Monthly Archives: April 2020

According to this morning’s data dump (unadjusted for vagaries in reporting), 63 patients with COVID-19 were admitted to Virginia hospitals yesterday while 62 were discharged. Meanwhile the number of patients in ICUs and on ventilators continued their long-term decline — further evidence that Governor Ralph Northam did the right thing yesterday when he announced that he would not extend the ban on elective procedures.

Total COVID-19 patients hospitalized — 1,566, down 16
COVID patients in ICUs — 372, down 15
COVID patients on ventilators — 208, down 14
Number of hospitals experiencing difficulty replenishing PPEs — 2

In other newsworthy developments, the number of test results reported reached 5,536 yesterday, a record number for Virginia and halfway to the Governor’s 10,000-test benchmark Virginia must meet before he begins reversing other emergency shutdown measures. Among the five criteria listed in the Governor’s Blueprint for easing public health restrictions is that the percentage of positive tests must show a downward trend over 14 days. It’s not clear, however, what that means.

Continue reading →

by James A. Bacon

We can all be thankful that Governor Ralph Northam has ended the ban on elective medical procedures. At least one sector of Virginia’s economy, healthcare, can start the struggle back to normalcy. Hopefully, hospitals will staunch losses that have ran up to $200 million or more, 30,000 furloughed and laid-off healthcare practitioners will get back to work, and thousands of Virginians will receive long-delayed medical treatment.

The question now: What next?

The restoration of normalcy will take months. President Trump, Governor Northam and governors of most other states have suggested that the process will unfold in phases as the COVID-19 epidemic recedes. But many details have yet to be worked out. In the days ahead I hope to explore the what-next question in a series of posts that articulate logical principles that should drive the Governor’s decision-making.

The first principle is this: Public action should focus on protecting the most medically vulnerable members of society while allowing the least medically vulnerable to return to normal life and work as quickly as possible. Continue reading →

Governor Ralph Northam will let hospitals and dentist offices resume service to patients who need elective procedures starting Friday. Speaking at a press conference earlier today, he said he would not renew his public health order issued in an effort to save personal protective equipment (PPEs) and bed capacity for an anticipated spike in COVID-19 cases.

Acccording to the Virginian-Pilot, Northam said hospitalizations have remained flat, and hospitals have enough personal protective equipment to start seeing patients again. The Virginia Hospital and Healthcare Association (VHHA) COVID-19 dashboard had reported that only one hospital in the state anticipated difficulty replenishing its supplies of PPEs.

The ban had led to thousands of furloughs in the healthcare sector across Virginia, and cost hospitals “well over $200 million, said Michael P. McDermott, VHHA chairman and CEO of Mary Washington Healthcare in remarks quoted by the Pilot.

Bacon’s bottom line: While the ban arguably was necessary in the early phase of the COVID-19 epidemic, it has been obvious for some time that it was creating needless havoc in Virginia’s healthcare sector. The Governor extended the ban unnecessarily last week, but we can all be grateful that he has decided to let it expire this week. This decision was a no-brainer. Other steps will be more controversial. At least we can move on and start having those conversations.

–JAB

Who was that masked man? Photo credit: Washington Post

by James A. Bacon

Virginia ranks near the bottom of the U.S. states and territories in tests per million population. Its rate of testing is on a par with Guam’s. So reports the Washington Post today (finally getting around to noticing the exact same point that contributor James Sherlock made a week ago on this blog).

The article quotes House Minority Leader Todd Gilbert, R-Shenandoah, as criticizing Governor Ralph Northam for a supposed failure to ramp up testing.

“At first Governor Northam blamed the Trump administration for not getting Virginia the resources needed to conduct tests. Then we learned that Virginia has testing capacity sitting idle,” Gilbert said. “The Governor then said we lacked the swabs and other testing materials. Yet other states have managed to obtain these resources. Something is fundamentally different — and possibly wrong — with the way Virginia’s testing is being handled. Virginians deserve answers, and they deserve them now.”

The criticism may be valid as long as you accept the assumption, which Northam obviously does, that more widespread testing is going to tell us something that we don’t already know. If there’s a scientific “consensus” about COVID-19 among experts around the world, it’s that more testing is better. What bothers me is that no one in Virginia has effectively explained why more testing is better. Continue reading →

No day at Bacon’s Rebellion would be complete without our statistical update courtesy of John Butcher. No question, the population of COVID-19 patients in hospitals is on a consistent upward paragraph. See my previous post for a discussion of why that might be the case.

— JAB

by James A. Bacon

In my daily update of COVID-19 statistics reported by the Virginia Department of Health (VDH) and the Virginia Hospital and Healthcare Association (VHHA), I abandoned some time ago the use of “confirmed cases” as a useful indicator of the progress of the epidemic through the general population. I turned instead to hospitalizations, which I figured was a more accurate reflection of that subset of the population displaying severe symptoms. It’s not a perfect number — it misses people who die at home or in long-term care facilities — but it’s more reliable number than confirmed tests.

Now I’m wondering about the hospital data. Either there’s something very wrong with the data, or I’ve stumbled across something very important occurring in how hospitals are responding to the virus.

Here are the salient statistics: Over the past 13 days, the VDH has reported that 1,211 COVID-19 patients were admitted to Virginia hospitals. Over that same period, the VHHA has reported that COVID 1,318 patients were discharged. In other words, 97 more patients were discharged than were admitted. One would expect, then, that the number of patients in hospitals would have diminished by some amount.

But the reverse has happened. The total number of COVID-19 patients currently in hospitals actually increased — by 18% to 232. (See details in the graph above.) Continue reading →

The impact of COVID-19 is uneven across Virginia. If its jam-packed parking lots Monday at noon were any indication, Henrico Doctors Hospital in Henrico County (owned by HCA) is feeling no economic pain. Furloughs are widespread at other Virginia hospitals.

by James A. Bacon

The Carilion Medical Center in Roanoke is the largest hospital in Virginia west of the Blue Ridge Mountains. It was staffed for 663 beds in 2018, according to Virginia Health Information, and it admitted roughly 40,000 patients a year. Twelve days ago, reeling from the drastic decline in admissions caused by Governor Ralph Northam’s emergency statewide ban on elective surgery,  Carilion Clinic announced a wave of furloughs, reduced hours, and pay cuts for senior administrators as the health system.

The Governor enacted the prohibition to ensure that there would be enough hospital beds, ICU units, ventilators, and personal protective equipment to handle the influx of COVID-19 patients. On Friday, he extended the ban for another week.

The number of COVID-19 patients at the 663-bed Carilion Medical Center Sunday night: two. Let me repeat that: Two. That’s according to an informed source whom I will not divulge because he/she may not have been permitted to release the information.

Similar reports have dribbled out for other hospitals. Kerry Dougherty writes in her column today that she was given a copy of a “medical staff update” distributed last Thursday at Sentara Norfolk General Hospital. The largest hospital in Hampton Roads, with 538 staffed beds, had nine COVID patients in regular rooms, two in the ICU, and none on ventilators.

Clearly, Northam’s statewide ban on elective surgery is a sledgehammer which may be appropriate for the hardest-hit parts of the state but is wildly inappropriate for others. That policy is directly responsible for thousands of delayed medical procedures, hundreds of furloughs, and millions of dollars in lost revenue. In sum, the statewide aspect of the edict has been calamitous for many, with no offsetting gains for public health. Continue reading →

by James A. Bacon

New COVID-19 hospitalizations in reported in Virginia yesterday shot up to a high of 139, but the spike came after a month-long low of 12 the previous day. It is reasonable to conclude that what we’re seeing is an artifact of data collection and reporting, not a reflection of the real world progress of the virus. If we average out the two days, we get an average of 75 each day, which is consistent with my contention that the spread of the virus has leveled off. The epidemic in Virginia not retreating, but it has leveled off.

Consistent with the new hospitalizations data from the Virginia Department of Health, we can see from Virginia Hospital and Healthcare Association (VHHA) that utilization of ICUs and ventilators are down. COVID-19 patients in ICUs hit a new low — 376, down from a peak of 469 — since the VHHA began reporting the data in early April. Likewise, the number of patients on ventilators remained at 217 for the third straight day, also the lowest reported.

As I have noted many times, the reported number of new confirmed cases of the virus is virtually worthless as an indicator of the progress of the disease. The number reflects the number of tests conducted, the protocols followed, and reporting delays far more than the prevalence of the virus.

Now, a more pessimistic presentation of the data from my collaborator in statistical malfeasance — OK, OK, I, not he, am the one guilty of statistical malfeasance — John Butcher: Continue reading →

COVID-19 data has been published today that can either calm you or alarm you, depending upon your inclination — or your support for or against Governor Ralph Northam’s economic lockdown measures.

On the positive side, the chart above, taken from Virginia Hospital and Healthcare Association data, indicates that COVID-19 still is not straining the capacity of hospitals to treat the most severely afflicted patients. ICU and ventilator use is trending down. Virginia hospitals have 5,433 beds available and only 1,455 patients with confirmed or suspected COVID-19 infection. Surely, we can allow most hospitals to resume elective surgeries, put healthcare practitioners back to work, and help people with a variety of medical conditions.

On the more worrisome side, the seven-day trailing average of COVID-19 cases is still trending higher — at a subdued, arithmetic rate of increase, as can be seen below in John Butcher’s graph, but higher nonetheless. Continue reading →