Virginia hospitals saw fewer births and more substance abuse-related stays in 2020

Hospitals in Virginia recorded a significant decline in birth-related visits throughout the COVID-19 pandemic, while alcohol- and drug-related hospitalizations rose compared to previous years

The data on substance use wasn’t a surprise amid a once-in-a-century public health crisis that’s seen record numbers of fatal overdoses across Virginia and nationwide. State officials have been highlighting the issue for months, warning that increased isolation, job losses and ensuing financial insecurity has led to rising reports of relapses. While the pandemic exacerbated the trend, hospitals have witnessed a growing demand for behavioral health and substance abuse treatment over the last several years, said Julian Walker, the vice president of communications for VHHA. 

From 2019 to 2020, visits related to alcohol and drug use — and mental health crises connected to alcohol and drug use — increased by roughly 3.5 percent. But the decline in discharges related to pregnancy and childbirth wasn’t as predictable. VHHA pulled data from its inpatient database, which covers 91 hospitals across the state. Over the last year, discharges related to childbirth, pregnancy and the six-week period after delivery decreased by about 3.3 percent. Discharges related to newborn visits declined by nearly four percent.

Walker said the association included the data amid rising interest over whether the pandemic could lead to a COVID-19 baby boom. But in Virginia hospitals, at least, that wasn’t the case.

“At this point, we haven’t necessarily seen it, obviously,” Walker said. Discharges related to pregnancy, childbirth and newborn visits didn’t take the same hit as some other services during the early days of the pandemic, when Gov. Ralph Northam issued a stay-at-home order and temporarily paused elective procedures. 

But while discharge numbers for other conditions recovered — including stays related to HIV and male reproductive disorders — birth-related visits declined in 2020 and remained lower overall compared to the previous three years. David Vaamonde, VHHA’s vice president of data analytics, described the decline as an “interesting observation” that warranted follow-up research.

“We’re looking to continue to track those trends,” Walker said. “And see if those numbers are unique to the hospital setting or if that pattern of decline holds true across all settings.”

One potential theory is that the decline in hospital births was offset by a rise in deliveries at home or other settings. Katie Page, president of the Virginia Affiliate of American College of Nurse-Midwives, said state and national statistics for 2020 aren’t currently available through ACNM’s benchmarking survey, which collects data on midwife-assisted births and outcomes. “That portal is voluntary, so it is only a snapshot,” she added in an email.

But, anecdotally, Page said Virginia’s certified nurse-midwives and certified professional midwives have reported growing numbers of patients and requests for care over the last year. One midwife told the Mercury she was spurred to open her own practice after an increase in interest from patients worried about giving birth in the hospital. Some were concerned about catching COVID-19, but others cited hospital safety policies that limited who could be in the room during childbirth.

“I can’t really say how much of it is people giving birth in other settings,” Walker said. The Virginia Department of Health hasn’t yet released data on the overall number of live births in 2020, so it’s also possible there was a statewide decline in numbers. But VHHA is tracking hospital use data, in part, to understand whether the COVID-19 pandemic will create lasting changes in health care utilization.

“It’s entirely possible there could be a wave of births yet coming that are pegged to nine months from October of 2020 or from November of 2020,” Walker said. “But I think other things we’ll be tracking is just to look at the world post-COVID, and do things rebound to where they were before?”

The pandemic has already had a dramatic effect on hospital volumes across Virginia. VHHA presented similar data in October that showed an abrupt 31 percent drop in discharges last spring, shortly after Northam’s stay-at-home order and moratorium on elective procedures. 

The updated numbers, presented by Vaamonde on Wednesday, include all of 2020. Overall, there was a 10 percent drop in hospital volumes, a 30 percent decrease in emergency room visits and several categories of discharges that haven’t recovered — including mental health visits that aren’t related to substance use disorders. 

Multiple hospitals have reported millions in losses due to dwindling visits and rising costs for personal protective equipment and COVID-19 testing. One was Ballad Health, a hospital system with locations in 29 counties across Southwest Virginia, Northeast Tennessee, Northwest North Carolina and Southeast Kentucky. As COVID-19 surged throughout the fall and winter, the system was forced to implement another pause on elective procedures to preserve bed space and staff. The decision led to major operational losses.

Wednesday’s data also highlighted the human toll of the pandemic. From April to December 2020, Virginia saw 50,667 COVID-related emergency room visits and 30,462 hospitalizations. By the fourth quarter of the year, which covers September through December, hospitalization numbers were higher than they’d ever been before.

“There’s basically now a COVID hospitalization coming from almost every zip code in the state, Vaamonde said. Black and Latino Virginians bore the heaviest impact. While Black patients made up a little more than 23 percent of total discharges, they accounted for nearly 28 percent of COVID-19 hospitalizations. Hispanic patients, who accounted for less than two percent of overall discharges, made up nearly 6 percent of COVID-related visits. 

More than 3,600 people died of COVID-19 in the hospital. Those patients were generally older than others hospitalized with the disease. While the average age for coronavirus hospitalizations was 67, the average age for in-hospital deaths was 74. Those patients were also significantly sicker, according to Vaamonde.

Nearly 79 percent of patients who died from COVID in the hospital had hypertension. Roughly 76.5 percent had chronic kidney disease, and a little more than 48 percent had diabetes.