Category Archives: Health Care

Vitamin D and COVID-19

by Carol J. Bova

Researchers at the University of Chicago have found that Vitamin D deficiency is associated with a higher  likelihood of contracting the coronavirus. In combination with other Vitamin D research, the results may point the way to a quick and inexpensive way to reduce COVID-19 deaths among African-Americans and Hispanics.

David Meltzer, MD, Ph.D, lead author of the article published September 3rd in JAMA Network Open, discussed their findings on a University of Chicago Medicine website. “Vitamin D is important to the function of the immune system and vitamin D supplements have previously been shown to lower the risk of viral respiratory tract infections. Our statistical analysis suggests this may be true for the COVID-19 infection.”

Another study from Spain, published August 29, had test and control groups well-matched for age, sex, comorbidities and clinical indications of COVID-19 severity. In the control group, 50% were admitted to ICU and two died. In addition to the same drugs given to the control group, the test group was given calcifediol, a vitamin D analog, which increases vitamin D levels in the body. The test group had no deaths and only 2% had to be admitted to the ICU. Continue reading

It Matters Where You Seek COVID Data

VDH chart of COVID-19 deaths over time in Virginia’s Northern Region, as of 9/5. Click for larger view.  Having been hit the worst early, it is now doing better than ROVA.

By Steve Haner

Even when there is no intent to twist the data, it still matters where you look if you want to see Virginia’s status in dealing with Our Permanent Pandemic.

The chart on the daily death count, for example, looks dramatically different on the Virginia Department of Health’s website when compared to the Virginia Public Access Project daily updates. It is clear example of how the same data can seem vastly different based on presentation.

What apparently is going on is that as VDH issues daily updates, the compilers at the health department account for each death on the date of actual death, which means 20 new reports on one day might be spread out back a week or more. At VPAP, the daily count is the daily count.

So, you get this chart below from VDH, as of Saturday.  See the steady decline in deaths, and the huge difference from the early peak to the present day.

VDH chart of statewide deaths over time, as of 9/5. Click for larger view.

VPAP chart of Virginia deaths over time, as of 9/5. Click for larger view.

The VPAP bar chart and seven-day average show more peaks, and a would lead you to conclude Virginia is in more dire shape. It shows a seven-day average death rate of about 15, almost three times the VDH chart’s seven day average below of below six. Fifteen versus six is a huge deal. Continue reading

Hey, Commish, Not So Fast on the COVID Vaccine

GeraldFordgettingvaccine.jpeg

by Kerry Dougherty

Well, he did it again. Virginia’s Commissioner of Misinformation, er Health, shot off his mouth and alarmed the public, and then state government factotums had to do damage control.

On Friday,  WRIC ABC News reported that Virginia State Health Commissioner Dr. Norman Oliver “plans to mandate coronavirus vaccinations for Virginians once one is made available to the public.”

Virginia state law gives the Commissioner of Health the authority to mandate immediate immunizations during a public health crisis if a vaccine is available. Health officials say an immunization could be released as early as 2021.

Dr. Oliver says that, as long as he is still the Health Commissioner, he intends to mandate the coronavirus vaccine.

“It is killing people now, we don’t have a treatment for it and if we develop a vaccine that can prevent it from spreading in the community we will save hundreds and hundreds of lives,” Oliver said.

Under state law, only people with a medical exemption could refuse the mandate.

With that, Oliver became the first state official in the US to threaten compulsory COVID vaccinations.

Bringing Analytical Clarity to the COVID Shutdown Debate

by James A. Bacon

While we’re on the subject of lazy, undisciplined thinking about COVID-19 vaccine mandates (see previous post), let’s address the topic of lazy, undisciplined thinking about economic shutdowns. The Wall Street Journal‘s Greg Ip brings some refreshing analytical clarity to the debate.

Ip addresses public policy responses to the COVID contagion around the world. Options can be viewed on a spectrum from a heavy authoritarian hand (China quarantining entire city populations) to an almost libertarian approach (Sweden restricting only large gatherings). The response of most countries, including the United States, has been between the two extremes.

Unfortunately, the U.S. response has been confused, vacillating and sub-optimal. Polarized between “protecting lives” and “protecting the economy,” Americans don’t really know what they’re trying to accomplish. Writes Ip: Continue reading

It’s Way too Early to Discuss a Vaccine Mandate

by James A. Bacon

Four days ago State Health Commissioner Dr. Norman Oliver said he planned to mandate a COVID-19 immunization once it’s safely released to the public. Yesterday Governor Ralph Northam said he’s not planning a mandate, despite what his top health official said.

When asked why the the Governor wasn’t embracing the stance of his top health official, Northam spokesperson Alena Yarmosky said in a statement, “We are focused on accessibility, affordability, and fair distribution of a vaccine—not on a mandate.”

“When a vaccine becomes available, we’re confident that Virginians will seek it out. That’s why we don’t have plans for a mandate,” Yarmosky continued in a separate email, reports WAVY TV.

I’m no expert on the subject of vaccines, to be sure, but it strikes me as way too premature to begin discussing a mandate. Many potential vaccine candidates are being tested, we don’t which one (or ones) will be approved, and we know nothing about the efficacy, side effects and trade-offs of each. Continue reading

Nursing Home PPE Shortages and Deaths Still Rising

Deaths in cases originating at Virginia long-term care facilities.

by Carol J. Bova

After a review of over 15,000 nursing home reports submitted to the Centers for Medicare and Medicaid (CMS), Brian E. McGarry, David C. Grabowski, and Michael L. Barnett published a paper in Health Affairs on August 20th. In “Severe Staffing and Personal Protective Equipment Shortages Faced by Nursing Homes During the COVID-19 Pandemic,” they concluded, “Despite intense policy attention and mounting mortality, the shortages have not meaningfully improved from May to July of 2020.”

While six fewer Virginia nursing homes reported nursing staff shortages as of August 9,  there were more reports of all other staff shortages and supplies of Personal Protective Equipment (PPE) between the weeks ending June 7 and August 9 according to the CMS COVID-19 Nursing Home Dataset. Meanwhile, COVID-19 cases and deaths continue to rise. Continue reading

The Tell Tale Heart: Racism in Richmond Medicine

By Peter Galuszka

On Saturday, May 25, 1968, the Medical College of Virginia, now part of Virginia Commonwealth University, made medical history.  A surgeon recruited from Stanford University a couple of years before successfully transplanted the heart from one middle-aged man to another.

MCV officials in Richmond officials were ecstatic. Organ transplants were a hot, fairly new surgical procedure. Once stuck in the junior varsity leagues of medical training and research, MCV was basking in glory from media coverage.

There was one peculiarity that no one seemed to notice. The name of the heart donor was missing. As it turned out, the donor was Bruce Tucker, a Richmond Tucker happened to be African-American.

Tucker had suffered a serious brain injury from a fall the day before. He was taken to MCV. Hospital officials made a perfunctory search for his relatives. Tucker’s brother was desperately looking for him and his business card was in Bruce’s pocket. No one found it.

So, after Bruce was pronounced dead, his heart was removed and placed in the chest of Richard G. Klett, a white business executive from Orange. This shocking story is well documented in a highly readable book by Richmond author and journalist Chip Jones that has been just published by an imprint of Simon & Schuster. Tucker’s brother finally located hospital officials who started talking about an autopsy and that he needed to find a funeral director. Continue reading

Shhh. COVID Deaths Drop. Keep It Quiet.

Virginia Department of Health. Click for larger view. Go to the website for the interactive version.

Isn’t this always the way? Just as the Virginia General Assembly arrives in Richmond to save us from COVID-19, Virginia’s number are getting way better.The 7-day average for deaths in the Northern Virginia region tracked by the Virginia Department of Health is zero. Zero. It has recorded zero deaths in August so far.

The statewide 7-day average, which tracks about a week back, has dropped to 5 deaths per day, the lowest average since the pandemic’s initial assault. That’s the chart above. Eastern Virginia’s 7-day death average is now below two per day, and here in the Central (read Capitol) region, is it about one death every other day. That region has had only six deaths recorded so far in August.  Continue reading

Governor Northam, Crack Down on Nursing Homes, Not Restaurants

By Carol J. Bova

Last week Julie Henderson, director of the Virginia Department of Health (VDH) Office of Environmental Health Services, said her agency was going to request $6 million for 92 positions to educate the public and businesses about executive orders and how to enforce them.

If there is $6 million available for enforcement and education personnel, send them out to the nursing homes, correctional facilities and other congregate settings. Restaurants are not causing the deaths and suffering occurring from those outbreaks.

Of 956 virus deaths reported since June 1, 498 or 52% were from long term care facilities. Since the outbreak tracking began, long-term care facilities were responsible 1,294 of 1,370 outbreak deaths – that’s 94.5% of all outbreak deaths.

Let citizens make their own choices about going to restaurants. Post a warning if a restaurant isn’t meeting your standards, but shutting them down based on a complaint system isn’t going to save lives in the same way enforcing basic hygiene and infection controls in nursing homes will. Put the money where it’s going to make a difference. Continue reading

COVID Workers Comp On House Democrat Bill List

By Steve Haner

The coming Special Session of the General Assembly will be narrowly focused but filled with controversy, based on the legislative wish list just released by House of Delegates Democrats. Only two bills listed fall outside of the major categories of “COVID-19 Relief” or “Criminal Justice and Police Reform.”

Under the heading “COVID Relief,” the Democrats wish to reopen their drive for employee paid leave and. as predicted. want to designate COVID-19 as a workplace disease.

The Senate Democrats have their own list, released in June and reiterated in a more recent news release. The release claims that one of the bills is ready for public viewing, but provides no link and the bill mentioned is not yet available through Legislative Information Services. Neither caucus has yet revealed any thoughts on how to amend the state budget, a task where Governor Ralph Northam naturally takes the lead.

Here is the list from the House Democratic Caucus, with some thoughts following:

COVID-19 Relief:

  • Requiring businesses to grant paid sick leave for Virginia workers.
  • Prohibiting garnishments of stimulus relief checks. (Office of Attorney General bill)
  • Establishing a presumption of workers’ compensation for first responders, teachers, and other high-risk essential workers.
  • Providing immunity from civil claims related to COVID-19 for complying with health guidance.
  • Combating price gouging for Personal Protective Equipment. (Office of Attorney General bill)
  • Protecting Virginians from eviction during a public health emergency.
  • Creating a Commonwealth Marketplace for PPE Acquisition.
  • Mandating transparency requirements for congregate-care facilities during a public health emergency.

Continue reading

Covid-19 Testing for Nursing Homes – the Strange Case of Heritage Hall

By Carol J. Bova and James C. Sherlock

The Department of Health and Human Services announced that it would begin to provide 2000 nursing homes with a point of care (POC) rapid-response testing assessment instrument and an initial supply of COVID-19 test assays starting July 20th.

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said, “It gives nursing homes the ability to swiftly identify residents that need to be isolated and mitigate the spread of the virus.”

Eventually, 15,000 analyzer instruments and an initial supply of SARS test assays for those instruments will be distributed nationally directly to nursing homes.

Devices have been allocated to the first 23 of Virginia’s nearly 300 nursing homes.

Heritage Hall. Tommy East is the President and CEO of American Healthcare, LLC, which controls Heritage Hall nursing homes. Mr. East is also listed as a director and officer for each Heritage Hall facility. He is the sole nursing home industry representative on the Virginia Board of Health.

Seven of 18 Heritage Hall nursing homes made it to the head of the line for the first 23 analyzer systems and test assays distributed in Virginia by the CMS program. Heritage Hall is the largest Commonwealth-based operator of nursing homes.

Continue reading

What if COVID-19 Never Goes Away?

by James A. Bacon

Here’s a question my wife and I have been asking ourselves recently: What if COVID-19 doesn’t go away?

From the beginning of the epidemic, we assumed that we (along with the rest of the country) were enduring a temporary inconvenience. We’d hunker down, restrict our social interactions, wear masks in indoor public places, avoid airplanes, and the like, and in a few months — by the end of the year at latest — it would be over and we could return to normal.

Now it is August, and the virus is spreading with no sign of respite. Our thinking has swung to the other extreme. We’re wondering, what if nothing works? What if the much-touted vaccinations are only partially effective? What if antibodies confer only temporary immunity? What if the virus mutates? What if all our efforts at “flattening the curve” do nothing but delay the inevitable and everyone — including us, and those we love — gets exposed to COVID-19 eventually?

Will there ever be a return to “normal”? And, if not, how long can we sustain the partial shutdown of our economy, the shuttering of public school buildings, the gusher of government red ink, and the helicoptering of relief dollars, all of which were predicated on the assumption that the virus would be tamed and all emergency responses would be temporary? Continue reading

Why Have Nursing Home Outbreaks Continued?

by Carol J. Bova

In a July 29 tele-press conference, Dr. Norman Oliver, Virginia’s Commissioner of Health, said, “We’ve made a concerted effort at testing in nursing homes and other congregate settings. … We’ve done 456 such point prevalence surveys [PPS] covering all of our skilled nursing facilities and correctional facilities.”

As of June 5th, the Department of Health had recorded 224 outbreaks with 5,230 cases in long term care facilities (LTCF) — nursing homes, assisted living and group homes — and 30 outbreaks in correctional facilities with 1,568 cases.

By August 5th there were 100 more outbreaks with 3,090 additional cases in nursing homes and similar facilities, and 18 more in correctional facilities with another 1330 cases.

That’s a total of 372 facility outbreaks, 11,218 cases, from the 456 facilities where PPS testing was carried out. There have been no recent statements on what impact the PPS testing had in reducing cases. Did the testing come too late in the pandemic, or did outbreaks occur in spite of the testing because of infection control failures? Continue reading

Hospitals Made Their Bed, but They Don’t Like Laying in It

by James A. Bacon

The Virginia Hospital & Healthcare Association has joined the Virginia College of Emergency physicians in suing the state Medicaid program over emergency budget cuts that they claim will cost them $55 million in reduced Medicaid payments, reports the Richmond Times-Dispatch.

The cuts will create hardship for hospitals already struggling with increased costs and decreased revenue relating to the COVID-19 epidemic, the VHHA says. Virginia hospitals claim to have suffered a net loss of $1 billion from March through June, even after federal aid from the Provider Relief Fund is taken into account. Losses for the year could exceed $3 billion.

I’m almost tempted to sympathize with the hospitals over a plight not of their making…. until I remember that Virginia’s hospitals led the charge for Medicaid expansion in 2018. And that, before the epidemic, Virginia’s biggest tax-exempt “nonprofit” healthcare systems earned profit margins far in excess of the 3.0% considered adequate for financially healthy hospitals, some of which they devoted to buying up doctors’ practices, starting their own insurance companies, and otherwise shoring up their vertically integrated monopolies.

The hospitals forgot a critical lesson: Politicians have no loyalty but to themselves. What the General Assembly giveth, the General Assembly can taketh away — and usually will in times of financial stress. Virginia’s hospitals fought for a bigger government role in healthcare, and they got it… good and hard. Continue reading

Take a Seat, the Doctor Will See You Shortly

By Dick Hall-Sizemore

The latest action by Virginia hospitals is sheer chutzpah.

The 2020 General Assembly adopted actions aimed to reduce state Medicaid payments for emergency room services later deemed to be unnecessary. As described by the Richmond Times-Dispatch, the aim was to discourage Medicaid recipients from unnecessary use of emergency departments instead of seeking care from their doctors or urgent care centers. “They should talk to their primary care physician,” said Del. Mark Sickles (D., Fairfax), chairman of the House Health, Welfare, and Institutions Committee and vice-chair of the House Appropriations Committee. Continue reading