Category Archives: Health Care

Virginia COVID Cases Up, Deaths Down

by Kerry Dougherty

Welcome to Day 121 of 15 Days to Slow the Spread.

Seems like just yesterday that we watched, aghast, as Italy’s hospitals collapsed under the weight of those sick and dying from COVID-19. It was late February. If we didn’t act we faced the same fate, experts said.

And so, in mid-March, 15 days to slow the spread was born.

A move that was never intended to stop the spread of the coronavirus, but to slow it so that hospitals could prepare to treat the sick.

I know I’ve written this before, but let’s say it again, for those eating paste in the back of the class: There is no stopping a novel virus. None of us had immunity to Covid-19 prior to January. At this point it’s not a matter of IF we’re going to contract the coronavirus. It’s a matter of when.

It quickly became evident that those most at risk of critical illness or death were the elderly and those with underlying conditions such as diabetes, obesity, COPD and compromised immune systems.

Once the 15 days were over, though, governors moved the goalposts. They closed schools, ordered businesses to shutter and told people to stay home.

Inequity Accounting for Hispanic COVID-19 Cases

by Carol J. Bova

Last week Del. Jennifer Carroll Foy, D-Prince William, wrote a letter to Governor Ralph Northam decrying the high rate of COVID-19 infection in Virginia’s Hispanic population. She blamed “longstanding and systemic factors, such as disparate access to information, testing, and treatment.” Jim Bacon responded that Virginia Department of Health (VDH) data did not support Foy’s assertion. But even Bacon took the VDH numbers as an accurate reflection of reality. In truth, VDH “confirmed cases” numbers, which suggest that Hispanics account for 43% of all COVID-19 cases in which race/ethnicity have been identified, are not reliable.

Originally, VDH number crunchers broke down confirmed cases as Black, White, Other, and Unknown. In mid-June they created Latino as a new demographic category, describing it as “Individuals of any race who identify as ‘Hispanic or Latino.’” To create the Latino category, VDH moved 11.3 percentage points from the White cases and 23.6 percentage points from Other and Unknown Race cases. The result: Hispanics accounted for 33.9% of all cases.

Ignoring 16,500 cases in the Unknown category increases the apparent proportion of Black and Latino cases and provides talking points for Del. Foy and the Governor that Latinos have 43% of all cases whose ethnicity was identified.

Continue reading

Virginia Hospitals Rank High Nationally (They Are Not the Ones You Would Assume!)

Sentara Halifax Regional Hospital, South Boston

By Dick Hall-Sizemore

In a new national ranking of hospitals, two Virginia hospitals are included in the Top 20 Hospitals in the country. Furthermore, the Commonwealth’s two major teaching hospitals are in the list of the 50 best teaching hospitals. Finally, one Virginia hospital was one of the 100 best safety net hospitals.

The two Virginia hospitals in the top 20 (which included teaching hospitals) probably would come as a surprise to most readers. They are Norton Community Hospital in Wise County (ranked 11) and Sentara Halifax Regional Hospital in South Boston (ranked 14). In the teaching hospital category, UVa Medical Center was ranked 18 and Medical College of Virginia Hospitals was ranked 39. The Virginia hospital recognized as being among the top safety net hospitals in the country was the Lonesome Pine Hospital in Big Stone Gap (ranked 29). Continue reading

Are Hispanics Victims of “Inequities” in COVID-19 Epidemic?

Jennifer Carroll Foy

by James A. Bacon

Hispanics make up 9% of Virginia’s population but 43% of the state’s COVID-19 cases. So, it seems a not-unreasonable thing for Del. Jennifer Carroll Foy, D-Prince William, a candidate for governor, to call upon Governor Ralph Northam to increase funding for outreach over Spanish-language media to build public awareness about the virus.

But then in her letter to the governor, she said some things that aren’t so reasonable: “The rates of infection are alarming, and magnify the inequities that are staring us in the face. They stem from longstanding and systemic factors, such as disparate access to information, testing, and treatment.”

Here we go again: “inequities,” “systemic” factors and “disparate” access. It is so widely assumed that Virginia is a hellhole of inequity and prejudice that no one even tries to prove statements like Foy’s. (She’s hardly alone in making them.) The allegations are accepted without question.

Let’s take a look at the numbers. The first thing to note is that the Hispanic population in Virginia has surged over the past two decades — from 239,000 in 2000 to 619,000 this year. Most of this increase was driven by immigration into the state. It is safe to assume that a large percentage come from poor countries in search of economic opportunity. With little education, most immigrants sought employment in occupations requiring manual skills. As a consequence, to quote Virginia Public Media, 85% of Latinos can’t work at home. They must leave their houses to go to work and get paid, which makes them more likely to be exposed to COVID-19. Continue reading

State Board of Health Regulations are Fundamentally Flawed

by James C. Sherlock

The Northam administration has a robust program for regulation review. It is time to use it to totally overhaul Virginia’s healthcare regulations.

Healthcare facilities and providers in Virginia are subject to dueling regulations — one set for state licensure and another for Medicare/Medicaid certification.

Virginia’s regulations in these cases are not just a waste of time on the government side. The administrative burden on healthcare providers is heavy and entirely unnecessar,y and the regulations violate both Virginia law and the Governor’s executive order on regulations.

It is expensive, counterproductive and in some cases illegal under Virginia law for Virginia to have different regulations for the same facilities and providers, yet we do.

Code of Virginia § 32.1-127.

Virginia regulations must be changed to conform to federal Medicare and Medicaid regulations for long-term-care facilities to comply with the clear direction of Code of Virginia § 32.1-127. That law requires that Virginia regulations for hospitals and nursing homes “conform” to “health and safety standards established under provisions of Title XVIII (Medicare) and Title XIX (Medicaid) of the Social Security Act.” Continue reading

The COVID Surge — Virginia Hangs Tight

by Verhaal Kenner

As of July 1st, Virginia is now in “Phase III” reopening as our state’s COVID cases seem to be almost holding mostly steady despite record daily infections in a few hot spots such as Hampton Roads. Phase III means the reopening of non-essential retail and restaurants (with six-foot table spacing). The complete  set of guidelines, found here, covers everything thing from camp grounds and beaches to racetracks and shooting ranges.

According to CNN three days ago, Virginia was one of only 13 states not experiencing a significant surge in COVID cases.  The worst hot spot was a bar in East Lansing linked to 152 cases in the last week.

Nationally, the country just broke a record 55,000 new cases in one day; that’s a growth of over 90% within about two weeks. Even with a slew of renewed lockdowns and mask regulations, the trend means it will likely take many weeks to get back to where we were a month ago.

I’m impressed that Virginians seem to be largely acting responsibly and following practical guidelines. There are about 650 new cases a day in Virginia and with a population of about 8.5 million, it’s under the 10 per 100,000 threshold that New York, New Jersey and Connecticut are seeking to use as a standard for requiring travelers to quarantine for 14 days. Continue reading

Why Is COVID-19 Trending Down in Virginia?

by James A. Bacon

As the COVID-19 virus continues to recede in Virginia, I’ve abandoned my day-to-day coverage of the numbers, but I think it’s still worthwhile to post periodic updates. The good news for Virginia as seen in the chart above, taken from the Virginia Department of Health COVID-19 dashboard, is that the number of confirmed cases and deaths reported daily continue to decline — even as the virus flares up in California, Texas, Florida and Arizona.

To what do we attribute Virginia’s good fortune? Has Governor Ralph Northam found the sweet spot in his policy mix of emergency measures? Are Virginians just better behaved — more likely  to wear masks and maintain social distance — than the citizens of other states? Does the Old Dominion have human settlement patterns — less density, fewer elevators, less mass transit — that lend themselves to the propagation of the disease? Do we look to demographic factors such as a smaller percentage of illegal immigrants living in overcrowded housing? Or, less likely but not inconceivable, is the population on a pathway to developing herd immunity?

Readers, weigh in.

— JAB

Housing Grants Just a COVID Relief Rounding Error

By Steve Haner

Will $50 million be enough? Will that get all the Virginians who have fallen behind due to COVID-19 square on their rent or mortgage payments? Or is that amount, in a relief program now fleshed out by the Northam Administration, merely a start?

There is a hint on the program’s web page, now available. “Financial assistance is a one-time payment with opportunity for renewal based on availability of funding and the household’s need for additional assistance and continued eligibility.” A Senate committee was told last week that Governor Ralph Northam is considering spending hundreds of millions more for the same purpose.

This first $50 million is just the latest way that the billions of federal dollars flowing into Virginia as COVID-19 relief will be used. Within that operation, it is a  rounding error. On June 23, primary day, the Senate Finance and Appropriations Committee met virtually to be briefed, among other things, on how the four waves of federal assistance have been or will be spent.

The usual suspects of the Capitol Hill press corps may not have been there (or to be exact, may not have been monitoring the Zoom conference.) The primary results and the Phase 3 announcement held their attention. A week later the unreported reports are still worth reviewing and links to them follow below.

Secretary of Finance Aubrey Layne, in his presentation, estimated that Virginia has received more than $28 billion in direct aid – $6.5 billion direct to the state and local governments, $14.4 billion to state businesses in the Payroll Protection Program and $7.3 billion pledged to municipal liquidity facility loans to cover revenue losses.  Continue reading

COVID-19 Update: Mixed Signals on Viral Spread

Here are three COVID-19 trends in Virginia worth watching:

  1. The seven-day moving average of the test-positive rate ticked upwards yesterday for the first time in more than a month;
  2. Hospital utilization by COVID-19 patients dipped to the lowest point since the Virginia Hospital and Healthcare Association began tracking the data in early April; and
  3. It turns out that multisystem inflammatory syndrome was not much of a thing.

Positive-test rate. The percentage of COVID-19 tests confirming the presence of the virus hit a seven-day moving average of 5.9% yesterday, based on data published today on the Virginia Department of Health (VDH) COVID-19 dashboard. That’s up from 5.8% the previous day. That doesn’t sound like much, but the seven-day moving average smooths out daily fluctuations, and it reverses what had been a steady decline since May. This number is an indicator that the viral spread in the general population, which had been retreating steadily, may start picking back up. This metric bears watching.

Hospital utilization. On the other hand, there is no indication yet that the greater numbers of infected people is translating into more trips to the hospital. Continue reading

Uh, Oh, COVID-19 Metrics No Longer Improving

Source: Virginia Department of Health COVID-19 dashboard

The bad news from recent COVID-19 statistics is that the numbers aren’t getting better. Virginia has hit a plateau in the number of confirmed cases, as seen in the chart above, which shows the seven-day moving average in the number of confirmed cases. To some degree, the tick upwards in COVID-19 cases may reflect increased testing. But it’s clear that the virus, which had been receding for a month, no longer is.

I’ve never worried overly much about the number of cases. The vast majority of cases cause no lasting harm. What matters is the number of hospitalizations and deaths. As it happens, the number of hospitalizations, which had undergone a month-long decline, also has hit a plateau, and the number of deaths has nudged noticeably higher than early June, as can be seen in the chart below. Continue reading

COVID-19: Milder than We Thought

The latest numbers from the state and hospital-association COVID-19 dashboards suggest that the coronavirus in Virginia still is retreating. The seven-day moving average of test-positive cases for COVID-19 tests continues to fall, hitting a new low of 5.8%.

Meanwhile, two measures of intensive hospital utilization have hit new lows. The number of COVID-19 patients in Intensive Care Units fell t0 219 yesterday, down from a high of 469 in early April, while the number on ventilators declined to 99, from a high of 302 in mid-April.

New research from the federal Centers for Disease Control suggest that only one in ten COVID-19 cases have been identified through testing, so the number of confirmed cases, which stands at 60,570, is likely the tip of the proverbial iceberg. If the national rate holds true here, more than 600,000 Virginians have contracted the virus. In other words, about 7% of the population has been infected. The bad news is that the virus still has a long way to run.

Here’s the good news: If that 600,000 figure holds up, and if the Virginia Department of Health’s 6,071 figure for the number of hospitalizations is reasonably accurate, it means that only 1% of the population that gets the disease ends up hospitalized for it. Given the 1,700 Virginia deaths so far, it also means that only three out of 1,000 who get the disease die from it. Continue reading

COVID Workplace Rules Endorsed, But Not Final

The Northam Administration’s Safety and Health Codes Board agreed yesterday that COVID-19 in the state’s workplaces demands an emergency state response, but the nature and exact wording of that regulation remains undecided.  If adopted, formal regulations come with the potential for heavy penalties for employers cited for failures.

Earlier versions of the key documents have already been revised by state staff, so should be reviewed again by concerned parties. The draft rules (here) and a related 200-page briefing package (here) were first made available June 12 and then revised June 23, right before Wednesday’s meeting. Further changes are likely.

A window for on-line written comments closed June 22, but more than three thousand were received, with the business community reaction overwhelmingly negative. To review the written comments already filed visit the meeting information page (here) and scroll down to a long list of documents. The massive set of online comments are on this related page on Virginia’s Regulatory Town Hall website.

The vote to proceed with something came after a contentious virtual emergency meeting where only members of the board and staff were able to speak. Three of the board’s members opposed the emergency declaration and three abstained, perhaps reflecting the broad and strong opposition the draft proposal generated from Virginia’s busines community. It will meet again to dive into the actual text soon.  Continue reading

BR’s COVID-19 Parallel Universe

By Peter Galuszka

Almost every morning, I wake up a little before dawn, make coffee, let the dog out and feed her and start reading the news.

I take The Washington Post in print along with The New York Times, Richmond Times-Dispatch, The Virginian-Pilot, NBC News, various television stations and, of course, Bacon’s Rebellion online.

Later in the morning, I check out Blue Virginia, Virginia Mercury and RVA.

When it comes to the COVID-19 pandemic, every morning I step into two different universes.

One gives me the global and national view that jumps right in and explains where we are with the virus and who and what are at risk.

The other view, that of Bacon’s Rebellion, mostly paints a very different picture. This view insists that the pandemic is exaggerated and overrated, needless regulations are being enacted by a dictatorial governor, our school system and housing trends are at risk and we should open everything up right now. Continue reading

Where Are the Other 52 Nursing Homes with Outbreaks?

by Carol J. Bova

The governor’s Long Term Care Facility Task Force list shows 179 nursing home and assisted living facilities with outbreaks of COVID-19. There are 52 more, according to the Virginia Department of Health (VDH) Outbreaks tab on the daily COVID-19 data, but no explanation why they’re missing from the Task Force list.

It took a little digging to narrow down where those facilities are located. The Task Force list can’t be downloaded or copied or sorted. But by adding its info to the CMS nursing home COVID-19 dataset and tagging each entry with the locality the Task Force used, I could compare the faciliity locations to the VDH Outbreaks Data Downloads and compile a list breaking down the number of missing outbreaks by Health District.

Alexandria – 4
Arlington – 3
Central Shenandoah – 3
Chesapeake – 1
Chesterfield – 2
Chickahominy – 2
Crater – 2
Eastern Shore – 2
Fairfax – 14 Continue reading

Nursing Homes Most at Risk from Virus are Bigger, Urban

Die, virus, die!

Three out of five of the 1,645 Virginians who have died from COVID-19 have been residents of long-term care facilities — one of the highest percentages of any state in the United States. There has been considerable speculation why. Vincent Mor, a research scientist with the Brown School of Public Health, has found that nursing-home staffing levels aren’t the issue. Neither is the source of funding, whether Medicaid or private insurance.

Mor argues that the size and location of long-term care facilities are the most decisive factors. Facilities most likely to have COVID-19 cases tend to be (1) located in larger urban areas with large populations of Hispanics and African-Americans, who are disproportionately likely to have the virus, and (2) the size of the facility, or, more specifically, the greater the number of employees coming and going.

“It’s all about the traffic,” he says in this PowerPoint presentation summarizing his research. “The bigger the building, the more people enter. … So, it’s NOT about the facility but the virus.”

I had never made these connections, and I think they are worth exploring here in Virginia. If the same pattern holds, it may influence how public health authorities prioritize the allocation of resources in the battle against the virus. Continue reading