Friday night update from the ER in Arlington, VA (read all the way to the end to see the guest co-author I brought in). As a nation, we’ve had record breaking COVID hospitalizations, exceeding 100,000 patients hospitalized for the first time. And the surge from Thanksgiving hasn’t started yet. As a hospital, our inpatient census continues to climb, hitting levels that we haven’t seen since May. Things are heating up and there’s so many moving parts that we’ve increased the cadence of our COVID task force meetings from once a week to three times a week. We’re wrestling with testing, staff, hospital space, outpatient treatment, and getting frontline workers vaccinated in the near future. We set our tent back up as a secondary ER waiting room this week as well. (see picture with our Nurse Patient Care Director on the left and Assoc VP on the right). We set our tent up the first time in early March and left it up for a while but didn’t have a lot of need for it during the spring. I think we’ll use it more effectively this time and it will be needed now. One big difference between the ED in April and now is that the ED volume was really low in the spring. There was a lock down order, people weren’t doing much, and were afraid to come to the ER. Although our volumes haven’t returned to normal yet, we’re 40% busier than we were in the spring, as much of the normal volume has returned, plus we’re seeing COVID patients.
As I said last week, our Rapid Abbott tests have become very difficult to obtain. We’ve switched gears to other testing modalities and will continue to adapt and make sure we’re able to take care of the all our patients. Meanwhile, we have about half the number of Abbotts that we had previously, and we use them in certain circumstances. This means that many of our discharged patients now have COVID tests performed that come back in 1-2 days. As we changed modalities, I didn’t have data last week on positivity rates; but thanks to an amazing analytics team, I have data today. We have almost double the number of positive cases in every way we look at data—symptomatic, asymptomatic, and total patients (both in the ER and hospital wide). Our positivity rate has almost doubled compared to any week in the recent past. Even our asymptomatic patients (those admitted for hip fractures or appendicitis) cases have basically doubled. Finally, our overall hospital rate is higher than it’s been in months. Ultimately, COVID is more prevalent throughout the hospital which likely means it’s more prevalent in the community. On the ED volume side, the number of patients we put under COVID isolation protocol, is 15-20% more than we’ve seen the last several weeks. We’re admitting slightly more of these patients than the last few weeks. And like I said earlier, we’re seeing our inpatient census reach levels that we’ve not hit since May.
We continue to plan to roll out vaccinations for front line employees. The Pfizer vaccine looks like it will be granted an Emergency Use Authorization (EUA) on December 10th and the Moderna vaccine will get EUA on December 17th. I suspect we’ll get Pfizer vaccine within days of it being granted the EUA and we’ll start vaccinating people. This will not decrease our masks or PPE usage, but it should reduce our risk of getting COVID. That’s critical at work but also critical for keeping a work force intact as our staff still has risk of getting sick from community spread. Nurses are a critical resource right now. When NYC was hard hit in the spring, they got help from nurses around the country. Now, the entire country is engulfed in the pandemic and everyone is facing nursing shortages. The Pfizer vaccine was approved for use in the UK this week. They will start their vaccination program next week so we will start to get additional data on at least the initial side effect profile.
Let’s take a look at a recent article published by the CDC in their Morbidity and Mortality Weekly Report that looked at the readmission rate of COVID patients. In further proof that COVID is just not another flu, the authors found that 9% of patients (1 out of 11) required another admission within 60 days of discharge from the first admission. About 1.6% required multiple readmissions. “Risk factors for readmission included age 65+, presence of certain chronic conditions, hospitalization within the 3 months preceding the first COVID hospitalization, and discharge to a skilled nursing facility or with home health care.” Another data point that came out of this study was a 15% mortality rate among hospitalized patients during the first hospitalization. Think about the 100,000 patients in the hospital today. 15,000 of them will likely die.
Also, out of the CDC are new guidelines that quarantine in an asymptomatic person can be shortened from 14 to 10 days with a negative test after an exposure. This certainly makes quarantine easier for people and gets people back to work sooner. Talk to your doctor and follow the recommendations.
For those wondering, my daughter tested negative after returning home from college. You can order an online test by searching Pixel Labcorb.
I’ve been asked many times over the last several months to share my thoughts on the benefits of vitamins as treatment for COVID. This week, I asked Dr Rohit Modak, director of the VHC Infectious Disease team to comment on that. Some of you may know Dr Modak from his mneumonic about COVID safety.
In order to minimize your risk, just remember “The MODAK Rules”
M: Mask always
O: Outdoors is best
D: Distance of at least 6 feet
A: Avoid crowds
K: Know the risks around you
Here are his thoughts on vitamins:“I often tell my patients that a well-functioning immune system is better than any antibiotic I can prescribe. And one of the most frequently asked questions I get is “How can I boost my immune system?” Of course, there’s no magic cocktail. It’s a matter of healthy living – a good diet, exercise, sleep, and low stress. Since I started eating 5 servings of fruits and vegetables daily almost 10 years ago, I no longer suffer with 3-4 URI’s per year, and overall, I feel much better. So why not take these vitamins and minerals as supplements? Shouldn’t that improve health?
I think it’s reasonable to take supplements, with the understanding that we are doing just that – “supplementing” our diet, I don’t think this will cure any infection. Lots of vitamins and supplements are advertised as immune boosters without clear clinical data. And even when there is data, it’s usually inconsistent, and at doses that can’t replicated by simply taking 1-2 pills per day. Personally, I take Vitamin D and Zinc daily. These supplements may not be helpful…but hopefully they’ll give my immune system a slight boost when a coronavirus particle floats my way unsuspectingly. I know this isn’t very scientific, but even an Infectious Diseases doctor has the right to hope!”
Thanks, Rohit for sharing. The pandemic is not over. We are not at the end of the pandemic. We are in the upswing of our second wave. A wave that was predicted over 6 months ago. The cases we expect to see from Thanksgiving travel won’t happen for another couple of weeks. Although the vaccine gives us hope and shows the light at the end of the tunnel, we likely have 6 months until there is mass vaccination. Hospitals are full. This time everywhere. Every hospital. People are dying. I’m very worried about the number of COVID patients that we’ll take care of over the next couple of months as the surge continues. This is the time to remain diligent and safe.
Science matters. Wear a mask. Practice physical distancing.