How A COVID-19 Outbreak Unfolded At A San Diego VA Office

The San Diego Counseling Center was operating like normal when its first employee fell ill.

The VA facility in Mission Valley offers social work, employment services, addiction therapy and mental health support to thousands of current and formerly homeless veterans in need of care. In mid-March, one of its staff members reported that she was experiencing COVID-19 symptoms, and she had been in close contact with her co-workers in the days prior.

Emails from managers and VA leadership in the coming weeks confirmed what dozens of counselors and social workers already knew: the outbreak was growing.

Within three weeks, 11 employees who worked in the building tested positive for COVID-19 and two of them were hospitalized. A spreadsheet workers compiled suggests the real number is much higher — roughly 30 people got sick, they believe, but some were never tested. That’s about a third of the employees at the Mission Valley office.

Emails, memos and text messages obtained by inewsource reveal the San Diego VA’s slow and inadequate response to the outbreak, which exacerbated its spread: Cleaning crews used ineffective products, supervisors didn’t quickly notify staff when their co-workers became sick and telework was only offered after employees started testing positive. Now, managers are conducting a fact-finding investigation into staff who organized a sick-out in mid-March to protest working conditions, though those staff members never followed through with the plan.

Seven VA employees who spoke with inewsource declined to have their names published out of fear of retaliation, but they provided documentation to help corroborate the events that occurred as the virus sickened their friends and colleagues. The details in this story were compiled using interviews and documents and were verified by multiple sources whenever possible.

“I worry it’ll happen again, that there will be another outbreak somewhere and the VA won’t take it seriously enough because they didn’t when it happened to us,” one employee said. “They’re risking people’s lives.”

In response to questions about the outbreak, San Diego VA spokesperson Cynthia Butler said in an email: “Our highest priority is the safety of our staff and the safety of the Veterans we serve, which is why we have consistently instructed staff not to come to work if they have symptoms concerning for COVID-19.

“Per CDC guidance and VA protocols, employees exhibiting COVID-19 symptoms are immediately isolated to prevent potential spread to others.”

Word of mouth

Employees who spoke with inewsource said their supervisors didn’t notify them when the first of their colleagues developed COVID-19 symptoms.

Two days after the first staff member became sick, managers instructed social workers to shift their in-person appointments with veterans to phone calls, but they didn’t explain the reason for the new policy.

“As of now, any contact with patients that can be done by phone, should be done by phone,” the email said.

“Information and guidance is rapidly changing. Thank you all for your patience and flexibility during these times.”

The news of a sick staff member spread slowly and informally through texts and phone calls among co-workers, who warned each other that they could have been exposed to COVID-19.

Fearing they might become sick, some of them contacted the VA’s Occupational Health Services department to explain they had been in close contact with the staff member on March 13, the day before she developed COVID-19 symptoms.

When one employee spoke with a healthcare worker in the department, they were informed their risk of exposure was “really minimal,” because their colleague didn’t have symptoms at the time the two had been near each other. They were encouraged to continue coming to work, the employee said.

However, scientific models and case studies had already shown by then that people infected with the virus can spread it before symptoms appear. The San Diego VA did not answer questions about the advice that Occupational Health provided staff potentially exposed to COVID-19.

Within the next few days, three employees who had been in close contact with the sick staff member insisted they self-isolate for two weeks at home in case they started developing symptoms, but their co-workers were not told why they were no longer coming to the office.

Instead, staff were told they should “feel free to spread out” in the building and work from the empty offices.

“We have staff who are out and there is work space available to spread out,” said a March 19 email, which listed the names of the four absent employees whose offices could be used but did not mention COVID-19.

Those offices, however, had not been disinfected.

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Three counseling center employees who spoke with inewsource said managers acknowledged on a conference call that week that the building’s janitors had not been using disinfecting products while cleaning, meaning that if the COVID-19 virus had been present in their colleagues’ workspaces, it was likely still there.

When an employee asked in an email the next day whether the co-workers’ offices had been disinfected, a supervisor replied that no one was on site who could thoroughly clean the office, but the VA hospital would be bringing in a contractor to disinfect the building.

“In the interim, please continue to use CAVI wipes or Clorox/Lysol wipes to keep your own areas clean and continue to follow handwashing, social distancing, and basic hygiene guidance,” the email said.

Hours later, staff received another message: The janitors would switch to disinfecting products and deep clean shared areas of the office, including the lobby and bathrooms, as well as the workspaces of people experiencing COVID-19 symptoms.

“The janitorial service will switch cleaning products to EPA approved products that are known to kill viruses such as cold, flu, and COVID-19,” the email said.

Management would contract out to a professional cleaning agency only if someone tested positive for COVID-19, according to the email.

“It’s scary, it’s really sad and it’s really infuriating because this all could have been avoided,” one employee told inewsource. “They knew somebody was symptomatic, and they didn’t tell anyone. They cleaned the office, and the cleaning people used the wrong cleaning solution.

“They had every opportunity to tell us what was going on before people started getting very sick left and right.”

First staffer tests positive

It was one week from the first sign of COVID-19 symptoms to when a staff member reported testing positive.

In the days before the first positive test was reported, VA officials insisted employees continue coming to work.

San Diego VA Director Robert Smith sent at least three emails telling staff to continue their in-office jobs — whether employed at a VA hospital, clinic, counseling center or elsewhere — because the VA didn’t have the technical capacity to support everyone working from home.

“If symptomatic, stay home. If not symptomatic, don’t let fear get the better of you, come to work, and help all of us continue the mission,” Smith wrote in a March 13 email.

A very limited number of “tier 1” employees were allowed telework on select days if they had approval from VA leadership, but most people did not qualify.

“Staff newly approved or already approved for telework may be asked to work on-site to preserve bandwidth or to perform essential duties outside of their normal jobs,” Smith told employees on March 20.

San Diego County requires employers to notify staff and customers if they may have been in close contact with an employee who recently tested positive for COVID-19 and instruct those close contacts to quarantine for 14 days. But because of limitations and delays with testing, many days can lapse between first seeking a test and finding out the result.

In mid-March, at the time the counseling center outbreak began, COVID-19 tests were mostly restricted to people with a doctor’s referral who had severe symptoms. As a result, San Diego VA staff looking for tests had difficulty getting them.

Plus, even though they worked for the VA, some employees could not get tested there. The San Diego VA is offering COVID-19 tests to staff with symptoms, but those who are asymptomatic have to go through other medical providers.

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On March 21, a counseling center employee told co-workers she had tested positive for COVID-19.

The next day, a manager informed staff that there had been an “exposure” in the counseling center building but did not specify that someone had tested positive for the virus.

“You may have heard that there was a COVID-19 exposure at the SDCC (homeless program) site,” the email said, referring to the San Diego Counseling Center. “We are working with infection control to further assess the potential exposure, and ensure that our work environment is safe.”

Staff were contacted over the phone that day and told they would be working remotely until further notice, three employees told inewsource, but they weren’t given any more detail about the exposure.

With little information to go on from supervisors and afraid more people would soon become sick, staff began tracking the outbreak themselves. They created the spreadsheet that included employees’ names, whether they had symptoms, if they were tested for COVID-19 and what their test results said. In the coming weeks, the spreadsheet continued to grow.

On March 24, the VA announced that five counseling center employees had tested positive for COVID-19, the first official email from leadership describing a positive COVID-19 test among staff. On March 28, a counseling center manager said the number of positive tests had jumped to seven. By April 1, it was up to 11.

At least two of those employees were hospitalized, but both have recovered, staff told inewsource.

“Infection control continues to assess the potential exposures, ensure that our work environment is safe, and make certain that anyone with potential exposure is appropriately notified and counseled,” a supervisor wrote in an April 1 email.

The week before that email was sent, the VA’s Office of Inspector General in Washington, D.C., released a report that highlighted the San Diego VA’s lack of preparedness for the pandemic. Inspectors found the San Diego VA wasn’t screening all patients for the coronavirus, had a shortage of nurses and didn’t have enough protective medical equipment for employees.

At the VA hospital in La Jolla, nurses have protested against the administration for restricting the use of protective gear such as goggles, masks and gowns. They’ve also called out hospital leadership for failing to quickly notify healthcare workers who have been exposed to someone with COVID-19.

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“Our nurses and other hospital staff need timely and consistent notification of exposure to COVID-19 positive patients and staff,” Donna Cook, a registered nurse who has worked at the San Diego VA for 15 years, said at a May 1 protest. “Having this information is vital for the safety and protection of those exposed so that there is an opportunity for appropriate medical followup.

“It is indeed the moral, ethical, responsible and simply the right thing to do.”

The San Diego VA did not answer most of the questions inewsource asked or dispute the information gathered about the outbreak at the counseling center.

However, Butler, the VA spokesperson, said the employee infection rate across the San Diego VA healthcare system is lower than at medical centers in Seattle and Detroit — cities that have led the country in coronavirus cases.

She credited the lower infection rates at the San Diego VA to its safety precautions and policies around the use of protective medical gear.

Telework challenges

Stuck at home to stifle the outbreak, counseling center employees tried to perform their jobs remotely, but the VA’s outdated computer system made it difficult.

Staff used remote desktops to keep track of their clients and access their emails. When dozens of counseling center employees began working from home in mid-March, the system wasn’t prepared.

“I’ve been trying to access the system for a week and a half,” one employee said at the time. “I’ve made a dozen calls to IT.”

The employee had hallmark COVID-19 symptoms: a fever, cough, headache, shortness of breath and chest pain. But a lot of workers becoming ill worried they didn’t have enough sick days available to take time off to recover, the employee said, since sick days are slowly accrued over time.

“I’m sick, but I’m working from home anyway,” the employee said. “As long as I can make phone calls and type, I’m going to keep working.”

Within five days of telling staff to work from home, supervisors were developing a plan to bring them back to the office. When one employee asked why staff were returning to the building, she was not given an answer.

“They need to get it together,” she said. “They need to push for telework to be accessible right now for everyone and for everyone to telework in whatever capacity they can. We should not be seeing clients or be around each other. This is an immediate risk to our safety.”

“We want to help our clients. That’s what we do,” she added. “We don’t want to fight management for our safety.”

It took weeks to negotiate with employees, get approval from VA leadership and update contracts with a professional cleaning agency, but eventually staff were told they would start working from the office again on April 27.

They would return to work in a rotation, one week at a time in the office and then two weeks at home. Workers would be screened for symptoms before entering the building, keep six feet of distance from each other, stagger lunch shifts, clean workstations before leaving the office and avoid entering shared spaces when possible.

As a precaution, workers were informed in an email, no veterans would be allowed to visit. All conversations with clients would be conducted remotely, from a one-story building on Mission Valley Road.

The main lobby “will be closed until face to face visits are resumed,” the email said. As of Wednesday, the lobby is still closed.

Butler, the VA spokesperson, said in an email that the “current work environment allows for staff to socially distance while observing strict infection control practices.”

As workers have started to return to the office, some worry that their jobs could be at risk.

Counseling center employees told inewsource that managers are now performing an administrative investigation into workers who organized a sick-out in mid-March, in which many staff members would have called out sick on the same day to protest working conditions. The sick-out never happened, staff members said, because they were told to work from home once workers started testing positive.

Investigators are interviewing workers and asking for details about the sick-out, they said.

“It makes you feel like they haven’t learned anything if this is what they’re focusing on,” a staff member said. “It’s disappointing. It lacks perspective about what the employees went through.”

inewsource video and photo journalist Zoë Meyers contributed to this story.