Even with ‘milder’ disease, Virginia’s latest COVID-19 surge is straining hospitals

On Friday, the Virginia Hospital and Healthcare Association announced a concerning milestone for the state — COVID-19 hospitalizations had reached an all-time single-day high of 3,329, surpassing the state’s previous single-day peak, in January of last year, by nearly 130 admissions.

The total included both confirmed positives and 226 patients with pending tests, which could lower Friday’s numbers if any of the results came back negative. Still, there’s no question that the current surge is increasing coronavirus hospitalizations in Virginia. Julian Walker, vice president of communications for VHHA, said the association’s confirmed admission numbers include only patients with a primary diagnosis of COVID-19 — unlike some areas, including Washington, D.C., with counts that include patients who test positive even if they’re not being treated for the virus.

The answer, per a DC Health official I just talked to, is the latter: Any patient who tests positive counts as a covid hospitalization.

This is good, indicating the record-high hospitalization #s show very high prevalence of virus right now but not necessarily severe cases.

— Julie Zauzmer Weil (@juliezweil) December 30, 2021

In total, that means just over 3,100 patients across Virginia were in the hospital Friday for complications related to COVID-19, a count on par with last year’s winter surge. The vast majority of them are unvaccinated, according to frontline providers and state data. And while it’s not totally clear exactly what percentage of new cases in Virginia are linked to omicron — a data point that’s limited by the state’s capacity to sequence samples of the virus — there are signs that the recently discovered variant is driving the spread. At VCU Health, omicron accounts for 95 percent of all positive COVID-19 tests performed in-house, the health system announced in a release last week. 

That complicates the narrative that omicron is “milder” than earlier versions of the virus. On a clinical level, it’s true there’s emerging evidence that the variant seems to affect the upper respiratory tract more than the lungs, carrying a lower risk for severe illness. And in Virginia, like many other places, the most recent surge in cases hasn’t corresponded with an equivalent surge in deaths — which can be traced, at least in part, to vastly improved treatments including monoclonal antibodies and antivirals to fight the severe progression of disease.

Still, there are thousands of Virginians requiring hospital levels of care for the virus, and those numbers could continue to go up. “Our test positivity rate is just unbelievably high right now,” said Dr. Todd Parker, president-elect of the Virginia College of Emergency Physicians, referring to the share of COVID-19 tests statewide that come back positive (nearly 35 percent as of Friday).

“So even though the average person is less sick than previously, because of the sheer volume of cases, we’re still seeing a big uptick in critically ill patients,” he added. “If we saw 50 patients before and 10 of them needed to be admitted, maybe now we’re seeing 100 patients with COVID and 12 of them need to be admitted. So instead of 20 percent, it’s 12 percent, but we’re still admitting 12 patients when before we were only admitting 10.”

While unvaccinated Virginians are still most at risk for serious complications, the ongoing wave of infections is having ripple effects across the state. As with previous surges, hospitals are bearing many of the worst consequences. Last week, two of the state’s largest health systems — VCU and Sentara — announced they were halting elective procedures for the foreseeable future. Inova, the dominant hospital system in Northern Virginia, went back on “emergency status,” a protocol that allows them to take similar action and shift other operating procedures as needed.

The problems are multifactorial. As with the previous delta surge, Parker said emergency departments and doctors’ offices are overwhelmed with patients seeking out testing — often because they have nowhere else to go. The rise in COVID-19 admissions is also reducing overall bed space, forcing many hospitals to board patients in the emergency room.

“Every hospital in our area is full,” said Parker, who works at Riverside Health System in the Hampton Roads region. “Every ER is holding patients that are waiting for beds upstairs. So if an ER has 50 beds, but 20 of them have admitted patients in them, then it functionally only has a capacity of 30.”

Like other industries, health systems are also struggling with a significant worker shortage, especially given the rise in both patient volumes and cases among health care providers. Sentara specifically cited staff capacity, not bed capacity, in its decision to pause elective surgeries. Ballad Health, the primary hospital system in Southwest Virginia, announced last week that “a significant majority” of employees in the cardiovascular surgery department of one of their Tennessee hospitals had tested positive for COVID-19. As a result, some patients were transferred to Bristol, further limiting bed space and staff. 

Those maxed-out resources are affecting Virginians across the state. With a pause on elective surgeries at some hospitals, patients will be forced to delay care just as they did earlier in the pandemic. Others are waiting hours for an emergency room bed. And the quality of care significantly suffers, especially in areas with lower vaccination rates and more limited resources. 

In September, at the peak of Virginia’s delta surge, Augusta Health reached out for federal assistance amid “unprecedented” levels of COVID-19 in the community, according to a letter from CEO Mary Mannix, obtained by the Mercury through a Freedom of Information Act request. At the time, the lone community hospital was so short on nurses that administrators weren’t sure how long it could continue accepting patients.

“We are in the catastrophic position of contemplating EMS diversion for critical care patients due to our limited ability to provide safe and appropriate care,” Mannix wrote. Statewide, the weekly average number of hospitalized COVID-19 patients was just over 2,000 — far lower than the current peak.

Right now, though, it’s unclear if help will be available for beleaguered health systems and the patients they serve. During the delta surge, hospitals spent weeks asking for assistance from Gov. Ralph Northam, including the reinstatement of previous emergency waivers. The administration never granted the request. So far, it’s been similarly unresponsive to a similar request from the Virginia College of Emergency Physicians at the end of December.

The state’s hospital association “remains in communication” with both the Northam administration and Gov.-elect Glenn Youngkin about potential policy options to support hospitals, Walker wrote in a Saturday email. The incoming leader, though, has been open about his intentions to repeal state mask and vaccination requirements, as well as his opposition to federal requirements.

“While we believe that the vaccine is a critical tool in the fight against COVID-19, we strongly believe that the federal government cannot impose its will and restrict the freedoms of Americans,” Youngkin said Friday in a joint statement with incoming Attorney General Jason Miyares, announcing their intention to challenge federal vaccination mandates in court.

“Virginia is at its best when her people are allowed to make the best decisions for their families or businesses,” they said.

Editor’s note: This story was updated to include comments from the Virginia Hospital and Healthcare Association.