Virginia Hospitals Have Capacity to Spare. Time to Rethink Elective-Surgery Restrictions.

Danny Avula at Friday press conference. Photo credit: Virginia Business

Virginia is “pivoting away” from setting up field hospitals to handle the hospital overflow of COVID-19 patients, Danny Avula, director of the City of Richmond and Henrico County health departments, said in a Friday press conference.

Although sites had been selected in Northern Virginia, Richmond and Hampton Roads, Avula said he saw less need to build out the facilities. Social distancing is working, and hospitals have increased their capacity by converting elective-surgery wards and unused wings and floors for use by COVID-19 patients, he said, as reported by Virginia Business.

“We’ve actually started to pivot away from those. There may never be a need for that significant a build-out,” Avula said. “Our health systems think they’ll be able to manage whatever amount of surge that comes.”

This is heartening news. Now that it appears that hospitals have significant excess capacity, the question arises if it is time to relax the tight restrictions on elective surgery that have devastated hospital cash flows and forced thousands of Virginians to postpone elective surgery.

Avula cited numbers that Bacon’s Rebellion had highlighted in past posts. Virginia hospitals have significant capacity to spare.

Hospital beds available: 5,961
Number of confirmed COVID-19 patients: 826
Number of suspected COVID-19 patients (tests pending): 468

Not all “available” hospital beds are necessarily suitable for COVID-19 patients. The figure includes beds for psychiatric patients, NICU patients, and psychiatric patients, for example. However, the number of available beds exceeds the number of COVID-19 patients by a wide margin, and hospitals don’t seem to be worried that they will run out of beds.

Identifying sites for field hospitals was a prudent measure at the time. No one knew how rapidly the disease would spread and whether we would be seeing scenes here in Virginia like those in China or Italy where hospitals were totally swamped. Likewise, it seems prudent to put on hold plans for building out the field hospitals. Resources can be better applied elsewhere to fight the virus.

If it is time to “pivot” away from field hospitals, it is likewise time to “pivot” toward the issue of hospitals’ financial viability. Bon Secours Health System in Richmond and Hampton Roads, Carilion Clinic in Roanoke and Western Virginia, and Ballad Health in far Southwest Virginia are among those that have announced large furloughs due to the decline in elective surgery. Virginia’s hospital industry would lose $600 million in revenue between late March and late April, association spokesman Julian Walker has told the Washington Post.

I have been a consistent critic of Virginia hospitals’ excessive profitability in the past, but that was under totally different circumstances. Profit margins are evaporating. Some hospitals may be suffering financial damage from which they can never recover.

Roanoke is not Arlington! The heavy-handed statewide mandate seems particularly excessive in western Virginia where the incidence of COVID-19 is low.

The table at left, taken from today’s Virginia Department of Health dashboard, shows the number of COVID-19 patients by health district. Arlington County has a population comparable to that of the Roanoke Valley (City of Roanoke, Roanoke County, and City of Salem). Yet the VDH reports 112 COVID-19 hospitalizations for Arlington compared to four in Roanoke — more than 25 times the number!

Prohibitions against elective surgery that might make sense in Arlington make no sense whatsoever in Roanoke. Patient volumes are down 40% to 70% in outpatient practices, urgent care, emergency departments at Carilion Clinic, the dominant health provider west of the Blue Ridge Mountains. Meanwhile, CEO said CEO Nancy Agee as reported by the Roanoke Times, expenses are inflated. “The cost of medical supplies and personal protection equipment is staggering, as is the increasing costs for medications.”

In addition to furloughing employees, Agee and other senior executives are taking a 20% pay cut, while vice president-level managers are taking a 10% cut.

As Governor Ralph Northam ponders when and how to roll back his COVID-19 emergency measures, he would do well to consider a basic truth: In a diverse state like Virginia, what makes sense for one geographic region may not make sense for another geographic region. Elective-surgery mandates may be doing more harm than good in Western Virginia and other parts of the state outside the major metropolitan areas. To avoid unnecessarily crippling Virginia’s economy, the Governor should tailor his mandates for the situation in each region.

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4 responses to “Virginia Hospitals Have Capacity to Spare. Time to Rethink Elective-Surgery Restrictions.”

  1. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    That has crossed my mind, also. I am having some trouble trying to reconcile opening up hospital business and keeping other businesses shut. Also, the equity of allowing hospitals in some parts of the state to go ahead with elective surgery, while prohibiting other hospitals from doing so. As with other areas, it looks as if the federal government is going to be throwing money at the hospitals.

    If hospitals were allowed to renew elective procedures, there would have to be strict safeguards, such as testing anyone who wanted to be admitted for such a procedure for COVIDS-19.

    If this ban keeps up through the summer, it looks as if I will have to get my colonoscopy later than I anticipated.

  2. Nancy_Naive Avatar

    Or… or, we could deliberately infect more people with COV2 and hurry the end of the infection.

  3. The same things trouble me. If we are prepared to relax in this instance, then we should do so for all businesses, within reason.

    These are hospitals, after all, where medical testing upon admission is practically a given, and pre-op testing before surgery is nearly always required. If we have COVID and antibody testing widely and easily available to the public, without charge, on-demand, then it would make sense to allow all businesses similarly to open their doors to all patrons who have been tested recently (whatever that means) and who undergo a forehead temperature check on admission to the business and agree to contact-tracing protocols if they turn up infected. I can rationalize a special break for hospitals in advance of that day, since they are uniquely qualified to deal with the consequences if an elective-surgery patient does show up with COVID, and since they are uniquely impacted by the loss of other business due to the proximity of COVID cases there. But, equitably, it still feels squirly to me.

  4. Atlas Rand Avatar
    Atlas Rand

    I think you have to look at the potential surgery backlog the longer this continues. How long do we want people waiting for “elective” procedures. If I need a knee or hip replacement it’s not life threatening, sure, but if I can’t walk it feels fairly important. If this goes on through the summer, it could be a year or two before some people can get these procedures done.

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