latimes--2020-04-01--Farmworkers face coronavirus risk: 'You can't pick strawberries over Zoom'

Before heading out with his crew of farmworkers , field lead Carlos Garcia donned a blue button-up shirt , a jacket , jeans and work boots .
He washed his hands before slipping gloves over them .
He washed his hands when he got to the orange grove near Visalia in the San Joaquin Valley , where pickers filled nearly 100 bins with Cara Cara oranges on a recent sunny morning .
He washed his hands before and after using the restroom .
He washed his hands before he left the ranch .
When he got home , he walked @ @ @ @ @ @ @ his clothes and threw them into the wash before hopping in the shower .
It was Garcia ’ s new regimen as he and thousands of other California farm laborers , many of them immigrants , adjust to the age of coronavirus .
Despite being 73 with diabetes , Garcia couldn ’ t afford to stop working .
His employer hadn ’ t said anything about the virus to workers , provided them with extra protective gear or supplied extra hand-washing stations , he said .
He worried about catching it and passing @ @ @ @ @ @ @ grandchildren , who constantly fill his home .
“ There ’ s never any attention paid to the campesino , ” he said — to the field worker .
“ God blesses us .
We can ’ t do anything else .
“ No one wants to die.
” More than a third of the country ’ s vegetables and two-thirds of its fruits and nuts are grown in California .
Shelter-in-place orders in California exempt farm workers as essential employees .
But many are undocumented , lack health insurance and don ’ @ @ @ @ @ @ @ COVID-19 relief , placing the state ’ s estimated workforce of 420,000 in a vulnerable position .
The United Farm Workers union has called on agricultural employers to protect workers from the coronavirus by extending sick leave , eliminating wait periods for sick pay eligibility , increasing cleaning of frequently touched surfaces and offering assistance with childcare amid school closures .
Some employers have issued identification cards or letters for workers to show law enforcement if they are pulled over going to or from a job site .
Some have taken further steps @ @ @ @ @ @ @ social separation , assigning workers to every other row of crops , supplying extra hand-washing stations and expanding sick leave beyond the three days mandated by the state .
Lucas Zucker , policy and communications director at the workers ’ advocacy group Central Coast Alliance United for a Sustainable Economy , said he worries that those directives might not trickle all the way down to each farmworker , especially at big companies with thousands of employees .
“ There are some inherent challenges in the agriculture industry that during these disasters become really @ @ @ @ @ @ @ The layers of contracting and subcontracting .
Messages get lost along the way .
Safety directives seem like they ’ re coming strong from the top but by the time they reach workers in the fields it ’ s like a game of telephone.
” For workers on the Central Coast , Zucker said , this is the worst possible time to face a health crisis .
As peak strawberry season ramps up next month , pay switches from hourly to piece rate , he said .
Pickers are incentivized to work hard @ @ @ @ @ @ @ of their own health .
Spending 20 seconds washing their hands could feel like an eternity .
“ You can ’ t pick strawberries over Zoom , ” he said .
Distancing requirements have made it particularly challenging to get information about coronavirus to workers who speak indigenous languages .
In mid-March , residents began asking advocates at the Mixteco/Indigena Community Organizing Project in Oxnard why supermarket shelves were suddenly empty and why smaller grocery stores were selling packs of bottled water that normally cost $ 3 for $ 13 .
Associate director @ @ @ @ @ @ @ pulling information from the CDC website , translating it to Mixteco , Zapoteco and Purepecha and recording public safety announcements , which have aired on MICOP ’ s radio station : Radio Indigena 94.1 FM .
The announcements , which are 15 minutes long and run several times a day , explain basics about the virus , instructions on proper hand washing , and how to look out for and report illegal price gouging of items like bottled water .
Around 3,000 people listen to the station per day , she said .
@ @ @ @ @ @ @ those languages rely heavily on context .
Unlike in Spanish , for example , there is no word for virus in Mixteco , so the sickness must instead be described in detail .
About half of farm workers between Oxnard and Watsonville are indigenous , she said .
Farm workers in California make $ 26,000 per year , on average , according to the U.S. Bureau of Labor Statistics .
Many families share a home with other families and drive to work in crowded vehicles , making social distancing difficult .
Health issues @ @ @ @ @ @ @ common among workers , Flores-Haro said .
Her goal is to make sure they aren ’ t left exposed .
“ These inequities that our families are living with , they ’ ve always been there , ” she said .
“ But when things like the wildfires happen , when things like a global pandemic happen , you really get to see those disparities laid bare.
” Lucy Cruz Lopez ’ s biggest concern amid the pandemic is making ends meet .
She has worked for the same strawberry farm in Oxnard @ @ @ @ @ @ @ s at work , her 16-year-old daughter watches over her three younger siblings .
They live an hour ’ s walk from school — too far away to grab the free lunches that are offered there on weekdays .
Pressured by the collective panic over the virus , Cruz Lopez spent the $ 200 she had in savings on extra food .
Now she worries about paying her $ 1,500 rent .
When it comes to her health , Cruz Lopez said she is doing what she can to protect herself .
On @ @ @ @ @ @ @ children don ’ t leave their one-bedroom apartment except to buy groceries .
She stays informed through advocates at CAUSE and shares the news with friends and neighbors who speak her native Zapoteco but aren ’ t fluent in Spanish , as she is .
But total social distancing isn ’ t possible .
She doesn ’ t know how to drive , so she depends on her sister-in-law for rides to work .
Cruz Lopez said her employer hasn ’ t mentioned the virus .
On an overcast day last week , @ @ @ @ @ @ @ song by Romeo Santos played from a loudspeaker .
Some workers were separated by several rows .
But one man in blue latex gloves labored in the row directly next to hers .
“ They say the virus comes from the air you breathe , ” she said .
“ But I have to work.
” Some growers have taken proactive and creative steps to support their employees .
Since early March , Brokaw Ranch and Nursery co-owner Ellen Brokaw has participated in weekly video conference meetings with other players in the Central @ @ @ @ @ @ @ during the pandemic .
The group includes four farmers , two farmworker advocates , the local agricultural commissioner , the president of the local farm bureau , a lawyer on the Agricultural Labor Relations Board and two employees with the Ventura County farmworker resource program .
Brokaw said the most crucial point is for employers to communicate early and often to ensure that employees have up-to-date , credible information .
“ The hardest thing maybe for everybody in this is that we have no idea how long it ’ s going to go @ @ @ @ @ @ @ We have to prepare for a long haul and hope that it ’ s not.
” With cherry season still a month away , leaders at Warmerdam Packing in Hanford , which grows and packs plums , kiwis and cherries , are devising coronavirus safety plans before they go from overseeing 100 workers to 1,000 .
They started by hiring a temporary infectious disease risk-assessment specialist and rolling out extra training .
Now they ’ re analyzing how to reduce pack lines , which are usually staffed with 100 people per shift , @ @ @ @ @ @ @ And at Reiter Affiliated Companies , the largest berry grower in the world and the leading supplier for Driscoll ’ s , Chief Executive Hector Lujan said he ’ s been on daily calls with a crisis management team for a month .
The company is developing take-home kits including toilet paper , cleaning supplies , hand sanitizer and soap so workers won ’ t have to struggle to find those items in grocery stores , he said .
Employees have received printed cards that identify them as essential workers , Lujan said @ @ @ @ @ @ @ serious health risks and recommending that they stay home .
They ’ ve expanded paid sick leave from three days to 10 days .
The company also dropped the $ 5 copay for workers to visit its healthcare clinic .
Lujan said his priority is keeping workers healthy and maintaining industry stability .
“ They ’ re essential today to the food supply — they ’ ve always been , but now there ’ s a new level of light shining on them , ” he said .
“ If people are fighting @ @ @ @ @ @ @ had to fight for food .
”

Before heading out with his crew of farmworkers, field lead Carlos Garcia donned a blue button-up shirt, a jacket, jeans and work boots. He washed his hands before slipping gloves over them.
He washed his hands when he got to the orange grove near Visalia in the San Joaquin Valley, where pickers filled nearly 100 bins with Cara Cara oranges on a recent sunny morning. He washed his hands before and after using the restroom. He washed his hands before he left the ranch.
When he got home, he walked in through the garage, stripped off his clothes and threw them into the wash before hopping in the shower. It was Garcia’s new regimen as he and thousands of other California farm laborers, many of them immigrants, adjust to the age of the coronavirus.
Despite being 73 with diabetes, Garcia couldn’t afford to stop working. His employer hadn’t said anything about the virus to workers, provided them with extra protective gear or supplied extra hand-washing stations, he said.
He worried about catching it and passing it to his five children and 12 grandchildren, who constantly fill his home.
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Carlos Garcia, 73, is being extra cautious amid the coronavirus pandemic because of his age and the fact that he suffers from diabetes. He now wears long sleeves and gloves at all times. (Tomas Ovalle / For the Times)
“There’s never any attention paid to the campesino,” he said — to the field worker. “God blesses us. We can’t do anything else.
“No one wants to die.”
More than a third of the country’s vegetables and two-thirds of its fruits and nuts are grown in California. Stay-at-home orders in California exempt farmworkers as essential employees. But many are undocumented, lack health insurance and don’t qualify for unemployment insurance or federal COVID-19 relief, placing the state’s estimated workforce of 420,000 in a vulnerable position.
The United Farm Workers union has called on agricultural employers to protect workers from the coronavirus by extending sick leave, eliminating wait periods for sick pay eligibility, increasing cleaning of frequently touched surfaces and offering assistance with child care amid school closures.
Some employers have issued identification cards or letters for workers to show law enforcement if they are pulled over going to or from a job site. Some have taken further steps, including staggering lunch breaks to encourage social separation, assigning workers to every other row of crops, supplying extra hand-washing stations and expanding sick leave beyond the three days mandated by the state.
Lucas Zucker, policy and communications director at the workers’ advocacy group Central Coast Alliance United for a Sustainable Economy, said he worries that those directives might not trickle all the way down to each farmworker, especially at big companies with thousands of employees.
Excelsior Farming in Hanford conducts a presentation for employees on safety protocols during the coronavirus pandemic. (Tomas Ovalle / For the Times)
Carlos Garcia washes his hands at an orange orchard near Reedley in the San Joaquin Valley. More than himself, he said he worries about infecting one of his grandchildren if he were to contract the virus. (Tomas Ovalle / For the Times)
“There are some inherent challenges in the agriculture industry that during these disasters become really magnified,” he said. “The layers of contracting and subcontracting. Messages get lost along the way. Safety directives seem like they’re coming strong from the top, but by the time they reach workers in the fields it’s like a game of telephone.”
For workers on the Central Coast, Zucker said, this is the worst possible time to face a health crisis. As peak strawberry season ramps up next month, pay switches from hourly to piece rate, he said. Pickers are incentivized to work hard and fast, sometimes at the cost of their own health. Spending 20 seconds washing their hands could feel like an eternity.
“You can’t pick strawberries over Zoom,” he said.
Distancing requirements have made it particularly challenging to get information about the coronavirus to workers who speak indigenous languages. In mid-March, residents began asking advocates at the Mixteco/Indigena Community Organizing Project in Oxnard why supermarket shelves were suddenly empty and why smaller grocery stores were selling packs of bottled water that normally cost $3 for $13.
Crescenciano Calleja picks oranges at an orchard near Reedley in the San Joaquin Valley. (Tomas Ovalle / For the Times)
Associate Director Genevieve Flores-Haro said the nonprofit responded by pulling information from the Centers for Disease Control and Prevention website, translating it to Mixtec, Zapotec and Purepecha and recording public safety announcements, which have aired on the group’s radio station: Radio Indigena 94.1 FM.
The announcements, which are 15 minutes long and run several times a day, explain basics about the virus, instructions on proper hand washing, and how to look out for and report illegal price gouging of items like bottled water. Around 3,000 people listen to the station a day, Flores-Haro said.
She said the translations were crucial because those languages rely heavily on context. Unlike in Spanish, for example, there is no word for “virus” in Mixtec, so the sickness must instead be described in detail. About half of farmworkers between Oxnard and Watsonville are indigenous, she said.
The Calleja brothers leave work at an orange orchard near Reedley in the San Joaquin Valley. (Tomas Ovalle / For the Times)
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Farmworkers in California make $26,000 a year, on average, according to the U.S. Bureau of Labor Statistics. Many families share a home with other families and drive to work in crowded vehicles, making physical distancing difficult. Health issues, including asthma and diabetes, are common among workers, Flores-Haro said. Her goal is to make sure they aren’t left exposed.
“These inequities that our families are living with, they’ve always been there,” she said. “But when things like the wildfires happen, when things like a global pandemic happen, you really get to see those disparities laid bare.”
Lucy Cruz Lopez’s biggest concern amid the pandemic is making ends meet. She has worked for the same strawberry farm in Oxnard for 13 years.
While she’s at work, her 16-year-old daughter watches over her three younger siblings. They live an hour’s walk from school — too far away to grab the free lunches that are offered there on weekdays.
Pressured by the collective panic over the virus, Cruz Lopez spent the $200 she had in savings on extra food. Now she worries about paying her $1,500 rent.
A farmworker washes her hands at an orange orchard in Visalia. (Tomas Ovalle / For the Times)
When it comes to her health, Cruz Lopez said, she is doing what she can to protect herself. On her off time, she and the children don’t leave their one-bedroom apartment except to buy groceries. She stays informed through advocates at the Central Coast Alliance and shares the news with friends and neighbors who speak her native Zapotec but aren’t fluent in Spanish, as she is.
But total social distancing isn’t possible. She doesn’t know how to drive, so she depends on her sister-in-law for rides to work.
Advertisement
Cruz Lopez said her employer hasn’t mentioned the virus. On an overcast day last week, she picked strawberries while a popular bachata song by Romeo Santos played from a loudspeaker. Some workers were separated by several rows. But one man in blue latex gloves labored in the row directly next to hers.
“They say the virus comes from the air you breathe,” she said. “But I have to work.”
Some growers have taken proactive and creative steps to support their employees.
Since early March, Brokaw Ranch and Nursery co-owner Ellen Brokaw has participated in weekly videoconference meetings with other players in the Central Coast agricultural industry to strategize best practices during the pandemic. The group includes four farmers, two farmworker advocates, the local agricultural commissioner, the president of the local farm bureau, a lawyer on the state Agricultural Labor Relations Board and two employees with the Ventura County farmworker resource program.
Brokaw said the most crucial point is for employers to communicate early and often to ensure that employees have up-to-date, credible information.
“The hardest thing maybe for everybody in this is that we have no idea how long it’s going to go on,” she said. “We have to prepare for a long haul and hope that it’s not.”
Advertisement
With cherry season still a month away, leaders at Warmerdam Packing in Hanford, which grows and packs plums, kiwis and cherries, are devising coronavirus safety plans before they go from overseeing 100 workers to 1,000. They started by hiring a temporary infectious disease risk-assessment specialist and rolling out extra training. Now they’re analyzing how to reduce pack lines, which are usually staffed with 100 people per shift, said human resources manager Natalie Martinez.
And at Reiter Affiliated Cos., the largest berry grower in the world and the leading supplier for Driscoll’s, Chief Executive Hector Lujan said he’s been on daily calls with a crisis management team for a month. The company is developing take-home kits including toilet paper, cleaning supplies, hand sanitizer and soap so workers won’t have to struggle to find those items in grocery stores, he said.
Employees have received printed cards that identify them as essential workers, Lujan said. Managers have begun identifying people with serious health risks and recommending that they stay home. They’ve expanded paid sick leave from three days to 10 days. The company also dropped the $5 copay for workers to visit its healthcare clinic.
Lujan said his priority is keeping workers healthy and maintaining industry stability.
“They’re essential today to the food supply — they’ve always been, but now there’s a new level of light shining on them,” he said. “If people are fighting over toilet paper, imagine if they had to fight for food.”


latimes--2020-04-01--As coronavirus tears through nursing homes, families face an impossible choice

Olivia Labrador ’ s mind started racing last week after she received a call from her 89-year-old father ’ s nursing home , Garden Crest Rehabilitation Center in Silver Lake , informing her that a patient at the facility had tested positive for the coronavirus .
“ Oh my God , ” Labrador thought , picturing patients she ’ d seen on breathing machines in the past .
“ What ’ s going to happen to all of them ?
” Labrador ’ s family considered their options .
They could bring her father home , but they worried he @ @ @ @ @ @ @ virus that causes COVID-19 , which would put other vulnerable relatives at risk .
As some experts advise pulling loved ones out of nursing homes to save them from the pandemic , Labrador and her family faced an awful dilemma , one that would have seemed unimaginable a month ago .
But they are far from alone .
Across the country , outbreaks are occurring in nursing homes at terrifying speed — leading administrators to ban visitors , confine patients to their rooms and scramble to create sterile wings to treat residents who @ @ @ @ @ @ @ stakes are literally life and death , since residents , who are elderly and almost always have underlying health problems , are among the most vulnerable to the lethal new pathogen .
Hundreds of long-term care facilities in the U.S. now have residents who are infected with the virus .
On Tuesday , health officials in Washington state alone reported 108 outbreaks at long-term care facilities .
And at a single nursing home in Tennessee , more than 100 residents have tested positive .
In Connecticut , state officials are re-opening previously closed @ @ @ @ @ @ @ for residents who are positive for COVID-19 — like modern-day leper colonies .
The “ extreme precaution ” is warranted , according to Connecticut officials , because the results can be catastrophic when the virus gets loose among such a vulnerable population .
One of the first coronavirus hot spots in the U.S. was at the Life Care Center nursing home in Kirkland , Wash. , where two-thirds of the residents and 47 workers fell ill , and 37 people died .
The worrisome national trend is picking up steam in Southern California @ @ @ @ @ @ @ Angeles County health officials announced that Garden Crest was among 11 area nursing homes with outbreaks , meaning three or more cases involving residents or staff had been confirmed at the facility .
That was nearly quadruple the number of nursing-home outbreaks county officials had announced on Friday .
The county ’ s Department of Public Health is also investigating reports of at least one suspected coronavirus infection at nine additional nursing homes .
Of the county ’ s 54 deaths from coronavirus , at least six have been nursing-home residents .
Debbie @ @ @ @ @ @ @ the Kensington in Redondo Beach , another of the L.A. County facilities battling an outbreak .
When Alexander heard about the first case from administrators , she considered pulling her mom out , but there was nowhere available to move her that would necessarily be safer .
Alexander , who is still going to work at a research laboratory at a San Diego hospital , worries she might infect her mother if they were living together .
While she ’ s nervous , Alexander said , she ’ s satisfied with the measures @ @ @ @ @ @ @ try to control the outbreak .
They are not allowing visitors to enter , and residents are mostly confined to their rooms .
Residents ’ temperatures are taken twice per day .
And administrators are sending a daily email update .
“ Obviously , I ’ m worried about Mom .
She ’ s very high-risk .
But I think they are doing everything they can , ” Alexander said .
Len Maisch , 84 , said he moved into the Kensington about five weeks ago to care for his wife Joann , @ @ @ @ @ @ @ fatal and degenerative brain disease .
They sold their Hermosa Beach home , a beloved place with citrus trees , when Joann could no longer use the stairs .
“ When you have someone you truly love , you try not to leave them in a facility alone , ” Maisch said .
“ She ’ s a beautiful flower , and she ’ s wilting , and so all you can do is give her love .
...
I can ’ t love her enough .
I can ’ t kiss her @ @ @ @ @ @ @ loose , the facility is essentially on lockdown , Maisch said .
But he and his dog , Sophie , are still allowed to go outside to the courtyard .
Every morning at 6 , he takes the black-and-white spaniel for a walk , then comes in to read newspapers : The Times , the Wall Street Journal and the Boston Globe , among others .
Maisch said some of the facility ’ s staff has left since the outbreak , which he understands .
He has been told one person tested positive @ @ @ @ @ @ @ concerns related to the outbreak .
But in general , he said , he feels safe .
“ I understand what ’ s going on , and I understand they are doing everything they can , ” he said .
“ I feel comfortable that they ’ ve done a good job.
” Officials at the Kensington declined to specify how many residents or staff have tested positive , or whether any residents have died of COVID-19 .
Families with loved ones in nursing homes should consider pulling them out if it ’ @ @ @ @ @ @ @ them at home , said Charlene Harrington , professor emeritus at UC San Francisco ’ s School of Nursing .
“ The risk of exposure is so overwhelming , ” said Harrington , who has studied nursing homes since the 1980s .
“ It ’ s a terrible concern.
” Even before the recent outbreak , Harrington said , there were less-than-ideal conditions at many facilities across the state .
Much of the work is done by certified nurse assistants , who have limited training in infection control and are paid minimum wage @ @ @ @ @ @ @ meet , workers often patch together shifts at two or three facilities and work even when they don ’ t feel well .
“ They don ’ t have sick leave ; they don ’ t have health insurance , ” she said .
“ They ’ re going to come to work.
” Also concerning to nursing-home administrators and physicians is guidance from federal and some state regulators to accept new residents and those returning from hospitals without proof that they are virus-free .
Hospitals in New York are so burdened for @ @ @ @ @ @ @ to take in discharged patients even if they are COVID-19 positive .
Those nursing homes will “ do their best , they ’ ll try to contain it , but people will run out of [ protective equipment ] , caregivers will get sick , and people will die , ” said David A. Nace , clinical chief of geriatric medicine for the University of Pittsburgh Department of Medicine .
“ New York will have killed people .
There ’ s no way to soften that statement .
It ’ s such a @ @ @ @ @ @ @ a geriatrician for more than 30 years and president of the California Assn .
of Long Term Care Medicine , is lobbying California regulators not to follow a similar policy .
“ If a hospital thinks they are going to save lives by sending a 90-year-old to a nursing home so they can get a 20-year-old on a ventilator , they ’ re right , they will save a life .
But in three weeks they are going to get 30 patients back from the nursing home , ” Wasserman said .
Current @ @ @ @ @ @ @ Health advises nursing homes to be prepared to accept patients with the coronavirus from hospitals and advises the homes to quarantine those patients and make sure staff members have access to protective equipment — which has been in short supply everywhere — and that they are trained in using it .
Even with all the concerns , some of the most well-informed family members are making the hard choice to leave loved ones where they are , hoping to ride out the crisis .
Peter Beilenson , the health director of Sacramento County @ @ @ @ @ @ @ he believes most nursing homes in the state are doing all they can under dire circumstances .
A few days ago , he went by his mother ’ s assisted-living facility but was unable to touch her .
“ I stood outside and delivered some packages to her and was not allowed in , ” Beilenson said .
“ We came to the window and put our hands together.
” In a press release on Tuesday , Paul Barron , administrator at Garden Crest , acknowledged that at least one resident had tested @ @ @ @ @ @ @ many others had .
Labrador knows of at least two .
After the first call last week to inform her family that a resident had tested positive , another call came a few days later with dreadful news : Her dad had tested positive , too .
She and her siblings can ’ t visit him anymore , and it ’ s difficult to communicate by phone , she said , because he has dementia .
They manage to FaceTime with him every other day or so .
“ It ’ s terrible @ @ @ @ @ @ @ , so far , he hasn ’ t shown any symptoms .
“ What if he does get sicker ?
What are we going to do ?
” For now , she and her siblings are taking things one day at a time .
They hope .
They pray .
And they imagine ways to get to their stricken father .
“ If I have to get a hazmat suit to see my dad , ” Labrador said , “ that ’ s what I ’ ll be doing .
”

Marisa Gerber, Matt Hamilton, Anita Chabria, Jack Dolan

The Kensington in Redondo Beach is one of 11 nursing home facilities in L.A. County with coronavirus cases.
Olivia Labrador’s mind started racing last week after she received a call from her 89-year-old father’s nursing home, Garden Crest Rehabilitation Center in Silver Lake, informing her that a patient at the facility had tested positive for the coronavirus.
“Oh my God,” Labrador thought, picturing patients she’d seen on breathing machines in the past. “What’s going to happen to all of them?”
Labrador’s family considered their options. They could bring her father home, but they worried he might already have been exposed to the virus that causes COVID-19, which would put other vulnerable relatives at risk.
Advertisement
As some experts advise pulling loved ones out of nursing homes to save them from the pandemic, Labrador and her family faced an awful dilemma, one that would have seemed unimaginable a month ago. But they are far from alone.
Across the country, outbreaks are occurring in nursing homes at terrifying speed — leading administrators to ban visitors, confine patients to their rooms and scramble to create sterile wings to treat residents who come down with the disease. The stakes are literally life and death, since residents, who are elderly and almost always have underlying health problems, are among the most vulnerable to the lethal new pathogen.
Hundreds of long-term care facilities in the U.S. now have residents who are infected with the virus. On Tuesday, health officials in Washington state alone reported 108 outbreaks at long-term care facilities. And at a single nursing home in Tennessee, more than 100 residents have tested positive.
In Connecticut, state officials are re-opening previously closed facilities to create separate nursing homes only for residents who are positive for COVID-19 — like modern-day leper colonies. The “extreme precaution” is warranted, according to Connecticut officials, because the results can be catastrophic when the virus gets loose among such a vulnerable population.
One of the first coronavirus hot spots in the U.S. was at the Life Care Center nursing home in Kirkland, Wash., where two-thirds of the residents and 47 workers fell ill, and 37 people died.
The worrisome national trend is picking up steam in Southern California, too.
Advertisement
On Monday, Los Angeles County health officials announced that Garden Crest was among 11 area nursing homes with outbreaks, meaning three or more cases involving residents or staff had been confirmed at the facility.
That was nearly quadruple the number of nursing-home outbreaks county officials had announced on Friday.
The county’s Department of Public Health is also investigating reports of at least one suspected coronavirus infection at nine additional nursing homes. Of the county’s 54 deaths from coronavirus, at least six have been nursing-home residents.
Debbie Alexander, whose mother is in an assisted living facility with an outbreak of coronavirus cases, works at a research laboratory at a San Diego hospital. (Eduardo Contreras / San Diego Union-Tribune)
Debbie Alexander’s 74-year-old mother is at the Kensington in Redondo Beach, another of the L.A. County facilities battling an outbreak.
When Alexander heard about the first case from administrators, she considered pulling her mom out, but there was nowhere available to move her that would necessarily be safer.
Alexander, who is still going to work at a research laboratory at a San Diego hospital, worries she might infect her mother if they were living together.
While she’s nervous, Alexander said, she’s satisfied with the measures administrators at the Kensington are taking to try to control the outbreak. They are not allowing visitors to enter, and residents are mostly confined to their rooms. Residents’ temperatures are taken twice per day. And administrators are sending a daily email update.
“Obviously, I’m worried about Mom. She’s very high-risk. But I think they are doing everything they can,” Alexander said.
Len Maisch, 84, said he moved into the Kensington about five weeks ago to care for his wife Joann, 71, who was diagnosed with a fatal and degenerative brain disease. They sold their Hermosa Beach home, a beloved place with citrus trees, when Joann could no longer use the stairs.
“When you have someone you truly love, you try not to leave them in a facility alone,” Maisch said. “She’s a beautiful flower, and she’s wilting, and so all you can do is give her love. ... I can’t love her enough. I can’t kiss her enough.”
Now, with the coronavirus loose, the facility is essentially on lockdown, Maisch said. But he and his dog, Sophie, are still allowed to go outside to the courtyard. Every morning at 6, he takes the black-and-white spaniel for a walk, then comes in to read newspapers: The Times, the Wall Street Journal and the Boston Globe, among others.
Maisch said some of the facility’s staff has left since the outbreak, which he understands. He has been told one person tested positive, and five others were removed over concerns related to the outbreak. But in general, he said, he feels safe.
“I understand what’s going on, and I understand they are doing everything they can,” he said. “I feel comfortable that they’ve done a good job.”
Officials at the Kensington declined to specify how many residents or staff have tested positive, or whether any residents have died of COVID-19.
Families with loved ones in nursing homes should consider pulling them out if it’s at all feasible to care for them at home, said Charlene Harrington, professor emeritus at UC San Francisco’s School of Nursing.
“The risk of exposure is so overwhelming,” said Harrington, who has studied nursing homes since the 1980s. “It’s a terrible concern.”
Even before the recent outbreak, Harrington said, there were less-than-ideal conditions at many facilities across the state. Much of the work is done by certified nurse assistants, who have limited training in infection control and are paid minimum wage, she said.
To make ends meet, workers often patch together shifts at two or three facilities and work even when they don’t feel well.
“They don’t have sick leave; they don’t have health insurance,” she said. “They’re going to come to work.”
Also concerning to nursing-home administrators and physicians is guidance from federal and some state regulators to accept new residents and those returning from hospitals without proof that they are virus-free.
Hospitals in New York are so burdened for space that regulators there ordered nursing homes to take in discharged patients even if they are COVID-19 positive.
Those nursing homes will “do their best, they’ll try to contain it, but people will run out of [protective equipment], caregivers will get sick, and people will die,” said David A. Nace, clinical chief of geriatric medicine for the University of Pittsburgh Department of Medicine. “New York will have killed people. There’s no way to soften that statement. It’s such a vulnerable population.”
California More than 50 infected with coronavirus at California nursing home A Southern California nursing home has been hit hard by the coronavirus, with more than 50 residents infected — a troubling development amid cautious optimism that cases in the state may peak more slowly than expected.
Dr. Michael Wasserman, a geriatrician for more than 30 years and president of the California Assn. of Long Term Care Medicine, is lobbying California regulators not to follow a similar policy.
“If a hospital thinks they are going to save lives by sending a 90-year-old to a nursing home so they can get a 20-year-old on a ventilator, they’re right, they will save a life. But in three weeks they are going to get 30 patients back from the nursing home,” Wasserman said.
Peter Beilenson, health director of Sacramento County. (Maximilian Franz / Associated Press)
Current guidance from the California Department of Public Health advises nursing homes to be prepared to accept patients with the coronavirus from hospitals and advises the homes to quarantine those patients and make sure staff members have access to protective equipment — which has been in short supply everywhere — and that they are trained in using it.
Even with all the concerns, some of the most well-informed family members are making the hard choice to leave loved ones where they are, hoping to ride out the crisis.
Peter Beilenson, the health director of Sacramento County, is among them. He said he believes most nursing homes in the state are doing all they can under dire circumstances.
A few days ago, he went by his mother’s assisted-living facility but was unable to touch her.
“I stood outside and delivered some packages to her and was not allowed in,” Beilenson said. “We came to the window and put our hands together.”
In a press release on Tuesday, Paul Barron, administrator at Garden Crest, acknowledged that at least one resident had tested positive. He did not say how many others had.
Labrador knows of at least two. After the first call last week to inform her family that a resident had tested positive, another call came a few days later with dreadful news: Her dad had tested positive, too.
She and her siblings can’t visit him anymore, and it’s difficult to communicate by phone, she said, because he has dementia. They manage to FaceTime with him every other day or so.
“It’s terrible,” she said, adding that, so far, he hasn’t shown any symptoms. “What if he does get sicker? What are we going to do?”
For now, she and her siblings are taking things one day at a time. They hope. They pray. And they imagine ways to get to their stricken father.
“If I have to get a hazmat suit to see my dad,” Labrador said, “that’s what I’ll be doing.”
Times staff writer Richard Read contributed to this report.


latimes--2020-04-01--'They're all tainted by it.' Federal corruption cases deal new blow to trust in City Hall

Even amid a global health crisis , the sordid revelations about Los Angeles City Hall have managed to astonish .
One Los Angeles city councilman , now out of office , admitted last week that he accepted envelopes of cash from a businessman in casino bathrooms .
Another took a trip to Las Vegas where , according to federal prosecutors , city officials were lavished with hotel rooms , an extravagant dinner and tens of thousands of dollars ’ worth of drinks at a nightclub .
Yet another council member allegedly sought a $ 500,000 cash bribe from a real @ @ @ @ @ @ @ deal struck between federal investigators and a political fundraiser who admitted collecting much of the money in a paper bag .
As city leaders face urgent pleas for help from Angelenos reeling from the ripple effects of a global pandemic , they are also confronting distrust and revulsion over the alleged bribe and other “ pay to play '' activities that are at the heart of the federal probe .
Even those who are doing good work at City Hall have been tarnished by the corruption scandals , said former Councilman Greig Smith @ @ @ @ @ @ @ of the system that is looked upon as corrupt , and they ’ re all tainted by it , ” he said .
“ You can ’ t be there and not be tainted by it.
” Corruption probes aren ’ t new to City Hall .
Over the past two decades , there have been building inspectors caught taking bribes ; an airport commissioner ensnared in a conflict-of-interest case ; and former City Councilman Richard Alatorre , who took nearly $ 42,000 in cash payments from people who sought to influence his @ @ @ @ @ @ @ felony tax evasion .
What makes the ongoing federal investigations so unusual — and potentially damning for L.A. city government — is that they touch on so many politicians at once .
Englander , who stepped down in 2018 , agreed last week to plead guilty to engaging in a scheme to deceive the FBI as it investigated allegations that a businessman provided him cash , a hotel room , an expensive meal , bottle service at a nightclub and the services of a female escort in Las Vegas .
Councilman John Lee @ @ @ @ @ @ @ confirmed he went on the Vegas trip but said he had sought to reimburse expenses — and did not receive cash or escort services .
His statement has done little to dissuade critics , who have questioned his ethics and called for his resignation .
In addition , political fundraiser Justin Kim agreed to plead guilty to bribery for helping a real estate developer deliver cash to another council member .
Although prosecutors did not name the elected official , their description made clear it is Councilman Jose Huizar .
A lawyer for @ @ @ @ @ @ @ Investigators also have been seeking information involving Councilman Curren Price , two appointees of Mayor Eric Garcetti and a high-level aide to Councilman Herb Wesson , according to a federal search warrant filed in 2018 .
And last summer , FBI agents searched the offices of City Atty .
Mike Feuer and the Department of Water and Power in an apparently separate investigation focusing on legal contracts , cybersecurity and the utility ’ s handling of a customer billing debacle .
Uver Santa Cruz , an electrician who lives in the Rampart Village @ @ @ @ @ @ @ the city ’ s elected officials were behaving in a corrupt way .
But the filing of charges against Englander last month cemented those beliefs .
“ We ’ re so deep in corruption , ” said Santa Cruz , who is active with the Los Angeles Tenants Union .
“ And this is only the things that we ’ ve discovered so far.
” The federal investigation into alleged “ pay to play ” activities exploded into public view in November 2018 , when Huizar ’ s home and offices were searched @ @ @ @ @ @ @ debated new campaign fundraising restrictions months later , many of its members said they were trying to address the perception — not necessarily any reality — of corruption at City Hall .
The filing of charges against Englander and Kim appeared to mark a turning point for some council members , who previously had declined to pass judgment on their colleagues .
Councilman Bob Blumenfield said he was “ sickened ” by the allegations contained in the two cases , saying they deal with “ straight up corruption.
” “ I hope that @ @ @ @ @ @ @ a day of reckoning , ” he said .
Another councilman , David Ryu , said he felt “ nothing but disgust ” over the allegations .
“ My worst fears about the kind of pay-to-play politics I have been working against are being realized , ” he said .
It ’ s not yet clear what impact the Englander and Kim cases could have on the reelection campaigns of City Hall incumbents , since both were filed publicly in the weeks after the March 3 municipal election .
The council ’ s @ @ @ @ @ @ @ the past two years , following a major increase in homeless encampments and a steady stream of stories about federal corruption investigations , said Eric Hacopian , a political consultant based in the San Fernando Valley .
Three years ago , polling showed that a majority of respondents had a favorable view of the council , he said .
By February , those numbers were “ upside down , ” said Hacopian , who expects public support to fall even more in the wake of the latest legal filings .
“ At the @ @ @ @ @ @ @ are not corrupt at City Hall , no matter how cynical we are , ” he said .
“ But they all get tarred with the same brush.
” Some say the latest revelations have simply confirmed their fears about city government .
For decades , residents have suspected that “ money has been passed under the table , ” said West Adams resident Chris Carlson , who sits on the United Neighborhoods Neighborhood Council , which takes in part of South Los Angeles .
“ It was a great relief to see @ @ @ @ @ @ @ , ” she said .
Serena Oberstein , a former member of the city ’ s Ethics Commission , said residents have known for years that the system is broken .
Part of the problem , she said , is that the city ’ s Ethics Commission lacks the money and authority to proactively go after wrongdoing .
Oberstein said one step toward rebuilding trust in City Hall would be to enhance the powers of the Ethics Commission , boosting the agency ’ s budget and giving it the authority to pass legislation @ @ @ @ @ @ @ not incumbent on the City Council to regulate itself.
” Doug Epperhart , who sits on the Coastal San Pedro Neighborhood Council , voiced doubts that additional ethics rules would address the type of problems uncovered by FBI agents .
The federal filings , he said , showed that at least two council members — one current , one former — are “ common criminals.
” “ I don ’ t care how many laws you pass , ” he said .
“ A determined thief will figure out a way to steal @ @

Even amid a global health crisis, the sordid revelations about Los Angeles City Hall have managed to astonish.
One Los Angeles city councilman, now out of office, admitted last week that he accepted envelopes of cash from a businessman in casino bathrooms. Another took a trip to Las Vegas where, according to federal prosecutors, city officials were lavished with hotel rooms, an extravagant dinner and tens of thousands of dollars’ worth of drinks at a nightclub.
Yet another council member allegedly sought a $500,000 cash bribe from a real estate developer, according to a plea deal struck between federal investigators and a political fundraiser who admitted collecting much of the money in a paper bag.
As city leaders face urgent pleas for help from Angelenos reeling from the ripple effects of a global pandemic, they are also confronting distrust and revulsion over the alleged bribe and other “pay to play” activities that are at the heart of the federal probe. Even those who are doing good work at City Hall have been tarnished by the corruption scandals, said former Councilman Greig Smith.
“They’re all part of the system that is looked upon as corrupt, and they’re all tainted by it,” he said. “You can’t be there and not be tainted by it.”
Advertisement
Corruption probes aren’t new to City Hall. Over the last two decades, there have been building inspectors caught taking bribes; an airport commissioner ensnared in a conflict-of-interest case; and former Councilman Richard Alatorre, who took nearly $42,000 in cash payments from people who sought to influence his decisions. He later pleaded guilty to felony tax evasion.
What makes the ongoing federal investigations so unusual — and potentially damning for L.A. city government — is that they touch on so many politicians at once.
Former Los Angeles Councilman Mitchell Englander, who stepped down in 2018, agreed last week to plead guilty to engaging in a scheme to deceive the FBI as it investigated allegations that a businessman provided him cash, a hotel room, an expensive meal, bottle service at a nightclub and the services of a female escort in Las Vegas.
Councilman John Lee, a former aide to Englander, confirmed he went on the Vegas trip but said he had sought to reimburse expenses — and did not receive cash or escort services. His statement has done little to dissuade critics, who have questioned his ethics and called for his resignation.
In addition, political fundraiser Justin Kim agreed to plead guilty to bribery for helping a real estate developer deliver cash to another council member. Although prosecutors did not name the elected official, their description made clear it is Councilman Jose Huizar.
A lawyer for Huizar has repeatedly declined to comment.
Investigators also have been seeking information involving Councilman Curren Price, two appointees of Mayor Eric Garcetti and a high-level aide to Councilman Herb Wesson, according to a federal search warrant filed in 2018. And last summer, FBI agents searched the offices of City Atty. Mike Feuer and the L.A. Department of Water and Power in an apparently separate investigation focusing on legal contracts, cybersecurity and the utility’s handling of a customer billing debacle.
Advertisement
Uver Santa Cruz, an electrician who lives in the Rampart Village area, said he had suspected that the city’s elected officials were behaving in a corrupt way. But the filing of charges against Englander last month cemented those beliefs.
“We’re so deep in corruption,” said Santa Cruz, who is active with the Los Angeles Tenants Union. “And this is only the things that we’ve discovered so far.”
The federal investigation into alleged “pay to play” activities exploded into public view in November 2018, when Huizar’s home and offices were searched by FBI agents. When the council debated new campaign fundraising restrictions months later, many of its members said they were trying to address the perception — not necessarily any reality — of corruption at City Hall.
The filing of charges against Englander and Kim appeared to mark a turning point for some council members, who previously had declined to pass judgment on their colleagues.
Councilman Bob Blumenfield said he was “sickened” by the allegations contained in the two cases, saying they deal with “straight-up corruption.”
“I hope that everyone who engaged in this behavior has a day of reckoning,” he said.
Another councilman, David Ryu, said he felt “nothing but disgust” over the allegations. “My worst fears about the kind of pay-to-play politics I have been working against are being realized,” he said.
It’s not yet clear how the Englander and Kim cases could affect the reelection campaigns of City Hall incumbents, because both were filed publicly in the weeks after the March 3 municipal election.
The council’s reputation has already taken a beating over the last two years, following a major increase in homeless encampments and a steady stream of stories about federal corruption investigations, said Eric Hacopian, a political consultant based in the San Fernando Valley.
Three years ago, polling showed that a majority of respondents had a favorable view of the council, he said. By February, those numbers were “upside down,” said Hacopian, who expects public support to fall even more in the wake of the latest legal filings.
“At the end of the day, most people are not corrupt at City Hall, no matter how cynical we are,” he said. “But they all get tarred with the same brush.”
Some say the latest revelations have simply confirmed their fears about city government. For decades, residents have suspected that “money has been passed under the table,” said West Adams resident Chris Carlson, who sits on the United Neighborhoods Neighborhood Council, which takes in part of South Los Angeles.
“It was a great relief to see these things are being confirmed and exposed,” she said.
Serena Oberstein, a former member of the City Ethics Commission, said residents have known for years that the system is broken. Part of the problem, she said, is that the Ethics Commission lacks the money and authority to proactively go after wrongdoing.
Oberstein said one step toward rebuilding trust in City Hall would be to enhance the powers of the Ethics Commission, boosting the agency’s budget and giving it the authority to pass legislation, “so that it’s not incumbent on the City Council to regulate itself.”
Doug Epperhart, who sits on the Coastal San Pedro Neighborhood Council, voiced doubts that additional ethics rules would address the type of problems uncovered by FBI agents. The federal filings, he said, showed that at least two council members — one current, one former — are “common criminals.”
“I don’t care how many laws you pass,” he said. “A determined thief will figure out a way to steal.”


latimes--2020-04-01--Pregnant women forced to get creative as coronavirus bears down on L.A. hospitals

Two weeks before her son was due , Layla Shaikley sat down to repack her hospital bag .
In went the Adidas slides , Glossier blush , washable prayer mat and a new baby swaddle printed with protective nazar eyes .
Out went the “ Big Sister ” T-shirts for her toddler Kamila , replaced with Shaikley ’ s iPad — a tool she now fears could be her only source of support in the delivery room .
“ They told me , at most your spouse or one visitor will be allowed , ” said the 34-year-old tech entrepreneur @ @ @ @ @ @ @ the other shoe to drop.
” More babies are born in Los Angeles County than anywhere else in the United States .
But with COVID-19 cases continuing to surge , many fear that the city ’ s hospitals might soon bar visitors from their maternity wards , as several in New York did briefly last week .
“ It could change within hours of you getting to the hospital , ” said Erica Chidi Cohen , co-founder and CEO of Loom , a boutique reproductive health and education center in Mid-City .
“ @ @ @ @ @ @ @ Already , hospitals across L.A. have banned anyone not giving birth from the obstetric triage area , leaving expectant Angelenos to labor alone — possibly for hours — while their partners wait in the car .
Recovery , too , is off limits : Once the baby is born , new families have just minutes together before the father or partner is asked to leave .
“ We understand this is not how people want to be giving birth — it ’ s not how we want them to give birth , ” @ @ @ @ @ @ @ fetal medicine specialist and an assistant clinical professor of obstetrics and gynecology at UCLA .
“ All of us physicians , we took an oath , and we are sticking to it .
We are going to do our best to keep our patients safe.
” Changes go far beyond restricting visitors .
One of California ’ s largest hospital networks , the Permanente Medical Group , has begun offering to induce labor as early as 39 weeks , the earliest point at which a pregnancy is considered full term .
Kaiser Southern @ @ @ @ @ @ @ well as planned cesareans due to coronavirus .
Many providers are telling patients not to come in until they ’ re at least five centimeters dilated , or halfway through labor — by which point would normally have received an epidural .
But the most controversial edict so far comes from the Centers for Disease Control and Prevention , which currently recommends a mother be quarantined from her newborn if she shows symptoms of COVID-19 , the disease caused by the novel coronavirus .
“ The CDC is recommending a seven-day separation , @ @ @ @ @ @ @ , and it keeps changing , ” said Dr. Sarah Kilpatrick , chair of obstetrics and gynecology at Cedars-Sinai and an expert in maternal fetal medicine .
“ The patient can refuse , but we are hoping to encourage her to accept.
” Healthcare workers emphasized the importance of quarantine after an infant in Illinois died from the virus over the weekend .
“ There is still much we don ’ t know about how COVID-19 spreads to babies , ” said Marianna Volodarskiy , regional maternal-child health director for Kaiser Permanente in @ @ @ @ @ @ @ decision , we have to recognize the importance of mom and baby bonding and protecting the baby from the virus.
” Such stringent new rules are temporary , experts said .
But many in medicine believe more subtle changes are likely to become standard .
Inventions born out of necessity — fewer prenatal visits , faster postpartum discharge and a spike in home births — long after this crisis is over .
“ Some of the interventions and testing and monitoring that used to be recommended are not being done anymore because of @ @ @ @ @ @ @ , ” said UCLA nurse midwife Shadman Habibi .
“ Our clients are very appreciative .
They ’ re happy not to come to clinic.
” Low-risk patients like Shaikley have begun monitoring their own weight and blood pressure from home instead of visiting the doctor for frequent third-trimester checks .
For higher-risk patients , including those with preexisting conditions that may make them more vulnerable to COVID-19 , the American College of Obstetricians and Gynecologists has recommended consolidating care into fewer visits and replacing fetal monitoring with kick counts and ultrasounds with @ @ @ @ @ @ @ obstetricians are replacing a common early fetal ultrasound with a blood test that can be taken weeks earlier and is far more sensitive at detecting the same chromosomal abnormalities .
“ Now we ’ re saying , just get the blood test , ” Kilpatrick said .
“ We still are doing the 18- to 20-week ultrasound , but we ’ re taking out that middle visit , which frankly probably wasn ’ t really necessary anyway.
” Chidi Cohen , the educator , has moved Loom ’ s birth classes online and @ @ @ @ @ @ @ skills ” for laboring alone .
UCLA lactation and breastfeeding specialist Genevieve Colvin-Thomas now assesses potentially fatal breast infections via video , while Rao , the obstetrician , manages anxious patients over the phone .
“ My version has always been , ‘ If you are worried , come in , ’ ” Rao said .
“ Now I say , ‘ If you are worried , call anytime.
’ ” But the pandemic has pushed some mothers-to-be out of hospitals altogether .
“ I ’ ve been getting at least five inquiries @ @ @ @ @ @ @ said Beth Cannon , a licensed midwife in Sherman Oaks .
“ People want to have their team , and they don ’ t want to be around the extra germs.
” Ashley Ackerman , 32 , an advertising executive at Netflix , is among those looking to opt out .
“ The plan was to give birth at Cedars with a doctor , my husband and a doula , ” Ackerman said .
“ But if going to the hospital means that I ’ m alone , I might choose a birth @ @ @ @ @ @ @ hand , said she is ready to labor alone if she has to .
“ I love my husband ; it ’ s a very important moment in our lives , but this is a crisis , ” she said .
“ I feel very fortunate I had such a wonderful birth experience the last time , but I ’ m ready to give it up if that has to happen .
”

Layla Shaikley, 34, is 38 weeks pregnant with her second child. She is preparing to go through labor largely alone.
Two weeks before her son was due, Layla Shaikley sat down to repack her hospital bag.
In went the Adidas slides, Glossier blush, washable prayer mat and a new baby swaddle printed with protective nazar eyes. Out went the “Big Sister” T-shirts for her toddler Kamila, replaced with Shaikley’s iPad — a tool she now fears could be her only source of support in the delivery room.
“They told me, at most your spouse or one visitor will be allowed,” said the 34-year-old tech entrepreneur. “I’m waiting for the other shoe to drop.”
Advertisement
More babies are born in Los Angeles County than anywhere else in the United States. But with COVID-19 cases continuing to surge, many fear that the city’s hospitals might soon bar visitors from their maternity wards, as several in New York did briefly last week.
“It could change within hours of you getting to the hospital,” said Erica Chidi Cohen, co-founder and CEO of Loom, a boutique reproductive health and education center in Mid-City. “You just don’t know.”
Already, hospitals across L.A. have banned anyone not giving birth from the obstetric triage area, leaving expectant Angelenos to labor alone — possibly for hours — while their partners wait in the car. Recovery, too, is off limits: Once the baby is born, new families have just minutes together before the father or partner is asked to leave.
“We understand this is not how people want to be giving birth — it’s not how we want them to give birth,” said Dr. Rashmi Rao, a maternal fetal medicine specialist and an assistant clinical professor of obstetrics and gynecology at UCLA. “All of us physicians, we took an oath, and we are sticking to it. We are going to do our best to keep our patients safe.”
Changes go far beyond restricting visitors. One of California’s largest hospital networks, the Permanente Medical Group, has begun offering to induce labor as early as 39 weeks , the earliest point at which a pregnancy is considered full term.
Advertisement
Kaiser Southern California has delayed such inductions, as well as planned cesareans due to coronavirus. Many providers are telling patients not to come in until they’re at least five centimeters dilated, or halfway through labor — by which point the overwhelming majority of American women would normally have received an epidural.
But the most controversial edict so far comes from the Centers for Disease Control and Prevention, which currently recommends a mother be quarantined from her newborn if she shows symptoms of COVID-19, the disease caused by the novel coronavirus.
“The CDC is recommending a seven-day separation, but it’s a tough one, and it keeps changing,” said Dr. Sarah Kilpatrick, chair of obstetrics and gynecology at Cedars-Sinai and an expert in maternal fetal medicine. “The patient can refuse, but we are hoping to encourage her to accept.”
Healthcare workers emphasized the importance of quarantine after an infant in Illinois died from the virus over the weekend.
“There is still much we don’t know about how COVID-19 spreads to babies,” said Marianna Volodarskiy, regional maternal-child health director for Kaiser Permanente in Southern California. “When making that decision, we have to recognize the importance of mom and baby bonding and protecting the baby from the virus.”
Such stringent new rules are temporary, experts said. But many in medicine believe more subtle changes are likely to become standard. Inventions born out of necessity — fewer prenatal visits, faster postpartum discharge and a spike in home births — could persist long after this crisis is over.
“Some of the interventions and testing and monitoring that used to be recommended are not being done anymore because of the risk of coming to the hospital,” said UCLA nurse midwife Shadman Habibi. “Our clients are very appreciative. They’re happy not to come to clinic.”
Low-risk patients like Shaikley have begun monitoring their own weight and blood pressure from home instead of visiting the doctor for frequent third-trimester checks.
For higher-risk patients, including those with preexisting conditions that may make them more vulnerable to COVID-19, the American College of Obstetricians and Gynecologists has recommended consolidating care into fewer visits and replacing fetal monitoring with kick counts and ultrasounds with blood tests.
In L.A., many obstetricians are replacing a common early fetal ultrasound with a blood test that can be taken weeks earlier and is far more sensitive at detecting the same chromosomal abnormalities.
“Now we’re saying, just get the blood test,” Kilpatrick said. “We still are doing the 18- to 20-week ultrasound, but we’re taking out that middle visit, which frankly probably wasn’t really necessary anyway.”
Chidi Cohen, the educator, has moved Loom’s birth classes online and revised its curriculum to include “tactical skills” for laboring alone. UCLA lactation and breastfeeding specialist Genevieve Colvin-Thomas now assesses potentially fatal breast infections via video, while Rao, the obstetrician, manages anxious patients over the phone.
“My version has always been, ‘If you are worried, come in,’” Rao said. “Now I say, ‘If you are worried, call anytime.’”
But the pandemic has pushed some mothers-to-be out of hospitals altogether.
“I’ve been getting at least five inquiries a day” about home births, said Beth Cannon, a licensed midwife in Sherman Oaks. “People want to have their team, and they don’t want to be around the extra germs.”
Ashley Ackerman, 32, an advertising executive at Netflix, is among those looking to opt out.
“The plan was to give birth at Cedars with a doctor, my husband and a doula,” Ackerman said. “But if going to the hospital means that I’m alone, I might choose a birth center.”
Shaikley, on the other hand, said she is ready to labor alone if she has to.
“I love my husband; it’s a very important moment in our lives, but this is a crisis,” she said. “I feel very fortunate I had such a wonderful birth experience the last time, but I’m ready to give it up if that has to happen.”


latimes--2020-04-01--In coronavirus fight, workers in ski masks are holding L.A.'s social safety net together

They were looking for a man named Wayne who was old and frail and probably hadn ’ t eaten in a while , putting him in the most vulnerable category for contracting the novel coronavirus .
Homeless outreach workers Christian Riehl and John Cudal had last seen Wayne in his dilapidated RV , which was parked at 135th Street and Broadway in unincorporated Willowbrook .
Riehl had a motel voucher for Wayne and hoped he could persuade him to surrender his RV and go indoors .
But when they got to the corner , his RV wasn ’ t there @ @ @ @ @ @ @ another RV and a disheveled man named Louie answered the door .
“ We ’ ve been sent by L.A. County to make sure that everybody over 65 has a place to stay , ” Cudal told him .
With the number of coronavirus cases expected to surge in the coming weeks , Riehl and Cudal were doing some things differently .
They wore masks — a ski mask for Riehl and neck gaiter for Cudal .
They spritzed their clothes and shoes with alcohol after each conversation with a homeless person , @ @ @ @ @ @ @ who are medically fragile .
But their mission had not really changed .
As outreach workers for St. Joseph Center , Cudal and Riehl exclusively work with homeless people who live in vehicles , and so they continued to introduce themselves to the hundreds of RV dwellers in South Los Angeles , and help them get services and housing .
While occupied RVs have become a common sight around the county , this stretch of Broadway , where the street is wide and the overnight parking prohibition is not being enforced , has @ @ @ @ @ @ @ and Cudal monitor the more than 200 vehicles parked there .
Some are mobile ; many are broken down .
Some look decent ; others are patched with cardboard or tarps .
A few are owned by people who choose to live on the cheap .
Most belong to people who have been beaten down by life , including squatters and tenants in an RV rental black market .
The Vehicle Homeless Outreach Program was founded in 2014 to deal with the problem .
The current number of RVs and cars is down @ @ @ @ @ @ @ program began , Riehl said .
Those who get housing can keep their vehicles if there is parking available and if the vehicles are still operational .
The program pays to tow and dismantle the cars and RVs that no longer run , so they don ’ t remain on the streets .
The path to success is seldom direct , and for every step forward there is often a step back .
Of the 129 people who have qualified for housing , so far , 79 have moved in , four of @ @ @ @ @ @ @ filed with the L.A. County Board of Supervisors .
Louie was new to the neighborhood , he told Riehl and Cudal .
He said he had been living in his RV in Lomita for five years until he was asked to move along .
“ At least I had a place to be , ” he said .
“ Now they don ’ t want me.
” Louie was ambivalent about getting services .
“ I just want to make sure you ’ re good and take care of yourself , ” Cudal @ @ @ @ @ @ @ ve got that , you got it.
” Riehl and Cudal moved to opposite sides of the street .
Cudal , working his way through a thicket of dated electronics , vehicle parts and broken appliances , asked at each door if anyone inside was 65 or older or ill.
It ’ s outreach workers who serve as the eyes and ears on the streets , a role that has become even more important as local and state officials have ordered social distancing to slow the pandemic .
These workers play the crucial @ @ @ @ @ @ @ rapidly growing list of services and resources , including emergency shelters , hotel and motel rooms , and quarantine facilities .
If Cudal , for example , did come across someone living in an RV with flu-like symptoms , a possible sign of COVID-19 , he would have to arrange for a medical team to transport that person to one of the quarantine facilities being hastily set up across L.A. County .
Homeless people who are at high risk for the virus but aren ’ t exhibiting any symptoms , go to motels @ @ @ @ @ @ @ outreach workers who must call an Uber or a cab to get them there .
Riehl hoped to do that for Wayne , now that he had found him .
He made a call , trying to first line up some food , but the cupboards were bare of donations .
He knew where he could scrounge up some food .
He said he ’ d return with it later and try to get Wayne into a motel .
But an emergency suddenly needed the outreach workers ’ attention .
A sheriff ’ @ @ @ @ @ @ @ a grandmother , three daughters and two granddaughters who were living in an RV a few miles away on Badera Street without plumbing or electricity .
Interviewing the women , Riehl and Cudal determined that neither the grandmother or mother was 65 or older , nor did either one have a high-risk health condition .
That ruled out Riehl ’ s first option of moving the family into one of the quarantine trailers at Dockweiler State Beach .
Instead , he tried to line up a motel — not a cinch for a @ @ @ @ @ @ @ of the day , Riehl and Cudal had mixed success in their efforts to help those whom they had found .
Wayne took the food , but declined the voucher for the motel .
An older couple who were in line to get an apartment had a motel room waiting to tide them over , but hadn ’ t checked in yet .
And , after securing the help of a housing specialist , the family of six moved into a motel .

John Cudal, left, sprays alcohol on Christian Riehl. The outreach workers with St. Joseph Center spent hours in South Los Angeles looking to help homeless people get off the streets.
They were looking for a man named Wayne who was old and frail and probably hadn’t eaten in a while, putting him in the most vulnerable category for contracting the novel coronavirus.
Homeless outreach workers Christian Riehl and John Cudal had last seen Wayne in his dilapidated RV, which was parked at 135th Street and Broadway in unincorporated Willowbrook.
Riehl had a motel voucher for Wayne and hoped he could persuade him to surrender his RV and go indoors. But when they got to the corner, his RV wasn’t there.
Advertisement
Across the street was another RV, and a disheveled man named Louie answered the door.
“We’ve been sent by L.A. County to make sure that everybody over 65 has a place to stay,” Cudal told him.
With the number of coronavirus cases expected to surge in the coming weeks, Riehl and Cudal were doing some things differently. They wore face coverings — a ski mask for Riehl and neck gaiter for Cudal. They spritzed their clothes and shoes with alcohol after each conversation with a homeless person, and searched out seniors and others who are medically fragile.
Mario Juarez, left, who lives in an RV, talks with St. Joseph Center case manager John Cudal in South Los Angeles. (Brian van der Brug / Los Angeles Times)
But their mission had not really changed. As outreach workers for St. Joseph Center, Cudal and Riehl exclusively work with homeless people who live in vehicles, so they continued to introduce themselves to the hundreds of RV dwellers in South Los Angeles and help them get services and housing.
While occupied RVs have become a common sight around the county, this stretch of Broadway, where the street is wide and the overnight parking prohibition is not being enforced, has become a linear RV village.
Riehl and Cudal monitor the more than 200 vehicles parked there. Some are mobile; many are broken down. Some look decent; others are patched with cardboard or tarps. A few are owned by people who choose to live on the cheap. Most belong to people who have been beaten down by life, including squatters and tenants in an RV rental black market.
St. Joseph Center case manager John Cudal talks with a homeless man. (Brian van der Brug / Los Angeles Times)
The Vehicle Homeless Outreach Program, funded by Supervisor Mark Ridley-Thomas’ discretionary account, was founded in 2014 to deal with the problem. The current number of RVs and cars is down from the more than 300 when the program began, Riehl said. Those who get housing can keep their vehicles if there is parking available and if the vehicles are still operational. The program pays to tow and dismantle the cars and RVs that no longer run, so they don’t remain on the streets.
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The path to success is seldom direct, and for every step forward there is often a step back. Of the 129 people who have qualified for housing, 79 have moved in, four of them this year, according to reports filed with the L.A. County Board of Supervisors.
Louie was new to the neighborhood, he told Riehl and Cudal. He said he had been living in his RV in Lomita for five years until he was asked to move along.
“At least I had a place to be,” he said. “Now they don’t want me.”
John Cudal, left, Christian Riehl and Joel Montes are trying to make homeless people aware of the new shelters at city recreation centers. (Brian van der Brug / Los Angeles Times)
Louie was ambivalent about getting services.
“I just want to make sure you’re good and take care of yourself,” Cudal told him. “If you’ve got that, you got it.”
Riehl and Cudal moved to opposite sides of the street. Cudal, working his way through a thicket of dated electronics, vehicle parts and broken appliances, asked at each door if anyone inside was 65 or older, or ill.
It’s outreach workers who serve as the eyes and ears on the streets, a role that has become even more important as local and state officials have ordered social distancing to slow the pandemic. These workers play the crucial role of connecting homeless people with a rapidly growing list of services and resources, including emergency shelters, hotel and motel rooms, and quarantine facilities.
If Cudal, for example, did come across someone living in an RV with flu-like symptoms, a possible sign of COVID-19, he would have to arrange for a medical team to take that person to one of the quarantine facilities being hastily set up across L.A. County.
St. Joseph Center case manager John Cudal. (Brian van der Brug / Los Angeles Times)
Homeless people who are at high risk for the virus but aren’t exhibiting any symptoms go to motels or shelters, and it’s outreach workers who must call an Uber or a cab to get them there.
Riehl hoped to do that for Wayne, now that he had found him. Riehl made a call, trying to first line up some food, but the cupboards were bare of donations.
“Not even Top Ramen?” Riehl asked in frustration.
He knew where he could scrounge up some food. He said he’d return with it later and try to get Wayne into a motel.
But an emergency suddenly needed the outreach workers’ attention. A sheriff’s deputy had tipped them off about a grandmother, three daughters and two granddaughters who were living in an RV a few miles away on Bandera Street without plumbing or electricity.
Interviewing the women, Riehl and Cudal determined that neither the grandmother or mother was 65 or older, nor did either have a high-risk health condition.
John Cudal, left, and Christian Riehl talk with homeless couple Denise Martin and Kim Eckholdt. (Brian van der Brug / Los Angeles Times)
That ruled out Riehl’s first option of moving the family into one of the quarantine trailers at Dockweiler State Beach. Instead, he tried to line up a motel — not a cinch for a family of six.
At the end of the day, Riehl and Cudal had mixed success in their efforts to help those whom they had found.
Wayne took the food but declined the voucher for the motel. An older couple who were in line to get an apartment had a motel room waiting to tide them over but hadn’t checked in yet. And, after securing the help of a housing specialist, the family of six moved into a motel.


latimes--2020-04-01--An L.A. couple is trapped on a coronavirus-stricken cruise ship with nowhere to dock

Fearing the coronavirus , the children of a Los Angeles couple are pleading for help for their elderly parents aboard the Zaandam , a cruise ship heading to Florida and trying to dock .
Shou-Yinn Cheng and husband Min-Lee Cheng started their two-week South American trip on March 6 , departing from Buenos Aires with eight friends , half of them from California .
They snapped pictures at the breathtaking Iguazu Falls , spanning the border of Argentina and Brazil .
They posed with penguins and spent evenings in the splendor of the ship ’ s dining hall .
Their @ @ @ @ @ @ @ Italy , was designed to house as many as 1,432 guests .
But days into their trip , travelers began to hear about people falling ill with symptoms of COVID-19 , the disease caused by the coronavirus .
After exploring Chile ’ s Punta Arenas along the coast , Min-Lee Cheng , 72 , feeling feverish , went to consult with the ship ’ s staff .
He was surprised to find the medical center packed — and soon , as the global pandemic halted markets and activities worldwide — officials on the @ @ @ @ @ @ @ On board , four people would die of COVID-19 .
Nine people have tested positive for the disease so far , according to Erik Elvejord , spokesman for Holland America Line , the cruise line .
Back home in Southern California , the couple ’ s sons , Jih-Fei and Jih-Hao Cheng , panicked .
They began to call members of the La Habra Heights City Council , where their parents live , along with elected leaders in Los Angeles , Sacramento and Washington D.C. , seeking to publicize the plight of more @ @ @ @ @ @ @ on a ship denied entry at port after port .
“ We must get them off , everyone .
Catching this disease — that is the absolute primary concern , ” said Jih-Hao Cheng , a regional director for a sporting goods company from Fullerton .
“ They ’ re in a petri dish , and the risk of them contracting the virus is incredibly high .
They told me their next-door neighbor has been coughing and coughing nonstop night and day .
And you know the thin wall that separates them .
@ @ @ @ @ @ @ moved but I understand how the staff is overwhelmed.
” Even with spotty Wi-Fi , he and his older brother tried to stay in constant contact with their parents who are barely eating or sleeping .
His father believes he may have gastritis .
He asked to be tested for COVID-19 , but without respiratory issues , doctors turned him away .
Crew members have separated the passengers ; those who have had no illness have been transferred to the Rotterdam , another ship owned by Holland America .
The Zaandam and Rotterdam @ @ @ @ @ @ @ deceased and two others in dire need of medical evacuation , possibly to Mexico .
The ships are destined for Florida ’ s Port Everglades , where Broward County officials , along with the U.S. Coast Guard , have demanded a plan “ for self-support of the medical issues occurring on board the vessels.
” Florida Gov .
Ron DeSantis , in an interview with Fox News , has said that “ we can not afford to have people who are not even Floridians dumped into South Florida using up those valuable resources.
@ @ @ @ @ @ @ requested and were denied to disembark in Chile , Peru , Ecuador , Panama.
” Officials in Panama , however , allowed the ships to pass through its canal and , before that crossing , gave permission for crew members to transfer supplies between the two vessels .
Crew members also were permitted to bring provisions and medication on board the vessels in Chile .
There are 797 guests and 645 crew members on the Rotterdam ; 446 guests and 602 crew members are on the Zaandam , according to Elvejord , who @ @ @ @ @ @ @ provide the information ” that Florida officials are requesting .
Meanwhile , with each day blurring into the next , “ we are not on a regular clock or routine anymore , ” said Min-Lee Cheng , a retired public health official and expert on diseases transmitted via mosquitoes .
Jih-Fei Cheng , a Scripps College professor , said his father ’ s medical background helped him to “ stay calmer .
But we are all fearful .
Can you imagine them watching from their room as most of their friends boarded the @ @ @ @ @ @ @ behind ?
They heard that those friends have reserved flights that will take them home — as soon as they are allowed to disembark — while what will happen to them ?
” He said it surprised him that people were criticized about going on cruises , adding that “ when my parents flew out of Los Angeles ... they were under the impression that there were very few cases in South America .
None of us knew how huge this would be .
Early intervention would have prevented all of this trouble @ @ @ @ @ @ @ harder it will be to resolve.
” Min-Lee Cheng said “ the biggest challenge is the uncertainty .
We are not given current information on board the ship .
We only found out this morning there are people who have tested positive for COVID-19 .
”

Four people have died of COVID-19 on the Zaandam cruise ship, which was on a South American trip when passengers fell ill. Above, the Rotterdam, which is now sailing in tandem with the Zaandam.
Fearing the coronavirus, the children of a Los Angeles couple are pleading for help for their elderly parents aboard the Zaandam, a cruise ship heading to Florida and trying to dock.
Shou-Yinn Cheng and her husband, Min-Lee Cheng, started their two-week South American trip March 8, departing from Buenos Aires with 10 friends, half of them from California. They snapped pictures at the breathtaking Iguazu Falls, spanning the border of Argentina and Brazil. They posed with penguins and spent evenings in the splendor of the ship’s dining hall. Their comfortable, elegant vessel, built in Italy, was designed to house as many as 1,432 guests.
But days into their trip, travelers began to hear about people falling ill with symptoms of COVID-19, the disease caused by the novel coronavirus.
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After exploring Chile’s Punta Arenas along the coast, Min-Lee Cheng, 72, feeling feverish, went to consult with the ship’s staff. He was surprised to find the medical center packed — and soon, as the global pandemic halted markets and activities worldwide — officials on the Zaandam urged all passengers to self-quarantine.
On board, four people would die of COVID-19.
Nine people have tested positive for the disease so far, according to Erik Elvejord, spokesman for Holland America Line, the cruise line.
Back home in Southern California, the couple’s sons, Jih-Fei and Jih-Hao Cheng, panicked. They began to call City Council members in La Habra Heights, where their parents live, along with elected leaders in Los Angeles, Sacramento and Washington, seeking to publicize the plight of more than 1,000 travelers and crew members captive on a ship denied entry at port after port.
“We must get them off, everyone. Catching this disease — that is the absolute primary concern,” said Jih-Hao Cheng, a regional director for a sporting goods company from Fullerton. “They’re in a petri dish, and the risk of them contracting the virus is incredibly high. They told me their next-door neighbor has been coughing and coughing nonstop night and day. And you know the thin wall that separates them. I’ve requested that they be moved, but I understand how the staff is overwhelmed.”
Even with spotty Wi-Fi, Jih-Hao Cheng and his older brother tried to stay in constant contact with their parents who are barely eating or sleeping.
Their father believes he may have gastritis. He asked to be tested for COVID-19, but without respiratory issues, doctors turned him away.
Crew members have separated the passengers; those who have had no illness have been transferred to the Rotterdam, another ship owned by Holland America.
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The Zaandam and Rotterdam are sailing in tandem, carrying the deceased and two people in dire need of medical evacuation, possibly to Mexico. The ships are destined for Florida’s Port Everglades, where Broward County officials, along with the U.S. Coast Guard, have demanded a plan “for self-support of the medical issues occurring on board the vessels.”
Florida Gov. Ron DeSantis, in an interview with Fox News, said that “we cannot afford to have people who are not even Floridians dumped into South Florida using up those valuable resources.”
Elvejord said company representatives have “requested and were denied to disembark in Chile, Peru, Ecuador, Panama.”
Officials in Panama, however, allowed the ships to pass through its canal and, before that crossing, gave permission for crew members to transfer supplies between the two vessels.
Crew members also were permitted to bring provisions and medication on the vessels in Chile.
There are 797 guests and 645 crew members on the Rotterdam; 446 guests and 602 crew members are on the Zaandam, according to Elvejord, who added that the company “will certainly provide the information” that Florida officials are requesting.
Meanwhile, with each day blurring into the next, “we are not on a regular clock or routine anymore,” said Min-Lee Cheng, a retired public health official and expert on diseases transmitted via mosquitoes.
Jih-Fei Cheng, a Scripps College professor, said his father’s medical background helped him to “stay calmer. But we are all fearful. Can you imagine them watching from their room as most of their friends boarded the Rotterdam while they were asked to stay behind? They heard that those friends have reserved flights that will take them home — as soon as they are allowed to disembark — while what will happen to them?”
He said it surprised him that people were criticized about going on cruises, adding that “when my parents flew out of Los Angeles … they were under the impression that there were very few cases in South America. None of us knew how huge this would be. Early intervention would have prevented all of this trouble. The longer we wait, the harder it will be to resolve.”
Min-Lee Cheng said “the biggest challenge is the uncertainty. We are not given current information on board the ship. We only found out this morning there are people who have tested positive for COVID-19.”