LITTLE ROCK, Ark. As the weekend comes to a close, Arkansas sees yet another day of declines in total hospitalizations.
Sadly, another 35 Arkansans died in the last 24 hours from the virus, moving the states pandemic total to 7,267.
According to the figures from the Arkansas Department of Health, hospitalizations fell for the fifth straight day, down by 13 to 1,118 patients admitted due to COVID-19.
Since Wednesday, Sept. 8, Arkansas has seen total hospitalizations drop by 110. Information as to whether those numbers are due to deaths or recoveries was not available.
The number of patients on ventilators also went down by 5, putting the number at 287 in the state.
The ADH reported 1,116 new COVID-19 cases on Sunday. The total number of active cases is 19,588, a drop of 265 from the previous day.
There were 5,188 COVID-19 vaccine doses administered in the past day.
There are currently 1,279,526 Arkansans fully immunized from the virus, an increase of 3,331, with another 314,645 residents having partial immunity.
The number of deaths in Arkansas due to COVID-19 are now more than the population of Trumann, Ark., which has a population of 7,243 the 50th largest municipality of the 496 in the state.
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The coronavirus struck nearly 20 years after the terror attacks in the United States on 9/11 and in a drastically different manner: slowly at first and essentially invisible, a far cry from the explosions after airliners slammed into Manhattans Twin Towers with the scene immediately beamed worldwide.
But the two crises which will likely shape generations of New Jerseyans share certain commonalities when it comes to public health. Both disasters prompted unprecedented levels of anxiety and depression, especially for those intimately involved in the response, experts note, and are likely to have long-lasting impacts on individuals, families and communities.
Both 9/11 and the COVID-19 pandemic have led people to view the responders firefighters and emergency medical personnel then, and nurses, doctors and other caregivers today as heroes, a term experts acknowledge can be good and bad. Sometimes the hero label can prevent these responders from seeking help for their own mental health or substance abuse issues, clinicians said, and those who endured 9/11 may find it even harder to handle with the pandemic stress of today.
If you are dealing already with mental health issues, anything pre-existing, you dont bode well if there is some kind of major trauma, explained Jodi Streich, mental health director for the World Trade Center Clinical Center of Excellence at Rutgers University, one of a network of federal programs set up in the wake of the terrorist attacks to assist responders and others who experienced health issues as a result of their time at ground zero.
The health care workers are now our first responders, Streich said, and they face a similar strain as those who rushed in to save lives when the World Trade Center towers collapsed.
First responders of all kinds are sometimes less willing to seek help when they need it, experts note, which creates an additional challenge. This is a very hard population to take care of because they are people who take care of other people and are not used to taking care of themselves, added Dr. Iris Udasin, the centers medical director.
Streich said that while the COVID-19 pandemic has triggered significant stress for health care providers and the public, individuals who have a history of post-traumatic stress disorder like the centers 9/11 patients are particularly at risk for a relapse. All of us are noticing as clinicians, and just as human beings, the heightened irritability and anger among people, she said. And for those with PTSD, Its a whole new, re-awaking of the previous trauma.
Udasin, a professor at Rutgers School of Public Health, said the center contacted its more than 2,000 patients to check on their well-being during the pandemic, which proved fatal for some. Many 9/11 survivors struggle with lung damage, she said, symptoms of which can mask the appearance of COVID-19 and make them more vulnerable to infection and serious illness.
Many of our patients were short of breath already, Udasin said. I lost a few patients to COVID who thought it was asthma or COPD. Another died of suicide, caused in part by the isolation resulting from the pandemic lockdown, she said.
COVID-19 has killed more than 650,000 people nationwide, including some 27,000 in New Jersey, where more than 1.1 million residents have been diagnosed with the disease since it first emerged in March 2020, state statistics show. Since then, COVID-19 has caused nearly 90,000 New Jerseyans to be hospitalized, and case counts and hospital admissions continue to tick upward with the growing presence of highly transmissible variants of the coronavirus.
Nearly 3,000 people died in the Sept. 11, 2001 terrorist attacks including 750 New Jerseyans and some 6,000 more were injured. But the death toll from that crisis continues to mount, as thousands more have since succumbed to cancer, lung damage or other illnesses linked to toxins emitted from the smoldering pile of debris at ground zero, which was the site of a rescue and recovery mission that lasted nine months.
The disparities in total fatalities hint at how the pandemics impact may eventually overshadow that of 9/11. The coronavirus was a tragedy for everyone. Nine-eleven was an assault on all of the United States, but if you lived in Nebraska you felt sad about 9/11 but you werent exposed to the toxins if you lived in Nebraska, Udasin said.
But there are clearly commonalities too. People are still dying from both. I think thats one parallel, said Steve Cicala, a founding member of the New Jersey Emergency Management Task Force, which was created in the wake of 9/11 to help coordinate the states response to mass-casualty events. Cicala lost his wife, a nurse, to COVID-19 in April 2020.
Despite the different nature of these two catastrophic events, the response to 9/11 has informed how New Jersey reacted to the pandemic, according to those involved. The EMS task force a nonprofit that is available to help coordinate large, multijurisdictional emergency responses itself is an example of that process, members said. And its work evolves more with each crisis or incident, with members learning from every hurricane, train crash or other big event, Cicala explained.
Before 9/11, EMS was a loosely knit group of agencies. There really was no connective tissue, recalled Mickey McCabe, another founding task force member who also runs a private ambulance company in Bayonne he started in 1973. McCabe recalled his struggle to effectively deploy assistance to ground zero from among the 200 ambulance units that had showed up on their own at Liberty State Park that day, all determined to help despite the lack of a coordinated plan.
Members said that since then the task force has used grants and other funding to acquire resources that were beyond the reach of local responders. The list includes ambulances with extensive medical equipment that can transport 20 prone patients at once, mini-ambulances for off-road use, and a unit that can refill multiple oxygen tanks at once. Its grown from a loose-fitting group with a vision, and we started to knit together a patchwork and make it work, McCabe said.
Part of the task forces evolution has involved working with local responders to create action plans that can help guide decisions in a crisis. As a result, the task force now has plans for some 15 different scenarios from dealing with tropical weather to performing water rescues to evacuating hospitals that give them a head start when disaster hits.
But all plans, including pandemic plans created by the task force, should be considered a starting point and need adjustment in real time, responders said. A COVID-19 response framework drafted by state officials was essentially abandoned when the pandemics requirements quickly outpaced the response outlined on paper.
These plans are really guidelines, said Lou Sasso, another task force leader who also serves as Middlesex Countys emergency response coordinator. These situations are always a little bit different and require flexibility, he said. But with bright people, the right resources and the right plans, thats how you make things work.
The state Department of Health also worked to beef up various preparedness programs after 9/11. Department spokesperson Dawn Thomas said federal funding was used to augment the capabilities of 22 local health departments that now serve as a coordinated public health network.
One of the lasting impacts was foundation building building and sustaining relationships with healthcare systems and local health departments, particularly in regard to preparedness, Thomas said. The alliances have continued, she noted, allowing the state to funnel additional federal funds to local hospitals for emergency preparedness needs.
The work of the EMS task force has also benefited from the relationships members have built over the decades with local responders and community groups. The groups connection to state officials has also strengthened significantly in recent years, providing new opportunities to support larger public health efforts, which became critical during the pandemic.
In March 2020 task force members helped state officials set up the massive, drive-through COVID-19 testing sites. Weeks later, the team was called in to evacuate dozens of frail elderly residents from the St. Josephs Senior Home in Woodbridge, which had been overrun by COVID-19 infections. The group worked with state officials and local providers to create pop-up vaccination sites at the Jersey Shore this past Memorial Day. By June, the organization had taken on the near-daily responsibility of distributing vaccine doses from a storage facility in Mercer County to vaccination sites throughout the state.
Weve become sort of the tip of the spear in some respects for the state Department of Health, Sasso said, enabling the state to quickly expand testing or vaccination capacity in communities hard-hit by COVID-19. Weve become their boots on the ground when it comes to public health.
Task force members are pleased with the groups progress and McCabe said he is proud of how EMS response has evolved to become more coordinated in New Jersey, which is known for its fierce commitment to local, or home rule. I think we are far ahead of where we were on Sept. 10, 2001, Cicala said. We have come a long way and we are more prepared now than we ever were.
However, there is always a need for additional funding, members said. New communication equipment is high on the list of needs, Sasso said, and it isnt cheap. Updating and maintaining what we have [is the priority]; if we could enhance it, even better, he said.
Udasin, from the Rutgers World Trade Center clinical program, said there is also a need for greater investment in mental health care. Access to treatment has improved over the years, she said, but insurance coverage for behavioral health care remains sub-par. And for some there is still a stigma around asking for help with psychological issues, she explained.
Thats one lesson we should take out of this crisis, Udasin said. It took a long time to make the treatment of mental health as accessible as physical health [treatment] in our world. And as a world, we need to collectively treat mental health better, to treat peoples fears better.
Streich, the mental health director at the same Rutgers program, said people also need to understand that it can take time before survivors are ready to discuss a trauma with others. It took a while for some of the World Trade Center first responders to accept mental health help, she said, and it may be the same for those now on the pandemics front lines.
Thats the thing with PTSD, youre not going to see it right at the moment, Streich said. But I do think its coming. Especially for all those who are burnt out and havent allowed themselves to deal with the current situation.
In that way, both 9/11 and the pandemic are likely to share a sad and lasting legacy. Thats the thing with mental health: Its permanent, Streich said. Treatment can save and improve lives greatly, she said, but you dont get over the problem. Its really always there.
Vaccinated people who are infected with COVID-19 and get a so-called breakthrough case that leads to severe illness are more likely to be older and have preexisting health conditions, a new study found.
"Overall, older population with underlying heart or lung disease, or with weakened immune system were the most highly represented in those with breakthrough cases with symptoms," Dr. Hyung Chun of the Yale School of Medicine, who led the study, wrote in an email.
Chun and his Yale colleagues identified 969 patient who were admitted to hospitals in the Yale New Haven Health System and who tested positive for COVID across a 14-day period from March 23 to July 1, according to commentary posted on the Lancet Infectious Disease website on Sept. 7.All patients were required to get tested when they were admitted and may have come to the hospital for illness other than COVID.
Roughly 18% of the patients who tested positive received at least one vaccine dose and a third of these were fully vaccinated, records showed.
The team focused on those fully vaccinated people and found a quarter of them (14 people) had severe or critical disease and required supplementary oxygen support. Four were in the intensive care unit, one on a mechanical ventilator and three died.
The patients with severe disease ranged in age from 65 to 95 years old and had a median age of 80.5, the researchers said. They had preexisting comorbidities including cardiovascular disease, lung disease, obesity and Type 2 diabetes. Some patients were on immunosuppressive drugs that may impact vaccine efficacy.
A large body of research shows COVID-19 vaccines are effective and have been instrumental in curbing the pandemic, but in rare cases people who are fully vaccinated contract the virus and get what are called breakthrough cases. In even rarer cases, a breakthrough case results in severe illness.The Centers for Disease Control and Prevention has received reports of 14,115 patients with COVID-19 vaccine breakthrough infection who were hospitalized or died. This accounts for an extremely small percentage of the 178 million fully vaccinated individuals in the United States.
"Vaccines continue to remain highly effective in preventing severe illness due to COVID-19," Chun wrote. "The likelihood of developing severe COVID-19 infection remains far lower for those vaccinated compared to those unvaccinated. Emerging data on breakthrough cases will need to be closely followed to determine the most effective strategies for booster vaccines."
The study was done before the highly transmissible delta variant became the predominant COVID variant in the United States. Chun said more research is needed to determine the impact of the delta variant on breakthrough cases.
BALTIMORE (WJZ) After months of declining COVID-19 cases, the virus is finding the most vulnerable population the unvaccinated.
It raises concerns for many parents with little ones.
The FDA said on Friday that they are working around the clock to support the process of making the COVID-19 vaccine available for children under the age of 12.
The vast majority of people that we see in the hospital are unvaccinated, said Dr. Esti Schabelman, Chief Medical Officer at Sinai Hospital.
Hospitals are staying busy and doctors say its not just COVID-19 patients.
Our biggest issue right now is just the tremendous volume of patients that we have due to people likely delaying care during the height of the covid pandemic, said Dr. Schabelman.
With the new school year underway, Dr. Schabelman said Marylanders should not let their guard down.
With kids especially who are currently unvaccinated, theres another virus that they get called RSV that can also present the same problems if they have it with covid, Dr. Shcabelman added.
We definitely carry hand sanitizer. I feel like the kids are really good and theyve gotten used to keeping a little distance between them, said Ryan Plunkett.
Flu season is also approaching and with it comes more concerns.
The more general viruses that we have going around, the more people were going to have in the hospital, Dr. Schabelman said.
Here in Maryland, more than 1,100 new covid cases were reported Sunday but the statewide positivity rate remains below 5 percent.
I think people dont want to go back down to any sort of lockdown, said Emily McDermott.
Efforts to get more shots in arms continue. President Bidens latest sweeping rule requires a vaccine mandate for all businesses with more than 100 employees or face weekly testing.
I definitely think this is the right message. Were not going to be able to end this pandemic until everyone is vaccinated, Dr. Schabelman added.
I wish it didnt have to happen. In a normal circumstance, I wouldnt agree with companies having a mandate for vaccinations. But unfortunately, because people arent doing it on their own, people arent doing their own part on their own, at this point in time, I do support the companies, said McDermott.
Prem Rokaya, a patient care technician, sanitizes a stretcher in a preoperative bay at Providence Alaska Medical Center on May 8, 2020. (Marc Lester / ADN)
As Alaskas hospitals grapple with short staffing, limited capacity and a health care system under serious strain, the state has reported ever-rising record numbers for COVID-19 hospitalizations.
But those tallies are complicated. They include people who may have been admitted for something else and test positive for the virus, but they also omit others who have been hospitalized for COVID-19 for so long that theyre not infectious anymore.
That all makes it harder to discern the true burden placed on health care facilities using a single number, Dr. Anne Zink, Alaskas chief medical officer, said in an interview Friday.
I dont think from a state perspective we can say its like really overcounting, we cant really say its undercounting, Zink said. We can say this is the only data that we can report out because its the only data that we have.
State hospitalization data also doesnt include emergency room visits, another way to quantify the burden on hospitals, since those are considered outpatient visits, Zink said.
The virus hospitalizations number recorded on the states online dashboard comes from hospitals that report into a federal database, and that information is then extracted by state public health officials.
While testifying before the House Health and Social Services Committee last week, Zink told legislators that the total number of hospitalizations reported on the states COVID-19 dashboard likely didnt represent everyone ill from the virus in Alaskas hospitals.
For someone, say, whos in their 30s who gets hospitalized, they might be infectious for the first 10, 15 days, Zink said. But they might require a monthlong or two-month-long hospital stay. And so that is a continued burden on the hospital that is not reflected in the overall dashboard numbers.
There may also be other patients who arent reflected in the dashboard, Zink said. Some patients might begin to recover and then experience a complication, like a heart attack or stroke, and are admitted and treated instead for that complication, according to Zink. That wouldnt always show up in state data.
When asymptomatic individuals who are COVID-positive are admitted to hospitals for other reasons, like labor, those patients still incur more work for hospital staff and require more resources. Staff have to gown up and patients need single rooms.
Asymptomatic patients also might get sicker while in the hospital, Zink said, and go from seeing no symptoms when they test positive to experiencing complications later.
Generally speaking, health officials say, once a patient is no longer positive for COVID-19, theyre no longer counted in the overall hospitalizations number. They might, however, still be in a hospital bed while symptoms persist, needing acute care and impacting capacity.
But there is some variety in how COVID-19 hospitalizations get reported.
Based on responses from various Alaska hospitals this week, some report all COVID-19-related hospitalizations while others only report active cases.
Alaskas largest hospital, Providence Alaska Medical Center, only reports active COVID-19 cases in their hospitalization numbers. That doesnt include others who are no longer infectious with the illness but still need hospital care, according to Providence Alaska spokesman Mikal Canfield.
On Wednesday, 50 people were considered active COVID-19 patients at Providence, while 22 others were not included in the case count since they werent infectious and were considered recovered, Canfield wrote in an email.
This does not necessarily indicate the patients are doing well, it just indicates these patients are no longer considered infectious, he wrote.
Similarly, Fairbanks Memorial Hospital only reports active COVID-19 cases, which as of this week was 24 cases, while there were no patients who were hospitalized past their infectious period.
The COVID-19 hospitalizations number of the states dashboard isnt necessarily an accurate portrayal of who may be hospitalized with the illness at Mat-Su Regional Hospital either, according to spokesman Alan Craft. Thats because, similar to other facilities, patients who are at the hospital for longer stays due to COVID-19 may not show up in those numbers after being reclassified.
At Alaska Native Medical Center, generally any patient that tests positive for COVID-19 is reported as hospitalization but may be pulled out of that tally based on symptoms and other Centers for Disease Control and Prevention guidelines even though they may still be hospitalized, said Dr. Robert Onders, of the Alaska Native Tribal Health Consortium.
However, at Alaska Regional in Anchorage, spokeswoman Kjerstin Lastufka said that their COVID-positive numbers include all patients who need care related to the virus until discharge.
The number that is reported to the state includes both patients in the acute phase of COVID-19 care as well as patients still recovering from COVID-19 those who are past the infectious period but are still hospitalized, Lastufka said in an email.
Officials at Bartlett Regional Hospital in Juneau said that they report new COVID-19 admissions within their infectious window and in some cases, depending how severe a case might be when theyre admitted, that infectious window can be extended to 20 days.
In a Thursday press conference, Yale New Haven Health system officials explained that approximately six percent of patients who test positive for COVID-19 and are symptomatic are fully vaccinated.
Maria Fernanda Pacheco 10:37 pm, Sep 12, 2021
Staff Reporter
Yale Daily News
As vaccination rates continue to increase in Connecticut and hopes for achieving herd immunity get closer to materializing, Yale New Haven Health system officials hammered home a resounding message: the best way to protect yourself and those around you is to get vaccinated.
In a Thursday press conference, Yale New Haven Health system President Christopher OConnor, Chief Medical Officer Thomas Balcezak and Senior Vice President and Chief Policy and Communications Officer Vin Petrini discussed hospital admission rates due to COVID-19, breakthrough infections and health system-wide vaccine mandates in light of the Delta variant.
The Delta variants propensity for immune evasion has been raising questions over the protective longevity of vaccines, but YNHHS officials stressed that occasional hospitalizations due to breakthrough infections do not mean that vaccines are not doing their job.
Six percent of our COVID admissions are among individuals that are fully vaccinated, Balcezak said, referring to people who were admitted to YNHHS for COVID-19 symptoms. That 6 percent is usually in folks that are older, have compromised immune systems and have other comorbid, particularly respiratory, conditions.
OConnor added that COVID-19 numbers for YNHHS are extraordinarily different from when we first started the pandemic a year and a half ago, which is a testament to the efficacy of the vaccine. According to Balcezak, the system peaked at almost 900 patients on a given day in early 2020, whereas as of Thursday, YNHHS had 132 hospitalized COVID-19 patients.
Balcezak explained that over 99 percent of COVID-19 cases currently coming into the health system are due to the Delta variant, which is notorious for its greater viral load and higher transmissibility compared to other coronavirus variants.
YNHHS is currently testing all incoming patients for COVID-19 upon entry into the hospitals regardless of whether or not they are experiencing the associated symptoms. But in the process of testing, COVID-19 is also being detected in asymptomatic patients who are coming into the hospital for other reasons such as traumatic accidents or emergency procedures.
Around 30 percent of all patients who are hospitalized and test positive for COVID-19 have been vaccinated, according to Balcezak. However, only six percent of all patients who test positive for COVID-19 upon hospitalization are exhibiting symptoms. The remaining 24 percent are asymptomatic and typically come into the hospital for other health concerns and find out of their COVID-positive status upon admission.
I think its important to underscore these statistics because there is no question that [the] vaccine works, Balcezak said. Those facts need to be out there so that folks dont think that the Delta variant emergence is a reason not to get vaccinated.
According to Balcezak, while the asymptomatic 24 percent will not need any treatment for COVID-19, they should still be isolated and properly cohorted according to their infection status while they address the health concerns that brought them to the hospital in the first place. This is meant to avoid unnecessary exposure for staff and other non-COVID-19 patients, he said.
To ensure the safety of those within YNHHS hospitals, the system has also implemented a vaccine mandate or progressive discipline process, as described by OConnor for employees. Under the mandate, employees who have not been vaccinated by October without having acquired an exemption will have their employment terminated.
As healthcare providers, it is our responsibility to provide a safe environment for patients and their families, and this is just one way were doing that, Balcezak said. If you work in healthcare, I think its incumbent upon you to do so in a way that protects people, and thats certainly the motivation behind doing what were doing.
YNHHS is holding COVID-19 vaccine fairs to give employees an opportunity to get vaccinated, Balcezak said. Since the institution of the mandate, vaccination rates among their staff have been moving pretty aggressively in a positive direction, according to OConnor.
The mandate parallels an Executive Order issued by Gov. Ned Lamont, whereby Connecticut state employees working in childcare facilities and preK-12 schools, in addition to state hospital and long-term facilities staff, will need to be vaccinated by Sept. 27.
Im pleased that Connecticut, because were 84 percent vaccinated, is relatively flat, Lamont said after a press conference in late August, as reported by CT Insider. Doesnt mean were out of the woods but we are what they used to say remember in the early days of COVID flattening the curve.
According to the Centers for Disease Control and Prevention, 75.3 percent of Connecticuts eligible population has been fully vaccinated.
Maria Fernanda Pacheco is a staff reporter for the Science & Technology desk of the Yale Daily News. Originally from Rio de Janeiro, Brazil, she is a sophomore in Grace Hopper College majoring in Neuroscience and participating in the Global Health Studies program.
LANSING, Mich. (WLNS) The Michigan Department of Health and Human Services (MDHHS) tweeted about increased guidance resources for parents with children exposed to COVID-19.
MDHHS has issued updated quarantine guidance for K12 students exposed to COVID-19 but dont have symptoms. This guidance will help ensure students and educators are as safe as possible in the classroom and keep students in school for in-person learning. https://t.co/idEbUYqrRk pic.twitter.com/0U2gjl4z1E
MDHHS recently released updated precautions that discuss things like quarantine versus isolation, when a student exposed to COVID-19 can stay in school and school testing opportunities.
The Michigan Department of Health and Human Services (MDHHS) recommends local health departments and schools work together to quicky isolate COVID-19 cases among students and staff, identify close contacts of those cases, and adopt quarantine policies that reduce the risk of transmission in schools while allowing in-person learning. When evidence-based prevention measures, including universal masking, are in place, modifications may be made to the 10- to 14-day at-home quarantine.
Now, what is isolation, what is quarantine- and how are they different?
According to MDHHS, isolation is necessary when one has already been infected with the COVID-19 virus, has tested positive- even if they arent showing symptoms. Quarantine is needed when one has been exposed to COVI(D-19.
Both quarantine and isolation are determined by local health departments, so quarantine factors may be modified.
What are the updated school quarantine guidelines?
There are three situations in which a student can have been exposed to COVID-19, and go to school without quarantining:
Additionally, there are situations where students have been exposed to COVID-19 should not return to school:
MDHHS goes on to state that anyone who shows COVID-19 symptoms should get tested for COVID-19 and isolate.
To see testing resources information, click here.
For the latest information on Michigans response to COVID-19, please visitMichigan.gov/Coronavirus. You can also call the COVID-19 Hotline at (888) 535-6136 oremail COVID19@michigan.gov.
Over the last few weeks, hospital systems across Virginia have been sounding alarms over the latest coronavirus surge, largely driven by the highly infectious delta variant.
In Southwest Virginia, Ballad Health is facing its worst-case scenario with more than 700 COVID-19 patients. In Northern Virginia, hospitals already nearing capacity with COVID-19 cases have been overwhelmed by recently arrived Afghan refugees. And on Thursday, the Virginia Hospital and Healthcare Association issued a statement on behalf of more than three dozen medical groups, pleading for unvaccinated Virginians to get their shots.
In just two months, hospitalizations have increased by 1,008 percent and new cases have jumped by 1,217 percent, it read. With hospital inpatient and ICU beds already filling ahead of a looming fall surge, it is imperative for unvaccinated Virginians to do their part to help save lives and slow the spread of this deadly virus by getting vaccinated.
Nowhere has the latest spike in cases been more obvious than in Virginias beleaguered emergency rooms, where unvaccinated and often seriously ill COVID-19 patients are adding stress to an already maxed-out system. Dr. Todd Parker, president-elect of the Virginia College of Emergency Physicians, said almost every hospital across the state is struggling with overcrowding, widespread staffing shortages and difficulty transferring patients who frequently require higher levels of care to facilities experiencing the exact same challenges.
The ongoing surge is sending ripple effects across Virginias medical system. On Sunday, Carilion said it set up a tent outside the emergency department at the New River Valley Medical Center in Christiansburg, expanding its waiting area as visits continue to swell. And the crush of patients isnt unique to Southwest Virginia. Across the state, emergency medicine physicians are reporting an ER safety net on the brink of crisis.
When the Mercury reached out with questions about the state of emergency rooms, the emergency physicians group polled its Board of Directors, a group of doctors representing multiple geographic regions. The association didnt disclose the names of individual health systems or physicians, who werent authorized to speak on their hospitals behalf, said spokesman Jeff Kelley.
But many of the responses painted a grim picture of how the ongoing pandemic continues to affect providers. One physician from a hospital in Eastern Virginia described the emergency department as a second ICU at this point.
We had to bring in more ventilators because we are running out, the physician said. Another doctor from a hospital in Southwest Virginia said the facility has experienced several deaths in the waiting area of its Level 1 trauma center among patients we wanted to room immediately but we just do not have the space nor the staff for it.
In our little community EDs, we are seeing people languish waiting for a bed to become available at a tertiary care center larger hospitals that can provide specialty services or higher levels of treatment the physician said. In some of those cases, patients are admitted on a progressive care level, which requires regular monitoring but isnt considered critical. By the time a space becomes available, though, the physician said many patients have been upgraded to ICU-level care.
I have also had to palliate patients rather than admit them because the only available inpatient bed is states away and family would rather be with them than send them away, the doctor said. So I just send them home on hospice.
There are multiple reasons why the current surge is disrupting emergency department operations at a far greater level than earlier in the pandemic. For one thing, theres more demand. Julian Walker, vice president of communications for VHHA, said early stay-at-home orders coupled with widespread fear of contracting the virus at the hospital led many non-COVID-19 patients to avoid the emergency room, even during genuine crises. In 2020, Virginia hospitals saw a 30 percent decline in ED visits, even after the state began to reopen.
For most hospitals, that period is over. Parker said many emergency departments are fielding larger numbers of patients than they did before the start of the pandemic. Doctors from the northern, central, eastern, southwestern and Shenandoah regions of the states all reported slightly to significantly higher patient volumes in recent weeks.
Not every case is an emergency, including one patient in Northern Virginia who came to the hospital with a stomach ache after drinking too much soda (this really happened, the attending physician said.) But overall, patients and not just COVID-19 patients are presenting with more complex medical problems.
To use the medical term, were seeing sicker people, Parker said. Many adults delayed medical care during the pandemic, and Walker said hospitals are now experiencing what he described as pent-up demand. Major shifts in medical care have also contributed to the complications.
In the first month of the pandemic, Gov. Ralph Northam ordered a temporary halt to elective procedures to preserve hospital capacity. Telehealth visits have also become commonplace, but one doctor from Northern Virginia said they havent reduced emergency room use. In some instances, primary care doctors direct patients to the hospital if they cant perform a physical exam or cant get a clear read on the severity of a patients symptoms.
Weve also been seeing more complications from the over-prescription of medications such as antibiotics, the physician said. According to Parker, that also occurs when patients arent being examined in-person.
When people cant provide the nuanced level of care they usually do, they tend to overprescribe, he said. Not everyone does this. But say someone has an earache. If Im doing telemedicine, I cant look in their ears, so a lot of urgent cares are just prescribing them antibiotics.
More than anything, though, its the massive spike in COVID-19 cases thats driving the disruption. Not every hospital is experiencing the same spike another physician from Northern Virginia reported admitting just one coronavirus patient over the last three months. But Parker said the situation is especially critical in regions with low vaccination rates.
Ballad, for instance, is treating more COVID-19 patients than it did during the systems previous peak in early January. Some are being monitored at home through telehealth visits, but more than half are hospitalized. Of those hospitalized patients, more than one quarter are in the ICU and nearly 20 percent are on a ventilator. Only 40.2 percent of people in the systems service area are fully vaccinated.
Its the highest census I can remember us having in the three and a half years Ive been working for Ballad Health, chief operating officer Eric Deaton said in a Thursday news briefing. Other hospitals in the near Southwest, an area that extends roughly from Blacksburg to Roanoke, have also experienced a rising number of hospitalizations.
Carilion, Centra, LewisGale, Sovah Health and the Salem VA Medical Center reported a total of 326 COVID-19 patients this week, 98 of whom were admitted into the ICU. In early June, all five systems had a total of 61 coronavirus patients, with 16 ICU admissions.
Across the state, though, physicians say virtually all COVID-19 hospitalizations have been among unvaccinated patients particularly cases requiring ICU or ventilator care. The surge has created a perfect storm for ERs, Parker said.
Doctors are now treating severe infections in addition to high-need and medically complex patients without coronavirus. As a result, more patients in general are being admitted from the emergency room, driving congestion throughout the hospital.
Its not the volume thats killing us, one emergency medicine doctor from Southwest Virginia said. Instead, its a growing influx of patients from the ICU and other hospital departments boarding in the emergency room. Another doctor from the same region said 61 of the 68 beds in a local emergency room were recently taken up by other inpatients.
Overcrowding, now endemic in Virginia emergency rooms and in hospitals across state lines, is creating delays across the system. LewisGale, Sovah and Carilion have all had to divert patients or decline transfers over the past two weeks.
When we issue this diversion status, we will not refuse care for any patient presented at our hospital, especially those in critical condition, LewisGale spokesperson Chris Finley wrote in an email last week. But it is a sign that emergency rooms are overwhelmed. At this point, though, its also increasingly difficult to find alternative sites for patients. One doctor in Central Virginia said there are currently 10 emergency departments in the area on ambulance diversion.
There have been times this past week at the start of the day shift that every monitored bed had an admitted patient, the doctor continued. In most cases, though, the issue isnt available bed space, but understaffing. Another emergency room physician in the Shenandoah region said theres currently a severe shortage of clinical nurses, with all available staff redeployed to assist in response to the COVID crisis.
This problem started months and months and months ago, Parker added. The problem is that nurses are leaving and going elsewhere. I think there is a huge burnout factor from doing this for so long.
Its not just nurses who are feeling the strain. Burnout among medical providers has been a serious concern for months, but many doctors said the downstream effects from the ongoing surge are only making things worse. Long emergency room delays are becoming more common, with waits between six to eight hours on some days, one physician from Central Virginia said. Pediatric COVID-19 patients are becoming more common in some areas. And transferring patients to get the care they need is a frequent challenge.
One hospital transferred a patient to us after calling more than 20 hospitals in four different states, the same physician said. And similar delays have spread across the continuum of care, from processing orders for medication to imaging and lab work. Another doctor from Northern Virginia said overcrowding in other hospital departments has led to pushback admitting patients from the ED. The stress of caring for those patients and the fight for appropriate care just adds to the strain.
Everyone has been pushing hard for so many months and this latest surge is grinding everyone down, added a physician from Eastern Virginia. We arent health care heroes. No one is sending food or thanks. We are just drowning with no one even noticing.
SILVERDALE As patients suffering from COVID-19 fill Kitsap County's main hospital to thebrim, a plan to alleviate some of that pressure is taking shape in the backlot of a nearby surgeon's office.
There,an increasing number of cars fill parking spaces.Those in the vehicles wait for a vanguard treatment for COVID-19, one proven to reduce hospitalizationsfrom the pandemic disease.
"People don't realize that we're in the middle of a disaster," saidDr. Kristan Guenterberg, asurgeon by trade, whose Kitsap General Surgery has volunteered to treat patients with COVID-19. "This is a way to decompress the system."
Guenterberg and the staff are likely the first in Kitsap to administerREGN-COV, a monoclonal antibody made by the drug company Regeneron of Tarrytown, New York. Patients in the parkinglot are receiving four total shots directly in the muscle in the legs, abdomenor arm, that are full ofcloning immune cellsshown to be effective against COVID-19.
It is the same treatment used by former President Donald Trump, Texas Gov. GregAbbott and others, and has been found to reduce symptoms of COVID-19 by days. But Guenterberg and the staff there aim not only to help individual patients, butto take pressure off St. Michael Medical Center, wheremore than 50 people have been hospitalized for COVID-19.
Kitsap General Surgery isn't the only providerin Kitsap that has recently begunthe drug for treatment. Just this week,Virginia Mason Franciscan Health's Family Medicine Clinic, on Kitsap Way, began to administer it as well, according toDr. Casey Kernan, one of the physicians there.
Kernan echoed the goals of Guenterberg, pointingout that the most important step residents can take against COVID-19 is to get vaccinated.
"We need to make it clear this is not a substitute for vaccination," he said. "The vaccines are safe andeffective, and our goal is to get people vaccinated."
Given the treatment's limited supply, it is only able to be used for the most high risk of cases including those pregnant, those over 65, those with a compromised immune system or those with chronic diseaseand is most effective when administered soon after the onset of COVID-19, when it best positioned tofight the rapidly multiplying virus.
The drug has also been authorized for people exposed to COVID-19 who haven't confirmed they are positive. But right now, the supply just isn't there yet to provide treatment in those cases.
"We just don't have enough Regeneron for everybody," Kernan said.
Guenterberg said emerging data is showing that for every 26 patients treated with Regeneron, one hospital stay will be prevented. On Friday, he and his team provided treatment for around 25 people.That should ultimately help at St. Michael Medical Center, whose intensive care unit is more than 90% full. But he cautions that supplies are still limited and they're doing the best they can to "ramp up" and help as many people as possible.
The treatment comes as the delta variant surges through Kitsap. The Kitsap Public Health District reported six more COVID-19deaths on Friday alone, bringing the total to 149 for the pandemic. More than 1,000 people are isolating themselves with COVID-19 cases in the biggest wave to date in the pandemic.
As the delta variant fuels an unprecedented surge ofcases in the pandemic, presidential adviser Dr. Anthony Faucisaid in late August thatmonoclonal antibodies are "a much-underutilized intervention" in the treatment of COVID-19. The government is currently subsidizing the cost of the treatment.
President Joe Biden referenced monoclonal antibodytreatments in a speech Thursday, saying that for the unvaccinated, they reduced the risk of hospitalization by up to 70%. He made sure to cast distinction on thetherapy versus the current tideof misinformation driving some to trydrugs likeIvermectin, which is used to treat parasites in horses and is toxic for humans.
"Additionally, were increasing the availability of new medicines recommended by real doctors, not conspiracy theorists," Biden said, adding that the government will boost the "pace of shipment" of an already-distributed 1.4 million courses of monoclonal antibodytreatmentsby 50% "to save lives and reduce the strain on hospitals."
Josh Farley is a reporter coveringthe military and health care for the Kitsap Sun. He can be reached at 360-792-9227,josh.farley@kitsapsun.comor on Twitter at@joshfarley.
