COVID Changes Medical Patient Visits

A year ago next week, the lives of residents and the fortunes of businesses were shaken by the arrival of the COVID-19 pandemic and Gov. Ralph Northam’s emergency declaration that closed schools and limited public gatherings.  At the time, surgeons stopped performing non-emergency surgeries, doctors amended their office procedures and many patients in need of medical treatment forwent visits to the emergency room and the doctor’s office.

Nearly a year later, doctors and dentists are reporting a rebound of sorts, but say many of the procedures put in place to prevent the spread of the coronavirus will be here to stay—ensuring that medical spaces remain among the safest locations in the community.

Tim Zelch, who has operated his Spine and Orthopedic Solutions physical therapy office in a second-story space in Ashburn’s Premier Plaza since 2019, said the volume of patient visits last spring dropped by 70% at the outset of the pandemic.

Zelch said that overnight drop in patient visits led to a rapid increase by July. He attributed that increase to the nature of his profession; patients who stopped going to their physical therapy sessions or who were unable to get surgery during the height of the COVID-19 outbreak were aching to go back to therapy for pain relief.

StoneSprings Hospital Center CEO Nathan Vooys said the hospital stopped offering non-emergent surgeries, such as knee replacements, for three weeks in late-March and early-April 2020. He said the only surgeries being performed were for emergency situations necessary to save lives, protect limbs and relieve major pain. Babies were also still delivered during that time.

Inova Chief Medical Officer Christopher Chiantella said Inova also halted non-emergency surgeries around that time.

Aside from a shift in the scheduling of surgeries, Zelch said he’s aware of another reason for the uptick in patient visits he saw last July: a change in peoples’ work habits. As more people began working from home, many were doing so from bed or the living room couch, neither of which are conducive of proper posture.

“I think we saw a big jump in volume because of that,” he said.

Zelch now sees more patients than he did at the beginning of 2020.

“By July it was like it never happened,” he said about the pandemic’s effects on his office.

On the first floor of Zelch’s building is Dr. Fuad Alykhan, who has operated the Loudoun Walk In Medical Center there since 2010. Alykhan said he saw a 50-75% drop in patient visits last spring. Like Zelch, Alykhan saw patients begin returning by the summer. But it didn’t last.

He said the number of patients he’s seeing now is at the same level it was when he opened 11 years ago, still down by about 50% over the level it was in early 2020.

“It’s pretty concerning,” Alykhan said.

Vogtle Ninh opened Dental 32 Fresh Smiles in Ashbrook Commons Plaza in March 2020. Because he opened his practice at the beginning of the pandemic, Ninh never saw a real drop in patient visits, but did note that “people were terrified” to come into the dentist. He said some patients with tooth issues have been waiting longer to come in than they should.

“They know that have problem and they know they need help and they’re putting it off,” he said.

At Inova, daily patient visits to the ER were halved by March 29 last year, down from 9,000 to 4,500. Inova Loudoun Hospital Chief Nursing Officer Marissa Jamarik said ER visits were back up to 5,000 by April, then into the 6,000s by July but are now back down by 15-20% over numbers seen at the beginning of 2020.

At StoneSprings, Vooys said, “it’s hard to remember what life was like” before the pandemic led to the heightened cleaning and protective measures doctors, nurses and patients have become so accustomed to by now.

“Absolutely there was a drop,” he said of patient visits to the ER, noting that those visits are still “significantly down.”

But Vooys attributed the decline in emergency room visits not only to people opting to deal with their injuries and pain rather than risk infection of COVID-19, but also to a shift in lifestyles. He noted that there are fewer people injured in traffic accidents because more people are working from home and there are fewer cars on the roads. He also pointed out that there are fewer sports injuries because fewer people are playing sports.

Jamarik said telemedicine appointments have also kept more people out of the ER in the past year. Because patients are more frequently opting for the convenience of visiting with their doctors over the web, they’re perhaps more willing to talk with a doctor about their conditions and are thus avoiding emergency situations down the line.

Ashburn-based Physical Therapist Tim Zelch works with a patient at an appropriate distance amid the pandemic. [Patrick Szabo/Loudoun Now]

Some COVID Protocols Are Here to Stay

At the outset of the COVID outbreak, many medical professionals were forced to change their safety measures, and amend their business models.

Zelch furloughed his front-desk receptionist and second full-time therapist and began wearing a face mask, a face shield and gloves. He also got rid of the magazines he had in the front waiting area, removed chairs and spaced out scheduling to keep the numbers of patients in the office at one time to a minimum.

He has since been able to bring his receptionist and second therapist back on board, and has even hired another part-time therapist. All of them have already received the full dose of the COVID vaccination.

Zelch’s team also continues to make it a point to show patients that the office is sanitary and safe against COVID-19, since some patients still call to ask about the cleaning regimen and scheduling. He said he uses 10 times the amount of cleaner he used to use and plans to tear down a wall in the office to allow for greater social distancing.

Alykhan transitioned his practice from a walk-in office to appointment-based, in part to keep patients from sitting together in the waiting room. Because of the initial shortage of personal protective equipment, Alykhan’s team early last year had to practice a little ingenuity, by using plastic tablecloths and shower caps as protective equipment.

On the dentistry end of the medical world, not much needed change to protect against COVID-19, since dentistry equipment has always been designed to protect against all types of diseases. Ninh said he installed an air filter and started wearing a face shield, but continued to practice the safety measures he and other dentists always have, such as wearing a mask and protective eyewear and cleaning instruments frequently.

“COVID is just one of the many diseases we as practitioners try to fight,” Ninh said.

At the hospital, the Inova staff activated a surge plan that saw medical teams transform 37 beds in the west wing of the Lansdowne hospital into negative-pressure, critical-care beds for COVID-19 patients.

“We moved very quickly,” Jamarik said.

Chiantella said the Inova medical team also worked to treat and discharge patients who had “minimal need” to be kept in the hospital any longer than necessary and set aside three units for critical care. He said medical professionals also were “lining up to help” amid the pandemic.

“Luckily for us the human resource piece was not a limiting factor,” he said.

StoneSprings began limiting visitors, established only two entrances to the hospital and implemented temperature screens and a symptom/travel questionnaire. Everyone in the hospital also began wearing the appropriate PPE, which was inventoried, moved to a secure location and controlled by a “PPE czar.”

“There isn’t a whole lot that we have unwound,” Vooys said about those protocols. “… Some of these things are here to stay.”

And it’s because of those new, more self-aware protocols that society in the future, Vooys said, should be able to limit case numbers of certain illnesses.

For instance, Alykhan and his team plan to always mask up when treating patients suffering from upper respiratory symptoms. Vooys said it’s protocols like those that are keeping cases of respiratory diseases other than COVID-19 “way down.”

“When we try to protect ourselves against COVID we’re also protecting ourselves against the flu,” Vooys said.

Chiantella said Inova has admitted nobody with the flu as a main diagnosis this season. It’s the first time that’s ever happened.

Alykhan said he’s hopeful COVID-19 will work its way through society as quickly as the Spanish Flu did, having begun in the spring of 1918 and largely subsiding by the summer of 1919, albeit only after Infecting one-third of the world’s population and killing about 50 million people worldwide.

“I think that’s the pretense that we’re working with,” he said.

Overall, the new safety protocols, along with recent vaccinations, have helped to curb the cases of COVID-19 and symptoms thereof.

Vooys said the number of daily COVID-positive cases StoneSprings doctors have treated was around five each day in November and closer to 10 in December. Now, Vooys said, the numbers are in the low single digits, if not zero on any given day.

At Inova, Jamarik said the number of patients coming in with COVID-related symptoms, or testing positive for the virus, is down by more than 50% compared with January, the deadliest time of the pandemic since the outset in spring 2020.

Chiantella said that while he’s not hearing about patients being scared to visit the hospital as much anymore, he emphasized that the hospital “still remains one of the safest places” to be amid the pandemic.

He said Inova would continue to heed the advice of the Centers for Disease Control and Prevention and not proceed toward a state of normalcy any faster or slower than what’s recommended.

“Inova will just continue to follow what those guidelines are,” he said, noting that it’s best to “stick to the basics” when it comes to preventing the spread of COVID-19.

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