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 posted on his Facebook page every week (although, sadly, next week will be the last!
Friday Night Update from the ER in Arlington, VA
I paid the price for being at a conference last week with a full administrative week and also a full clinical week. I finished working in the ER today just prior to posting this so I apologize if it’s on the brief side.
I read in Arlington Now about multiple teenagers who overdosed in a parking lot earlier this week. The fentanyl problem is real. I talk to my kids about not experimenting with or trying pills (or brownies that make you feel “good”) because you never know what’s in it. There’s definitely some kids who are addicted. Talk to your teenagers. I’m surprised at how many patients I’ve either seen or heard about from other physicians who say they use fentanyl. By comparison, it’s much less commonly used than alcohol and cannabis but it’s not as rare as one would think. Opioid withdrawal is very hard, but treatments are much better now than years ago. And much of opioid use disorder treatment can be accomplished as an outpatient.
The COVID numbers looked great this past week. We saw our lowest numbers of positive tests among the ER population and the lowest percent positivity rates (for both symptomatic and all comers) since March/April 2022. One week is not a trend but if the numbers follow past trends, we may finally be able to have 4-8 weeks of lower case numbers.
We have had a downward trend for the last 4 weeks on the number of patients who require COVID isolation in the emergency department. As I look at the graph, this current surge started in late October. That was back when we are seeing a lot of flu and RSV in addition to COVID. This marks the sixth wave we have seen since the pandemic began in March 2020. By sheer number of patients on a weekly basis who required COVID isolation, the highest numbers we saw were January 2022. As our current wave subsides, this is the second biggest and probably longest duration of a wave, since it spanned 3 to 4 months. The number of patients hospitalized with COVID has continued to decline over the last few weeks and is down about 50%.
There is another virus to look out for. The CDC is reporting an outbreak of chikungnya in Paraguay. Most cases have been reported in one metropolitan area. This virus is spread by mosquitoes and we have had outbreaks in other parts of the world before. Mosquitoes have transmitted a variety of illnesses in the past and one way to protect yourself is to protect yourself from mosquito bites by using insect repellent, wearing long sleeve shirts and pants, and staying in places with the conditioning or that have window and door screens. I was in the Carribean once when this virus was down there and remember staying a house years ago that had mosquito netting over the bed for protection.
The FDA approved an over the counter rapid test that can detect both COVID and flu. This is a game changer for people come flu season who want to know if they have covid or flu. My standard covid test in the ER is actually a joint covid and flu test because if I think you could have covid, you could just as easily have the flu. It’s a nasal swab for ages 2 and up is simple enough that it’s allowed to be used by individuals as low as 14 years old. There can always be false positives and false negatives but the sensitivity and specificity look very good. Of course, pricing, insurance coverage, and availability will need to be reasonable and worked out, but I think if it’s really as accurate as it sounds, it may keep some people out of the ER come flu season.
Coronavirus is not quite done with us yet.
Science matters. Get vaccinated (or your booster). Keep a mask handy.
Mike
PS: Reminder that next week will be my last weekly update. Be sure to check out next week’s post as I’ll reflect on the last 3 years and talk about what’s next (actually, I have no idea. There’s no outline yet)
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