Don’t Fear the ER, Health Leaders Urge

Sitting at home with chest discomfort, or a strange numbness? Have an injury that needs stiches or an X-ray? Don’t delay treatment because you’re afraid of coming into contact with the coronavirus at the emergency department. 

That’s a message leaders at Inova Loudoun Hospital are working to drive home as they encounter patients who waited longer than they should have to get checked out. 

“The risk of a delay in diagnosis of a medical condition far outweighs the risk of catching COIVD in the emergency department or in the hospital,” said Dr. Edward Puccio, director of emergency medicine at Inova Loudoun Hospital. “We have worked so hard over years to tell people time is brain, time is heart muscle, minutes matter, call 911. And now people are waiting hours for a heart attack. Hours or days with a stroke and all of that progress has been eliminated because of how long people are waiting because of this fear of catching COVID at the hospital.”

That’s not something they should fear at Inova Loudoun, Puccio said, in part because patients with COVID-19 symptoms are isolated from other patients even before they enter the hospital.

Everyone is screened outside the ER door, where their temperature is taken and they are given a mask. Those suspected of a possible COVID-19 infection are sent to a specially built triage area where doctors check their vital sighs, administer tests and determine whether they be sent home, moved into negative pressure isolation rooms or to a room in a section of the hospital reserved for those undergoing treatment for the coronavirus—all without ever entering the ER waiting room. And recent expansion at the Lansdowne campus made plenty of room, now with 49 ER beds and 36 for intensive care. 

“I think part of [the fear] is because the only pictures they see of hospitals are people on ventilators in the waiting room and people on the floor waiting to be seen,” Puccio said. “That’s local in some areas, but when you look at healthcare across the country you have to look at: what is happening in my community? What is happening in my community’s hospital? And we have not been in that position at all. We have always been able to have patients be seen right away.” 

This week, Loudoun County crossed the threshold of 1,000 confirmed COVID-19 cases, as the cumulative number of hospitalized patients reached 100 and the local death toll climbed to 24. 

Physician Assistant Jackie Concaugh-Gruendel talks with Emergency Department Director Dr. Edward Puccio about patient care in the COVID-19 respiratory wing of Inova Loudoun Hospital in Leesburg. [Doug Graham/Loudoun Now]

More than 1,000 COVID-19 tests have been administered at the hospital. Puccio said about 70 percent of those patients are sent home to self-quarantine, with instructions to return if symptoms worsen. At the hospital on Tuesday, there were 38 positive in house patients.

So far, 74 hospitalized COVID patients have been released, including several who required treatment on a ventilator. “Some of these people were very sick, but we’ve been able to turn them around in the hospital,” Puccio said.

He said the virus is “completely unpredictable” and the symptoms vary broadly. And while the fatal cases in Loudoun have largely involved elderly residents—17 of the deaths involve patients age 80 or older, five were in their 70s, one in his 60s and one in her 50s—young, healthy people also face serious threats.

Some people coming to the ER can walk in and find themselves on a ventilator only hours later. Others may just need a few days on oxygen before they are released home. “It’s sort of like there are people who have zero symptoms and they’re positive and have nothing. So, it is the entire spectrum. It’s not just cough, fever, shortness of breath. It could be chest pains,” Puccio said.

When the coronavirus presents as blood clotting disorder, it often takes people by surprise. “People are coming in with no risk factors—no smoking, no family history, no cholesterol, no diabetes—and they are getting chest pain. So, they’re like ‘no this can’t be a heart attack because I don’t have any risk factors. I’m 40. I’m healthy,’” he said.

Likewise, with stroke systems, Puccio said, “a young person could have numbness and weakness and think ‘I’m young and healthy, this can’t be a stroke’ and they are delaying coming in.”

They’ve also seen cases begin with simple pinkeye.

Puccio said that his staff’s prior experience with cases of SARS and Ebola has them well prepared to handle the outbreak. 

“Having that experience so successfully in the recent past—we know we can do this and with calm and organization can really handle this. There really was no panic or worry about safety. Everyone was confident in their safety,” Puccio said. “We feel safe working together and our patients are safe.”

Physician Assistant Jackie Concaugh-Gruendel, talks with Pediatric Emergency Department Director Dr. Jill McCabeMedical Director in the COVID-19 respiratory wing of Inova Loudoun Hospital in Leesburg. [Douglas Graham/Loudoun Now]

Outside the Hospital, Counts Continue to Rise

As the numbers of confirmed infections continue to climb, difficulty getting a firm handle on how many people are actually infected out in the community remains. Loudoun County Health Department Director Dr. David Goodfriend said Tuesday a sharp increase in local fatal cases reported this week did not reflect a spike in deaths, but catching up on paperwork on old ones.

“That was really just us catching up on reports that had come in over the past several weeks and just didn’t get married up,” Goodfriend said. “…When we were able to find those orphan reports and then attach them to Loudoun County residents, we were able these past couple days to increase our numbers to what we think is now a more accurate count.”

But, he advised, many people never show symptoms and yet can still be infected. And even the updated counts may leave some COVID-19 deaths out.

“There are still folks that may never have gotten tested, died at home, and if it’s not on the death certificate, we may never know about it,” Goodfriend said. 

The Health Department has put a particular focus on stopping outbreaks of the virus in retirement communities and other group settings. And Falcons Landing, which earlier in the pandemic lost three of its residents to the virus, got a little help from the Virginia National Guard last week.

On April 28, soldiers and airmen rolled into the retirement community to conduct wide-scale testing, gathering samples from more than 230 staff and residents to be tested at the University of Virginia.

It was the first community in Northern Virginia to be selected for the Virginia Department of Health’s new Point Prevalence Survey, in which everyone in a particular group setting is tested for the virus to see how widespread it has become. In Falcons Landing, those were the two assisted living facilities, Johnson Center Nursing & Assisted Living, and West Falls Assisted Living.

Statewide, the health department has reported 20,256 total cases, with 2,773 requiring hospitalizations. As of May 5, about 1,500 patients were undergoing hospital treatment for the coronavirus. There have been 713 COVID-19-related deaths in the commonwealth.

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