Home COVID-19 Friday Night Update from the ER in Arlington, VA: “I’m optimistic we’re...

Friday Night Update from the ER in Arlington, VA: “I’m optimistic we’re on the downward slide of the curve for now.”

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Thanks as always to Dr. Mike Silverman, Chair of the Department of Emergency Medicine at the Virginia Hospital Center in Arlington, for these superb updates!

Let’s start with the good news. We saw a noticeable decrease in the number of new COVID diagnoses we made this week in the ER and the percent positive rate dropped. We’ve been seeing a general decline in the COVID cases since late August but among symptomatic patients, this past week was one third lower than the last several weeks and less than half the number we were seeing in mid-August. The percent positive rate for our “symptomatic” patients was about 30% in mid-August and was just below 17% this past week. Among all comers, despite testing more than in mid-August (our ER volume is higher), our percent positive rate has dropped from approximately 13% to 6.4% and we’ve seen about a 40% drop in the number of patients we diagnosed with COVID this week compared to mid-August. We are 30-40% less than we were seeing the last few weeks. We also have a few less people requiring hospitalization this week compared to recent weeks. One week doesn’t make a trend but the numbers are similar to previous declines we’ve seen so I’m optimistic we’re on the downward slide of the curve for now.

I’m also optimistic as more people are getting their bivalent booster shot. Our hospital had a vaccine clinic yesterday but I was on call and didn’t want to risk having side effects that would make working challenging. I am hoping to get my booster in the next week or two and although I’ve never really felt poorly after a vaccine dose, I will time it for when I have 24-48 hours of non-clinical time.

More booster news. The preliminary data on the Moderna booster also looks quite good. There was significant improvement in neutralizing antibodies. The CDC released a statement saying they will meet in early to mid-October to make recommendations on the use of the new bivalent booster for the 5-11 year old age group. This should lead to boosters being available for this age group by mid-October.

Unfortunately, there are still patients dying of COVID, many of these from pneumonia and respiratory failure. There was phase 3 trial data of a first in class monoclonal antibody drug called vilobelimab, presented at an international meeting this week. And scientists found a reduction in mortality at 28 and 60 days among patients with COVID pneumonia. There was “a 10% absolute reduction and 23.9% relative reduction in 28-day mortality. This meant one additional life was saved for every 10 patients treated with vilobelimab.” That’s fantastic. The mortality rate isn’t nearly as high for hospitalized patients now as it was in 2020, but any way we can further reduce it is great news.

My son was sick this week. He’s vaccinated and boosted and gets sick about once a semester. He had a cough, sore throat, and high fever. His rapid COVID at home was negative. I know the rapid COVIDs aren’t great, and I wanted a PCR test to really know. We’ve used a local place that is very efficient, bills insurance, and generally gets PCR results back the same day as the test. But it’s been months since we’ve been there, so I hit google to find their number (I didn’t remember the name but roughly knew the location).

So here’s the point of the story. I called, was told the rapid tests were done elsewhere but I could get a test with same day results. Although my son has never had COVID, he’s had his share of tests. Usually, we’re in and out in 10 minutes. This week, however, registration took 10 minutes, a tech took a pretty thorough history, and then I knew we were in trouble when the tech took vital signs—pulse ox and temperature. Before I knew it, we were having a zoom telemedicine visit with an advanced practice provider. I definitely felt scammed as I didn’t want a telemedicine visit. I just wanted a COVID test and that’s what I thought I was getting.

In all fairness to this company, at least they did conduct a telemedicine visit, which they will bill as a new patient (higher charge) comprehensive visit (all these questions by the tech also lead to higher charges). I’m pretty sure my wife was charged previously when she got a test for a comprehensive, new patient visit and there wasn’t even a hint of her ever seeing a provider. It was fully covered by our insurance but that’s insurance fraud.

As it turns out, the FBI has gone after a handful of doctors from around the country who fraudulently billed Medicare massive amounts of money for new patient visits when patients only went in for a quick COVID test and never saw a provider. These doctors are appropriately facing big penalties—financial and time in jail.

Perhaps I didn’t read the fine print this when I brought my son to a testing center for a COVID test but I won’t be going back there. The need for testing isn’t going away and I don’t recommend the ER for routine testing (my son wasn’t sick enough to warrant an ER visit). But I do hope that next time I’m smarter than I was this week and read the fine print. And definitely check your insurance statements to see what was billed and paid on your behalf.

And you may be as surprised as I am that my son still hasn’t had COVID yet.

Coronavirus is not quite done with us yet.

Science matters. Get vaccinated (or your booster). Keep a mask handy.

Mike

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