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!
Friday Night Update from the ER in Arlington, VA
Our busiest COVID surge ever was December 15. 2021 through January 19, 2022. At this point last year, we were doing around 400 COVID tests in the emergency department a week and having about 10 positive tests a week. How did it go from 10 a week to 30 a week in mid-December to almost 400 positives a week by New Year’s?
Our weekly volume in the ER was about 1130 a year ago. Pre-Covid we averaged about 1260 a week. We’re now seeing about 1400+ patients a week in the ER and doing 600-700 COVID tests a week. Although our percent positivity rate is not higher than it was earlier this fall, we have seen an increase in the number of people we are diagnosing with COVID the last few weeks compared to earlier in the fall. We’re also sitting a much higher percent positivity rate then we were this time last year. We are definitely having more positive tests a week than we did a year ago.
The Tripledemic that you’re hearing about on the news is real. The combination of COVID, Flu, and RSV is bringing more people to hospital ERs and causing more hospitalizations than we’ve seen over the last few years. Every year, emergency departments face a month or so of surging volumes because of the flu. I have seen flu surges in the fall, and I have seen them in March. Prior to the pandemic, I had never had a year as an attending physician without some sort of impact by a flu surge. What has me concerned about this year is how early the flu has impacted our community and the potential for how long the ER volume surge will continue. What’s to say we will not see an increase in COVID this winter as we did last winter?
In a study published by the Commonwealth Fund, with a lead author from the University of Maryland, analysis published this week shows that if “school-aged children were vaccinated with the updated COVID-19 booster shot at the same rate that they were vaccinated against the flu last season–between 50% and 60% coverage–at least 38,000 pediatric hospitalizations could be averted.” And if “COVID-19 booster coverage reached 80% along school-aged children by the end of the year, more than 50,000 hospitalizations could be averted.”
I took care of a school-aged child earlier this week. His father brought him in for several days of cough and now having one day of fever. The child was not vaccinated against COVID or flu. The child was not ill-appearing, got Tylenol for fever since he had not had any since the night before (14 hours), got an apple juice, and tested positive for the flu. I am hoping the parents get the patient a flu shot next year and I talked to them about that (and COVID vax).
So why does ER overcrowding matter? It definitely contributes to burnout among staff and providers which leads to bigger staffing issues. Much more important though is the impact that it has on patient care. In a recent publication in the Journal of Health Services Research. investigators looked at more than 5 million discharge records to determine if “ED overcrowding on the day of discharge impacts the patient’s length of stay, in-hospital mortality, and ED readmission rate.” Investigators concluded that “when ED overcrowding reached its peak, patients were on average 5.4% more likely to die.”
Even a mild case of COVID can increase your risk of having a seizure or developing epilepsy in the next 6 months. Reported in Neurology this week, in a population of 300,000 patients who had COVID or the flu, there was an increased risk of having a seizure in the next 6 months, and the risk was higher if you’re younger. Although the general risk of having a seizure is low, those with COVID-19 “were 55% more likely to be diagnosed with a seizure or epilepsy in the next six months,” particularly “among people who were not hospitalized.”
A friend of mine got COVID this week and started Paxlovid. We then talked about what his rebound risk is. I’ve had a lot friends take Paxlovid and a lot of them have had rebound. About ten minutes after my friend and I took guesses on the data, I got an email about an article that was released on the very subject. The study was on 127 patients taking Paxlovid and compared them to 43 patients not on Paxlovid. They looked for increasing viral loads and clinical rebound. Viral loads increased in 14% of patients on Paxlovid (control 9%) and rebound occurred in 19% of Paxlovid patients compared to only 7% in the control group. The rebound rate was about higher than originally expected.
Omicron BA.5 has been the dominant strain for most of the year. The CDC published data last week that showed the new subvariants, BQ.1.1 and BQ.1 now are the dominant strains—combining to make up around 44% of new COVID infections whereas BA.5 makes up just 30%.
It seems like there’s always some sports tournament going on but on this weekend, I want to wish luck to all the boys playing in the Bethesda Cup soccer tournament and I hope all the parents stay warm. I’ll be on the sidelines freezing with you and hoping there’s no concussions or knee injuries. I also want to wish luck to all the girls playing in the President’s Cup in Texas this weekend. This tournament is a rite of passage for high school girl lacrosse players and my daughter and I have some good memories from when she played in it 5 years ago in Orlando.
Coronavirus is not quite done with us yet.
Science matters. Get vaccinated (or your booster). Keep a mask handy.