It’s sort of like a plane flying through a thunderstorm, said Dr. Edward Puccio, three days into the third calendar year fighting the COVID-19 pandemic.
“The pattern the plane has to take to avoid a storm and land safely may change by the minute,” Puccio, medical director of Inova Loudoun Hospital’s Department of Emergency Services, said. “That’s what we’re trying to do, constantly take the safest course based on the information we have now.”
Those changes run the gamut, such as new CDC guidelines on quarantine times for symptomatic and asymptomatic COVID patients that have caused their own confusion—not to mention a new, highly transmissible variant, Omicron, that is likely linked to the sharp increase in positive cases, even for those fully vaccinated and boosted. With a rise in positive cases the county and the nation have not seen since the pandemic’s earliest days in the spring of 2020, Puccio and his team at Inova Loudoun Hospital again begin a new year battling a familiar, pesky foe.
As 2021 came to a close, COVID cases skyrocketed. On Tuesday, the Virginia Department of Health’s latest report for Loudoun indicated a seven-day positivity rate of 32%. Almost 6,000 COVID cases have been reported to the health department over the past week. There has been an average of 776 new cases reported daily over the past week. One month ago, there were an average of about 90 new cases daily and the positivity rate was about 6%.
“We’re definitely in a surge. We are in a double surge; we’re in the winter surge and the Omicron surge hitting at the same time. And Northern Virginia is bearing the brunt of it right now for whatever reason,” said Dr. David Goodfriend, director of Loudoun’s Health Department.
And as he told the Loudoun Board of Supervisors on Tuesday: “I’m assuming that at least one person in this room is contagious with COVID.”
‘Not a Reason to Panic’
But while COVID cases are breaking records, the number of people dying from the disease from day to day has stayed relatively low in Loudoun. On Dec. 29, as the winter surge began, Gov. Ralph Northam issued a statement calling the case numbers “a reason for concern, but not a reason to panic.”
“We have all studied the ‘number of cases’ for many months now, but this data point means something different today, compared to this time last year,” Northam stated. “One year ago, vaccines had just become available, so nearly no one had gotten a shot. Today, more than 14 million shots have been given in Virginia. Only nine states have given more shots, and those states are all larger than Virginia. That’s good news, and it’s thanks to a lot of hard work by Virginians.”
Northam, a pediatric neurologist, said with the virus becoming endemic, it is now time to study not only case counts, but also the severity of symptoms and the number of hospitalizations.
Inova Loudoun Hospital President Susan Carroll told the county board Tuesday that the hospital had a record 59 COVID-19 inpatients. She noted that vaccinated patients with break-through cases have much shorter hospital stays—two or three days—and better outcomes generally. Last year, the average COVID patient faced an eight-day hospital stay. Unvaccinated patients suffering from COVID or the flu, or both, are not doing well, she said.
Short on Tests
The Omicron variant, which many medical professionals believe to be the culprit behind the majority of the new positive cases, is believed to have arrived in the U.S. in the fall after first being detected in South Africa. It follows on the heels of the still present Delta variant, which arrived just in time for schools to go back in session this fall.
The surge comes at a particularly difficult time, with COVID-fatigued residents longing for holiday gatherings and normalcy of yore, and a decent portion of the population choosing to go forward with their holiday plans as scheduled, despite a rise in cases.
The rise of cases has also entailed a significant jump in demand for COVID testing, with desperate residents even flocking to social media sites offering to pay strangers double the amount they paid for a COVID home test when available free testing could not be found. Loudoun County has begun twice-weekly COVID testing events that has seen demand significantly outpace supply, with many turned away at each event when tests ran out, and those successful in obtaining a test only doing so after waiting in line for hours.
Prior to the current surge, Goodfriend said, the county testing event had regularly attracted around 200 participants each time. In the last week of December, between its two events at Philip A. Bolen Park in Leesburg, more than 4,000 people turned out to be tested, many having to be turned away. Goodfriend said scarce supplies of home tests at area pharmacies are likewise caused by the unanticipated surge in demand.
“[Pharmacies] were purchasing based on their expected amount of demand. That has gone up tremendously so they are going to have to go back to their suppliers to order more. It’s going to take a bit of time for supplies to keep up with demand,” he said.
Alyssa Laeser and her Sterling-based Mobile Medical Health Clinic have tried to help meet the surge in demand from those seeking COVID tests.
“We literally went from testing five people a day to a house call here and there, to today we just finished testing 50 people,” she said on a recent early Thursday afternoon. “It’s been a tenfold increase with only a one-fold increase in staff.”
Laeser has taken to social media to solicit nurses and medical professionals to join her staff to meet the demand, and also to account for sick employees, but has been so busy herself she hasn’t been able to initiate a hiring process in earnest.
From her end, she said the patients testing positive for COVID of late tend to have milder symptoms than in previous surges, mirroring those of a common cold. She did say that those vaccinated patients who did not receive a booster do tend to be sicker than those who are boosted.
Hospitals Bear the Brunt
Laeser echoed the recent sentiments shared on the social media pages of both local hospital systems, Inova Loudoun and HCA StoneSprings—don’t go to the emergency room merely to get a COVID test or for mild symptoms.
The rise in cases and subsequent rush to area emergency rooms is already having an impact. Dr. Nafis Ahmed, chairman and medical director of the emergency department at StoneSprings, said the Aldie hospital is seeing a “tremendous increase” in visits to its ER.
“It’s astonishing, the record-breaking numbers that we’re experiencing at StoneSprings,” he said.
He said a majority of recent ER visits have been those patients presenting with only mild symptoms, and thus not in need of inpatient treatment, or even just those who want to be tested.
“I understand a lot of people are afraid and want the reassurance of knowing if they have COVID or not, but it’s starting to overwhelm the system with the amount of visits. We’re really urging the community if they’re asymptomatic or not exhibiting severe symptoms, we encourage you to quarantine. If you’re feeling critically ill or short of breath come to the emergency department, we’re ready to take care of you,” Ahmed said.
Meanwhile hospital staff are dealing not just with the exhaustion of their work, but their own health. StoneSprings CEO Nathan Vooys said Jan. 4 that over the past two weeks, about 15% of his workforce has contracted COVID. Similarly, Carroll said despite the Inova’s vaccine mandate and 99.5% vaccinated workforce, some staff members are out sick with COVID.
Ahmed also said he is understanding of those vaccinated and boosted individuals who are becoming more ill than perhaps they thought they would.
“I think [vaccinated] people are in shock that they’re feeling symptoms. What I’m telling folks is it likely is COVID and it’s most likely the new variant which appears to be more contagious, more transmissible but luckily is not as severe especially for the vaccinated population,” he said.
Puccio said the activity at Inova Loudoun mirrors that of the early days of the pandemic, in March and April 2020.
“I would say that we are seeing as many patients coming in for COVID symptoms or COVID testing as we were during the initial peak,” he said. “However, much more of these patients are able to go home and don’t need to be hospitalized. I think that is due to the penetration of vaccination in our area.”
Most of the treatment the hospital is currently doing for COVID-positive patients is supportive care in the form of over-the-counter medications like Tylenol, and dehydrated patients are given IV fluids for hydration. COVID patients who require oxygen need to be admitted to the hospital, Puccio said.
Monoclonal antibody treatment is also available, but qualifications for that have changed dramatically over the last month.
“Right now, it’s only for those people who are severely immunocompromised—[patients who are] under active treatment for a solid tumor or hematologic malignancies, organ transplant recipients, HIV patients, or those who are on high doses of steroids or chemotherapy,” he said. “Those who are not sick enough to be admitted but have the potential to be very sick they are being referred to [Inova’s] Reston infusion site to schedule a monoclonal antibody infusion. We’re trying to do this within seven days [of testing positive]. If you come to one of Inova Loudoun’s ERs and you’re on day six or seven and are high risk you can get an infusion at Inova Loudoun’s main hospital [in Lansdowne] before being discharged but the supplies at the hospital are very limited.”
The standards are determined by state supplies, and current supplies at area hospitals are very limited. That is attributed in part to the monoclonal antibody treatment of choice changing recently, from Regeneron to Sotrovimab, which has been shown to be more effective against the Omicron variant, Puccio said.
The rise of new variants, Puccio said, should serve as further impetus for the public to do its best to prevent the spread of COVID.
“Everyone around the world in labs are looking for variants. That’s why we’re really trying to limit the amount of people that get sick. The less people that have COVID the less variants will develop. That’s why it’s important to really get the vaccine out to the whole world. If we move one area of the world and coronavirus is spreading amongst that population regardless of travel restrictions it will get here, and it will spread here. This is a whole world problem,” he said.
Whereas flu cases in the area were scarce, if not altogether absent, last winter, they are now returning, Goodfriend said. The state currently has widespread flu activity, he said, and traditionally flu outbreaks begin in mid-January.
With mitigation strategies not as stringent as they were a year ago, and schools fully back in person, it could be a wild winter. Goodfriend said it is likely that January will bring with it a rise in cases of respiratory infections of all forms, from COVID to flu to RSV to the common cold. Couple that with the return of residents from large holiday gatherings, potential super-spreader events, and the worst, unfortunately, may be yet to come.
That has area medical professionals bracing for a rocky start to the New Year.
“The peak may not have happened yet,” Ahmed said. “I think we’re in the middle of it.”
County, Inova Offer COVID Testing
With a rise in demand for COVID-19 testing, both the Loudoun County government and the Inova Health System have announced regular testing events.
Loudoun County government has announced plans to offer twice-weekly, free, drive-through COVID testing events on Tuesdays and Fridays, with the location changing each week. Testing begins each day at 9 a.m. and is held rain or shine. There are no age or residency restrictions, and no ID is required to be tested.
A registration form in both English and Spanish can be found at loudoun.gov/covid19testing, and is recommended to be printed and filled out ahead of time to expedite testing. More information on testing sites and dates can be found via that same link.
The next testing date is set for Friday, Jan. 7, at Philip A. Bolen Park in Leesburg.
Inova Health System has opened a vehicle-side testing site in Falls Church for symptomatic individuals.
Testing is available by appointment only for individuals experiencing symptoms of COVID-19. Asymptomatic patients or individuals who have been exposed to COVID-19 without symptoms will not be tested.
The testing site is located at the Inova Telestar Court Office Building, 2990 Telestar Ct., Falls Church, and is open Monday through Friday from 8 a.m. to 5 p.m. Additional testing hours on weekends may be added depending on demand.
Appointments can be scheduled by calling 571-472-6843. Inova offers PCR testing only (no rapid tests) and results will be available within one to two days through Inova’s MyChart Patient Portal.
Inova also offers COVID-19 testing for symptomatic primary care patients. Individuals should call their primary care office for more information.