Tag Archives: COVID-19

Don’t Blame Northam for Virginia Medicine’s Structural Flaws

Governor Northam when announcing stay-at-home order this morning.

by James C. Sherlock

I have to give Governor Ralph Northam a partial pass on a key issue. Much of the criticism directed at him is for actions or inactions that are based on incomplete data and, as a a consequence, incompletely informed staff assessments concerning the business of healthcare in this state. That is a structural problem in state government, not a leadership problem.

The Department of Health is not designed as a crisis action agency and has no authority to oversee Virginia’s healthcare system as an industry. It administers Certificate of Public Need regulations and oversees the practice of medicine, not the business of medicine. No agency regulates that business except in the narrowly focused and demonstrably failed COPN system. There is no such regulation because Virginia’s integrated health systems don’t want their businesses to be regulated, and not any other reason.

Virginia’s Board of Health is not designed or populated to function in a crisis and it hasn’t in this one (See this post from Feb. 22). The public health issues addressed by the Virginia State Board of Health include the prevention and control of chronic disease, not pandemics. Continue reading

Some Perspective

I have appended the number of COVID-19-related deaths to a ranking of the leading causes of mortality in Virginia, based on 2017 data, the most recently available from the Centers for Disease Control.

The number of COVID-19 deaths will increase, of course. For purposes of comparison, the Institute for Health Metrics and Evaluation forecasts that Virginia could experience 1,543 deaths — roughly equivalent to the number of drug overdoses.

(Hat tip: Sheila Gunst)

— JAB

Neighborhood Narcs

Getting fresh air is all we have left. Looks like the neighborhood busybodies want to shut that down, too.

by Kerry Dougherty

I always liked the idea of Neighborhood Watch. You know, loosely organized groups of residents who keep an eye on things.

Sort of like homeland security for your street.

We don’t have an organized watch in my neighborhood, but we do look out for each other.

Here’s an example: I remember walking my dogs late one night when I saw a man I didn’t recognize trying to open a neighbor’s front door. It was locked and I saw him duck around the back.

Despite the fact it was after midnight, McKerry the Crime Dog went home, grabbed her phone, woke the neighbors only to learn that the “intruder” was the husband’s brother, visiting from out of town. They’d left the back door open for him. Continue reading

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

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

An Interview With the State Epidemiologist

Here is interview I did today for Style Weekly with Dr. Lillian Peake, the State Epidemiologist for Virginia. It was for Style Weekly, but I think they won’t mind if I share it with you.

— Peter Galuszka

Help for the State Budget

In answer to some calls on this blog for immediate adjustments to the state budget, my response was: Don’t panic.  There is a process already in place to deal with such a situation. Now, there is even less reason to panic. It is reported that the Commonwealth will receive at least $1.5 billion from the federal rescue package that will soon be enacted.

Just as the Obama stimulus package (along with shortchanging the state pension system) helped Bob McDonnell balance the budget in the middle of the financial crisis without a tax increase, this new rescue or stimulus package should help Governor Northam weather the economic storm caused by the coronavirus. 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