Friday Night Update from the ER in Arlington, VA: “While clearly the surge of cases is over, I think we are still a few weeks away from going back to life as normal”

Thanks as always to Dr. Mike Silverman, Chair of the Department of Emergency medicine at Virginia Hospital Center, for these helpful updates!

Friday Night Update from the ER in Arlington, VA

For the second week in a row, I didn’t see any COVID patients during my shifts this week. I don’t even remember seeing COVID patients on our tracking board today though odds are there were at least a few.

Overall, the hospital continues to move in the right direction regarding Covid. Inpatient census, the number of people currently hospitalized, is less than it was last week. We’re not back to our summer lull but we’re certainly moving in the right direction. The total number of positive patients we diagnosed in the emergency department this week is less than last week. However, the number of symptomatic patients we’re diagnosing is similar to last week and also not quite at our typical lull. The biggest drop in number of cases was among our asymptomatic/screening patients. In theory, the provider team is not suspicious of these patients having COVID. Rather, these patients mimic general population. Our asymptomatic screening is down to a percent positivity rate of 7.51. This is great to see and the lowest it is been in a long time. Our overall percent positivity rate is about 8.6%. The number of patients that require COVID isolation in the emergency department continues to drop week over week. Of these patients, the total number that actually require being admitted to the hospital has remained constant 2 weeks in a row and the slope of the curve is not a steep downwards than the rate of patients requiring isolation.

While clearly the surge of cases is over, I think we are still a few weeks away from going back to life as normal (at least temporarily until the next variant surge). There are clearly people still out there getting Covid. Like I said last week, several very good friends of mine had Covid run through their family and were dealing with it for most of this week. We are also wrestling with getting the kids 6 months to 5 years old vaccinated as the FDA pushed back their meeting originally scheduled for next week because they want more data. This is extraordinarily frustrating for so many.

In case you don’t need more convincing that better masks offer better protection against contracting COVID, there was a nice article published by the CDC this week looking at the effectiveness of mask use for preventing COVID. We knew that face masks and respirators (N95s and KN95s) are effective at filtering virus size particles in the lab. This study included about 1800 participants and found (drum roll as clearly no surprises) that wearing an N95/KN95 and wearing a surgical mask was “associated with lower adjusted odds of a positive test compared with not wearing a mask” or wearing a cloth mask. Details of the data are presented in the attached image.

I find the decisions that Governors across the country are making about mask mandates to be very interesting. I am starting to feel relatively safe about going out to dinner however I am still wearing a mask when I go to Costco and the grocery store this weekend. I really would love to see some guidance from the CDC that outlines mask recommendations based on case rates and percent positivity. Throughout the pandemic, I have not seen consistent guidance or decision making about public policy based on actual data and I find this frustrating.

The Coronavirus is not done with us yet.

Science matters. Practice physical distancing. Get vaccinated (or your booster). Wear a mask.

Mike