Author Archives: James A. Bacon

Virginia Should Issue Immunity Certificates

Yesterday I argued that Virginia should allocate a chunk of its COVID-19 helicopter dollars from the federal government to conduct widespread testing for the presence of coronavirus antibodies. If the antibodies are present, the person presumably is immune to the sickness and should be free to re-enter society and the workforce.

Turns out, the Germans are planning to do just that. The Telegraph reports that Germany plans to introduce coronavirus “immunity certificates.” Researchers plan to test 100,000 members of the public at a time and issue documentation to those who have overcome the virus.

Explains Gerard Krause, the epidemiologist leading the project: “Those who are immune can then be given a vaccination certificate that would, for example, allow them to be exempt from any (lockdown-related) restrictions on their work.”

After saving lives, the No. 1 priority of the Northam administration must be to expedite a return to economic normalcy. Public health authorities in Virginia should bend every effort to make immunity certificates a reality.

— JAB

COVID-19: Up, Up, and Away

The latest data from the Virginia Department of Health:

Total confirmed COVID-19 cases Sunday: 1,020, up 130 from Saturday.
Total hospitalizations: 136, up 24 from the previous day.
Total deaths: 25, up three.
Total tests: 12,038, up 1,429.

Doubling times: John Butcher has updated his calculations of how long it takes for these epidemic metrics to double. Based on the latest data, the doubling time has lengthened a tad, a tentatively positive sign.

Case count: 3,18 days
Hospitalizations: 3.71 days
Deaths: 2.65 days

Beds, Ventilators, and Epidemiological Models

by James A. Bacon

The Richmond Times-Dispatch is getting frustrated with the lack of hard information about the COVID-19 epidemic forthcoming from the Northam administration. Reporter Bridget Balch has been trying to track down data on the number of ventilators in the state to treat patients stricken with respiratory afflictions. Frustration with the Northam administration’s lack of responsiveness is leaking into her news coverage.

Virginia, with a population of 8.6 million, has 2,000 ventilators on hand, Balch quotes Cotton Puryear, spokesman for the Virginia COVID-19 Unified Command Joint Information Center, as saying Friday. That’s the first time I’ve seen that number. Balch’s article pointedly says that the newspaper had been asking for the number since March 16.

Virginia public health authorities have not released any own internal forecasts of expected demand for ventilators, But the state has requested an additional 350 ventilators from the national stockpile, Puryear said.

Also, regional groups comprising the Virginia Healthcare Management Program “have ventilators that can be deployed to hospitals,” said Julian Walker, spokesman for the Virginia Hospitals and Healthcare Association in a statement. But is not clear if those ventilators are included in, or in addition to, Puryear’s 2,000-ventilator number. Continue reading

COVID-19: Doubling Every Three Days

The latest numbers from the Virginia Department of Health, reflecting yesterday’s developments:

Cases: 890, up 151 from previous day.
Hospitalized: 112, up 13 from previous day.
Deaths: 22, up 5 from the previous days.
Tests: 10,609, up 1,443 from the previous day.

Here’s John Butcher’s cheerful little calculation, based on the latest data, of the “doubling time” for key Virginia metrics:

Case count: 3.14 days
Hospitalizations: 3.68 days
Deaths: 2.56 days

And then there’s this: The Institute for Health Metrics and Evaluation has forecast when the virus will start overwhelming hospital capacity in the 50 states. The Institute forecasts that Virginia will encounter “peak resource use” on May 2, 2020. At that point, 3,435 hospital beds will be needed. Virginia has more than enough beds, so there will be an acute-care “bed shortage” of zero. The problem is that Virginia will need 512 ICU beds. Only 329 will be available, creating a shortage of 183 ICU beds. Also, Virginia will have a shortage of 276 ventilators. Continue reading

What Can Northam Do, and Not Do, about COVID-19?

by James A. Bacon

Two days ago, Peter Galuszka posted an interview he conducted with state epidemiologist Lilian Peake, a key functionary in Virginia’s response to the COVID-19 crisis. I found her responses appalling. The degree of passivity cannot be overstated. Her responses to most of Peter’s questions amounted to: “We’re tracking and monitoring the situation.” If the Northam administration was actually doing anything, it wasn’t evident from this interview. (Here’s my snarky summary of what little she had to say.)

One can glean from media accounts that the administration is working behind the scenes on some things, though to what effect it is impossible to tell. The only clearly visible leadership emanating from Richmond has been Governor Ralph Northam’s move to take strong — some might say excessive — action to enforce social distancing (and shut down much of the economy in the process).

Meanwhile, testing kits remain in short supply, making it impossible to accurately track the spread of the coronavirus; the commonwealth still has yet to develop an epidemiological model to help it forecast the spread of the disease; and the healthcare industry is in a state of panic over the looming shortage of hospital beds, personal protective equipment, and ventilators. As for taking measures to put people back to work, I’ve seen nothing. Zippo.

Broadly speaking, there are three main clusters of issues, and we need clarity of thinking about each one: (1) implementing social-distancing measures to slow the spread of the virus; (2) expanding the capacity of hospitals and healthcare practitioners to care for the inevitable surge in COVID-19 patients; and (3) getting people back to work as quickly as possible without undermining measures to counteract the virus. Let’s look at each one. Continue reading

NoVa Physicians List COVID-19 Priorities

by James C. Sherlock

I re-publish here a communication from the Medical Society of Northern Virginia Board of Directors on matters of importance to its member physicians. Their concerns are the public’s concerns.

Dear members,

First, on behalf of the board of directors, I would like to thank our first line responders; primary care physicians, hospital-based physicians and their ancillary staff, who are risking exposure to COVID-19 daily, while taking care of sick patients. In keeping with all the recent advisories and regulation waivers from CMS and the state, we offer the following recap and added recommendations to protect yourself and your practice.

We support Governor Northam’s recent executive order, issuing temporary restrictions to public gatherings to less than 10 people for non-essential business and adherence to social distancing recommendations. Medical services are excluded since we are essential services. However, the shortage of PPEs and COVID-19 testing pose serious impediments to mitigating the spread of this virus. As we indicated to the Governor last week, most independent practices are not equipped to handle specimen collections. Our offices are generally not set up for dealing with the aerosols associated with this highly communicable disease.  Continue reading

COVID-19 Update: More Tests, More Infections

Latest data from the Virginia Department of Health: 135 new confirmed COVID-19 cases yesterday, bringing the total to 739. Another 16 hospitalizations, bringing the total to 99. And another three fatalities, bringing the total to 17.

Testing is ramping up in a major way — 1,929 tests yesterday, more than double the number from two days previously. A total of 9,166 tests have been administered in Virginia so far.

The VDH has begun publishing more detailed information. Of particular interest is this graph which shows the number of COVID-19 cases in Virginia by the day the illness began.

Continue reading

Scenes from the Quarantine

by Philip Shucet

Sunshine was an invitation to take a walk yesterday. Since March 9, I’ve been out only twice for grocery store runs. Both trips were on rainy days.

Streets in my Norfolk neighborhood are generally quiet, but now they are nearly silent. There’s more time between the sounds of passing cars. Parking spaces that usually jump around like checkers are mostly stationary. The street has settled into its own brand of calm.

Across the street a woman came out to walk her dog. But even such a familiar sight came with an exception: She was the only other person on the block. Should I be out, I wondered. And then I remembered every good reason to take a walk. Especially on a sunny day. Continue reading

COVID-19, COPN, and Strawmen

by James C. Sherlock

Every time the discussion in this space turns to COPN and its relationship to lack of capacity to deal with COVID-19, some commenters accuse the authors of these columns of favoring nonsensical solutions such as forcing hospitals to build excess capacity. Those same commenters then reject those concepts as unworkable. That is the very definition of a straw man. Unfortunately it mirrors what will be a all-hands-on-deck attempt by Virginia’s hospitals and their lobbyists to sweep the damning history of COPN under the rug in the 2021 General Assembly.

No author has suggested building excess capacity to “sit idle”; what we each have suggested is to let commercial businesses, both for-profit and not-for-profit, build what they think is necessary where the think it is necessary without state interference other than enforcement of antitrust and licensing laws. Every one has carefully wrought business plans. If some misjudge demand, then either they will fail or their competitors will. If it existing provider facilities fail, that means that the new entrant offered better care or a better price or both. Any restrictions on such creative destruction must be swept away for the good of all of us.

What about day-to-day non-crisis access for the poor?

“Recent research by Thomas Stratmann and Jacob Russ demonstrates that there is no relationship between CON programs and increased access to health care for the poor. There are, however, serious consequences for continuing to enforce (COPN) regulations. In particular, for Virginia (COPN restrictions) could mean approximately 10,800 fewer hospital beds, 41 fewer hospitals offering magnetic resonance imaging (MRI) services, and 58 fewer hospitals offering computed tomography (CT) scans. For those seeking quality health care throughout Virginia, this means less competition and fewer choices, without increased access to care for the poor.”[1] Continue reading

Quantifying the Hospital-Bed Shortage

Source: ProPublica by way of Virginia Business.

by James A. Bacon

Two weeks ago, I raised the alarm: Virginia doesn’t have enough hospital beds to cope with the COVID-19 virus; capacity was most constrained in Northern Virginia. Yesterday, Bacon’s Rebellion contributor Jim Sherlock explained why: Certificate of Public Need (COPN) regulation throttled the addition of hospital beds in the Northern Virginia area. Now Virginia Business magazine — which is really stepping up its news coverage, by the way — explores the repercussions.

If only 20% of Virginia adults contracted COVID-19, hospitals in all metro regions across Virginia would be overwhelmed, according to data from the Harvard Global Health Institute.

The most staggering results from the Harvard study come from the Arlington hospital referral region (HHR) — which encompasses Fairfax County and other Northern Virginia localities. If 60% of adults were to become infected there, hospitals in the region would require an increase of nearly 600% more hospital beds to deal with the crisis. The Newport News region — which includes Williamsburg — takes a close second. Hospitals there would need nearly 500% more beds if 60% of the adult population were to be infected.

So, it is abundantly clear that Virginia does not have enough hospital beds if the COVID-19 virus continues spreading at an exponential rate. The big question is: What are we doing about it? Continue reading

COVID-19 Update: Buckle Your Seatbelts!

The number of confirmed COVID-19 cases is surging, according to the latest data from the Virginia Department of Health. Confirmed cases reached 604 yesterday, a one-day increase of 164, the biggest yet. Meanwhile, the number of COVID-19 victims hospitalized increased to 83, also the biggest one-day increase yet seen in Virginia.

It is difficult to gauge how much the increase in the number of confirmed patients is due to actual spread of the disease and how much to increased availability of testing kits. The number of Virginians tested yesterday, 1,148, also set a record. The evidence I’ve seen suggests that the identified cases represent just the tip of the iceberg. Hundreds, if not thousands, of patients with COVID-19 symptoms are not being tested, due to a shortage of tests. In all likelihood, the epidemic has sunk much deeper roots in the population than indicated by the official numbers.

As the production and distribution of testing kits accelerates, a new bottleneck may emerge: a shortage of medical practitioners to administer the tests. Health professionals require training to give the test and they must wear personal protective gear when doing so. The training issue may be a short-lived problem, but the chronic shortage of protective clothing and equipment may be more difficult to solve as scarce supplies are allocated disproportionately to “hot spots” such as New York.

— JAB

COVID-19: More Everyday Heroes…

Beech Tree Elementary to the rescue! When Beech Tree mother Van Nguyen heard about the shortage of medical face masks, she put her sewing skills into action and produced 20 masks. Local medical professional pleaded for more. Then Beech Tree 5th grader Caroline joined the effort. Learning how to sew from her mother and YouTube tutorials, she has completed three face masks and has 30 more in production, reports the Fairfax County Public School community relations staff.

Scanning for fevers, donating masks. Based on its experiences dealing with the COVID-19 situation in China and Singapore, Micron Technology, which operates a semiconductor manufacturing plant in Manassas, is using noninvasive thermal scanners to determine if entering employees have a fever.  Sick employees can be told to return home. The company responded early to the epidemic, increasing site-cleaning rotations, making changes to cafeteria serving, and restricting large gatherings. The company is sharing its experience with other major employers across Virginia — and joining other firms, such as Huntington Ingalls, the Newport News shipbuilder, in donating personal protective gear to healthcare workers, reports Stephen Moret, CEO of the Virginia Economic Development in a recent communication to economic development partners.

Another $1 million for tests. The Charlottesville-based Quantitative Foundation has donated $1 million to UVA Health to accelerate the number of tests performed by the health system from 200 daily to more than 500. The grant provides for putting aside a portion for inpatients at other Virginia hospitals and for clinical providers and first responders with symptoms. Prior to the deployment of UVA Health’s in-house testing, patients were waiting five to nine days for results. Thanks to the UVA Health’s ability to produce its own tests, local turnaround time has been cut to 24 hours.

A limited number of trained personnel has constrained the ability of UVA Health to administer tests. The hospital system’s lab is using the grant to add a new lab tech position. That, in addition to the current cross-training of existing laboratory personnel, reports UVAToday, will allow testing in a second shift. The funds will also be used to order a second robotic instrument which, when installed, will further increase capacity.

— JAB

Yes, You Should Wear Masks — to Protect Others, If Not Yourself

— by a contributing writer

This week Governor Ralph Northam restated what we have all been hearing for weeks: “Hospitals and medical facilities in Virginia and around the country are in desperate need of additional masks, gowns, gloves, and other personal protective equipment.” HCA Virginia reiterated the need Monday when announcing that it had set up donation boxes to receive extra masks from the public.

Virginia is still at the front end of the COVID-19 storm. Maybe a state-wide shut down and self-isolation will “flatten the curve” until better treatments are available. Until then, what should individual citizens do? Haven’t we heard medical experts claim that masks really won’t help us? That we probably don’t know how to use masks properly anyway?

It’s time to think this through. If you absolutely must venture out and interact with others, it makes sense to cover your face, even if it is only with a bandana. No, this is not so much to protect you, although it helps a little. It’s to protect others from you. Continue reading

COPN’s Deadly Quid Pro Quo

The Arlington hospital referral region had the highest ICU capacity gap in the country in this 2018 American Hospital Association survey.

by James C. Sherlock

The Northern Virginia Community Hospital in Arlington was bought by HCA in 2002.  The Arlington facility was closed in 2006 to comply with a 2005 Certificate of Public Need (COPN) decision that required HCA provide “trade-in” beds in the same health region to gain state permission to build a hospital in Loudoun County. (See this Washington Business Journal story. You will see that the business press knew the deal back in 2002.)

Regular Virginians have to ask why in the world HCA was required to buy and close the Arlington facility to build 30 miles away in Loudon County. And why in the world was the state involved in such a business decision in the first place?

In approving that application, the Health Commissioner reversed the recommendation of the DCOPN staff. We don’t know the reasoning for either the staff recommendation or the Commissioner’s reversal. Was some formula used? Why did Arlington, with its population far higher than when Arlington Hospital Center (now the only hospital in Arlington) was built, suddenly need fewer hospital and ICU beds? We know only the outcome.

The Commissioner was presented with a Hobson’s choice as a result of esoteric COPN rules devised by the VDH itself. A hospital in Arlington or a hospital in Loudon?  “Both” was not historically an available decision. After 47 years of COPN, that is what has evolved.

Continue reading

COVID-19 Update: The Epidemic Intensifies

The Virginia Department of Health has published yesterday’s COVID-19 numbers, and they continue to show a rapidly spreading epidemic.

Total confirmed cases (the tip of the iceberg) have risen to 460, an increase of 69 from the previous day.

The number of hospitalizations has risen to 65, an increase of six from the day before.

The number of deaths has leaped to 13, up from nine.

The number of tests has surged to 6,189, up 819.

— JAB