Friday night update from the ER in Arlington, VA
Happy Thanksgiving.This is my holiday weekend to work. I spent a good chunk of yesterday working in the ER and will be there this weekend. It was a fairly typical Thanksgiving with below average volume and waiting for my first kitchen related accident of the day (which occurred a little later in the morning than I expected).
The big issue on the VHC home front is once again supplies. The attached picture is a view of two boxes of gloves. We’ve used blue nitrile gloves for as long as I can remember. Yesterday, our large gloves were green. Gloves are in high demand and we’re using other vendors to source products. In fact, the world’s largest manufacturing of latex gloves (located in Malaysia), had to shut down over half of their factories after 2500 workers tested positive for COVID. Just like we continue to see shortages in our daily life at home (TP, bicycles, chlorox wipes, etc…), healthcare is not immune. I’ve been very thankful that we have maintained a good supply of PPE though, like every other hospital, continue to reuse masks beyond the one patient at a time they were designed for. A study came out recently that N95s lose some of their protective benefits if worn for more than 2 days. Many people I know who work on the frontlines at other hospitals are wearing them much longer than this. This is a risk to healthcare workers. We also have plenty of ventilators (as does most hospitals). The push to build ventilators was great but there continues to be a need for PPE, tests, and other things that hospitals need.
The Rapid Abbott tests we have built our safety net around are in limited supply. I’ve heard rumors the government has acquired large amounts of them for heavier hit areas and I’ve also heard that they had a manufacturing issue. I don’t know what the reason is but I know that we, like a lot of hospitals where my friends and colleagues work, won’t be getting our usual weekly shipments, and therefore we are pivoting to other testing strategies. The good news is that we’ve had some back up plans in the works for a bit, but it’s a change in how we do business. Additionally, pipettes are apparently in real demand. You’ll remember pipettes from chemistry class. The little things you squeeze to get liquid out of vial and move it to another vial. Apparently, we use hundred and hundreds of these a week and there’s a shortage of these as well.
The change in our testing strategy has put a little kink in how I interpret our ED percent positive rate and numbers of positive of tests. Those data points need a little more analysis and scrubbing. However, there’s some other data points we can look at to get a sense of how this week compares to last week. The number of hospitalized COVID patients is slightly more today than it was a week ago. Our ICU has a decent amount of critically ill COVID patients with many requiring ventilators. Although the overall mortality rate of COVID appears to have decreased since March, the mortality rate once you’re on a ventilator has not changed and remains high at about 50%. The other metric we have that doesn’t rely on testing is the number of patients requiring COVID isolation in the ED. We started with this metric in March when testing was pretty much non-existent. It remains a useful tool. The good news is that after seeing 2 weeks in a row of increasing numbers of patients who required isolation in the ED, we saw it flatten this week compared to the two previous weeks of increase.One of the most important commodities for the healthcare team to continue to provide high quality care is staff. We’re 9 months in and people are exhausted and are also not immune to getting sick. Many people probably saw that the Mayo Clinic hospitals in the mid-west had 900+ nurses out with COVID. While that sounds awful, this is across 23 hospitals and I’ve been told represents a very low percentage of their workforce. But the reality is, nurses, respiratory therapists, and other healthcare workers are a critical resource right now. While our risk of getting sick from a patient is very low, it’s not zero. Plus, all of us have the same day to day risks that non-HCW’s have—we go to the grocery story, our kids interact with others, etc… Additionally, a big risk for all of us is how we interact at work in the breakroom, which is often the site of transmission. Some good news towards keeping us healthy is that the Pfizer vaccine is likely to be granted emergency use authorization on December 10th, which means hospitals could be receiving it within a day or two after that. As a hospital, we continue to make plans on how to prioritize staff to receive the vaccine. This is relatively welcome news. I don’t know that I’ll be first in line, but I will likely be in line and will let you know how it goes. Keeping in mind that it’s 2 doses, 21 days apart, and immunity isn’t really achieved until 28 days after the first dose, I’m optimistic that I can continue to minimize my risk for the next 6 weeks. But I also realize the next 6 weeks will be a lot of COVID exposure.
The vaccine news continues to roll in. Released this week was the data regarding the AstraZeneca-Oxford vaccine. While the overall data came out to be about 70% effective, this was interesting because a lower first dose dosing regimen with a full second dose actually helped the vaccine reach 90% effectiveness. This was also the first study that tracked asymptomatic positives. The best news is that none of the symptomatic cases required hospitalization. But this vaccine also tracked asymptomatic positives. Over and over, we hear that asymptomatic patients contribute to spread so we’d like a vaccine that reduces the likelihood of people getting the virus, even if they’re asymptomatic.
I hope everyone has a wonderful and safe Thanksgiving holiday weekend. I’m incredibly thankful for my family, my hospital, the team that I work with, and all of the support we’ve received from family, friends, and the community. Thank you.