the San Francisco
Department of Public Health at grant.colfax@sfdph.org.
Sincerely,

London N. Breed
Mayor
cc: The Honorable Mike Pence, Vice President of the United States of America
The Honorable Nancy Pelosi, Speaker of the U.S. House of Representatives
The Honorable Jackie Speier, U.S. House of Representatives
The Honorable Dianne Feinstein, U.S. Senate
The Honorable Kamala Harris, U.S. Senate
The Honorable Gavin Newsom

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