Friday Night Update from the ER in Arlington, VA
My responsibility at the hospital gets split between administrative time as the chair medical Director and clinical time. This past week, I worked a lot clinically. The pace that we see patients throughout our shifts varies as the shift goes on. Typically, in the first hour of the shift, I will see 4-6 patients. The numbers decline as the shift goes on and I usually do not see any new patients in the last hour of my shift but rather spend that time finishing up the care of the patients that I am taking care of. During two shifts this week I looked at my tracking board (part of the electronic medical record that has my active patients) and noticed that I saw 5 patients in my first hour during each of these 2 shifts and that 4 of those 5 each time were COVID positive. Some come in knowing they are COVID positive, others we diagnosis as having COVID. At the end of the day, that is obviously a very high percentage of patients that have COVID. Fortunately during each of those shifts, the percentage of patients who had COVID decreased.
protocol. About 25% test positive in the ER and another 10% are known to be positive prior to arrival. The other 5-10% either have the isolation status removed or have other risk factors and are still considered high risk for COVID.
About 25% of patients that come to the ER get admitted to our hospital. That’s up from 20% pre-pandemic. Our individual physician rate is most impacted by the shift that we do and the responsibilities that come with that specific shift. This past week, I admitted about 50% of my patients. That’s a lot of sick people. I admitted several patients with COVID this week to the ICU. None of them were vaccinated. I did admit a couple of patients who were vaccinated with COVID as well. But consistently, they are just not as sick as the unvaccinated patients.
On the administrative side, I did a TV interview Wednesday afternoon (see link in comments below). While I look at data every day, data that I discuss in these updates is always fresh and is the data that I populate my spreadsheets with as the Mike “official weekly data.” But in preparation for the interview, I put together some stats. As of Wednesday, the number of patients that were hospitalized from COVID was up two times compared to 2 weeks earlier and was up more than 10% compared to last Friday. However, we’ve had a lot of patients leave the hospital over the last few days and so the number of patients that are hospitalized today is actually less than earlier in the week. Last Wednesday was our record for the number of covered patients requiring hospitalization. It’s still about twice as much as 2 weeks ago but we seem to be heading in the right direction.
Let’s look at our ER data. We’re now about 4 weeks into this current surge. Our ER volume and the number of patients we’re caring for that are COVID related, seems to have peaked in the week between Christmas and New Year’s. For the third week in a row, we are seeing a decline in the number of patients who require our COVID isolation procedure. We’re also seeing a decline in the number of patients that we are diagnosing with COVID. With that said, we are still seeing about 10 times more COVID patients then we were a month ago and 25 times more than number of COVID patients than we were during our lull in November, when I finally switched out of my N95 for surgical mask during my shifts (that lasted about a week). Our overall testing positivity rate has been constant the last 3 weeks at about 40%. Across all testing throughout the hospital, we did see a subtle decrease in the positivity rate.
For patients who require COVID isolation, we’re still admitting about the same number of patients over the last 3 weeks though this represents an increase in the admission rate among this patient population. Sick people still find their way to the hospital. I suspect one of the reasons are COVID isolation numbers are dropping is that we’re seeing less people come in for routine testing. My sense is that people have figured out ways to get tested and/or have figured out the coming to the emergency department for a routine test or when you do not need emergency care is not a good use of your time or money.
When I put all of this together, it does give me hope that the current surge is going to end. From an ER point of view, at my specific hospital, it is possible that we are past the peak. We will make that determination over the next couple weeks. And while we may be in a decline, there is still a lot of COVID in the community that is bringing people to the hospital. I suspect we have a few more weeks for this surge, so please continue to be diligent about mask wearing and avoiding public crowds. It is certainly not too late to get vaccinated or boosted, as the unvaccinated patients continue to be sicker than the vaccinated patients.
From a testing point of view, our percent positivity rate is about 5 times higher than it was a month ago. Among our screening patients, our percent positivity rate is 15 times higher than a month ago. Although our numbers are trending in the right direction, there is still a lot of COVID in the community.
The CDC is on the verge of recommending KN95 masks over surgical masks for routine day to day use because Omicron is so infectious. The supply chain is considered strong enough that there are enough of these masks for everyone. I bought a box of 100 about a year ago for my family and am still going through them. They’ve gone up in price some but I’m buying more to send my daughter back to college with some. My son’s school recommended kids wear them since returning from winter break and I fully support that. There’s definitely no place for cloth masks anymore and I highly recommend you invest in a few KN95 with ear loops that are comfortable and will keep you safer.
The CDC published a report in MMWR that showed an increased likelihood of getting diagnosed with diabetes 30 days after infection compared to those <18 compared to those who didn’t have COVID or had a non-COVID related respiratory illness. For the last two years, we’ve seen an increased number of adults get diagnosed with Diabetic Ketoacidosis (a severe elevation of glucose resulting typically requiring an admission to the ICU) when diagnosed with COVID and this study identifies a link in pediatric patients as well. It’s unclear what causes this though it could be a result of the the virus attacking organs, including the pancreas, where insulin is regulated. Other hypotheses include diabetes occurring as a result of steroids being given during hospitalization or just an increase in BMI due to change in activity from quarantine. Nonetheless, this link adds to the reasons for pediatric patients to get vaccinated and continuing to wear masks when around others.
Reported this week was a new study using outpatient data from Kaiser Permanente Southern California healthcare system during December 2021. Data looked at clinical outcomes for patients who were infected with the Omicron variant compared to the Delta variant. This study showed, compared to the Delta variant, Omicron had a 53% less risk of symptomatic hospitalization and there was a 74% reduction in risk of requiring the ICU. There was approximately 91% less risk of dying with the omicron variant. The authors did not include data related to vaccine and/or booster status.
Omicron certainly appears to be much less virulent than other types of COVID we’ve seen. With that said, we are seeing over 1 million new cases of COVID a day in the 7-day average for people hospitalized around the country is 130,000 patients and that number has been climbing since late December. We knew hospitalizations and deaths would start to rise a couple of weeks after the Omicron variant was identified. Even though the risk of getting hospitalized is lower with Omicron versus Delta, the ease of transmission of this variant makes it likely that hospitals will be at or over capacity for at least a few more weeks.
Like I said, I had a very busy week, so this is on the short side.
Have a great Friday night.
The Coronavirus is not done with us yet. Science matters. Practice physical distancing. Get vaccinated (or your booster). Wear a mask.