Home COVID-19 Friday Night Update from the ER in Arlington, VA: The “hospital is...

Friday Night Update from the ER in Arlington, VA: The “hospital is full,” but “we have also seen a decrease in the amount of COVID we’re diagnosing”

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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!

After a couple of weeks of very high emergency department volume, our hospital is full. My colleagues are seeing this all over the country as well. This makes it more challenging to care for the patients coming into the emergency department as we have more patients “boarding” (waiting on their inpatient bed to be available) than typical. Even though our ER volume has come down a little bit compared to recent weeks, it still feels just as chaotic because of all these extra patients waiting for a bed to be available.

Along with a slight drop in volume, we have also seen a decrease in the amount of COVID we’re diagnosing. Overall, we diagnosed about 20% less patients with COVID this week compared to the prior 2 weeks. Our overall percent positivity fell from about 16.5% to 12.4%. The biggest drop we saw was in our symptomatic patients. Although we had about 20% less patients classified as symptomatic, we had about a 40% drop in the number of positives. This correlates to a 31% positivity rate dropping to a 21% positivity rate. Our general screening percent positivity remained stable at about 11%. For these patients, either the clinician has a low suspicion that the patient has COVID, but COVID is included in the differential diagnosis, or they are asymptomatic and require testing for admission/surgery/etc.

Consistent with the reduction in new diagnoses, we also saw a reduction in the number of patients who required COVID isolation in the ER compared to the prior two weeks. And the hospital has about 20% less admitted COVID patients than we did last week.

Throughout the pandemic, scientists have looked to repurpose existing medications to fight COVID. Ivermectin is one example but there’s been several. I’ve written twice about fluvoxamine, an antidepressant. I first wrote about it in the summer of 2020 as a possibility. Then a Brazilian study was released in the fall of 2021 that showed some promise. Unfortunately, a large study published in JAMA this week did not show benefit. The drug was used to look at recovery time in mild to moderate COVID patients appropriate for outpatient treatment, between those medicated versus a placebo, with a secondary look at those who ultimately required hospitalization. The study had over 1300 patients and unfortunately did not show a statistically significant reduction in recovery, nor did the medication impact the secondary outcomes.

Good news on the Ebola front. On January 11th, “the Ebola outbreak that affected Uganda was declared over. According to the WHO, there were 164 cases in Uganda associated with the outbreak, including 55 confirmed deaths and 87 recovered patients. The CDC no longer recommends post-arrival risk assessment and management of travelers arriving in the US from Uganda. And the CDC has removed its Ebola travel health notice for Uganda. (Monkey pox numbers are also way down.)

“The US government again extended the Covid-19 public health emergency, maintaining measures that have expanded access to health care for millions of Americans since the outbreak began in 2020.” HHS Secretary Xavier Becerra on Wednesday “extended the emergency through mid-April, a move some health experts anticipate could be the last renewal.”

Coronavirus is not quite done with us yet.

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

Mike

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