Friday Night Update from the ER in Arlington, VA: “Many people early on expected COVID to ultimately be like the flu and mortality wise, COVID is closer now.”

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 ever week!

Friday Night Update from the ER in Arlington, VA

Full disclosure, I’ve been away at a conference this week. I was in the hospital Monday for meetings and have been in touch with the team via phone and email, but I didn’t work clinically. My flight landed at 610pm so I’m pretty happy to get this out tonight (admittedly, most was written before I landed).

COVID is not over. We had an increase in the number of COVID cases we diagnosed this week. We’d had a nice drop last week and I was hoping that would continue. We’re back to where we were 2-3 weeks ago. Our general screening population had a 5% positivity rate last week but 7% this week (8% six week running average). Overall, we saw about 30% more cases than a week ago. It’s better than 4-6 weeks ago. But COVID is still around, forcing people to the ER.

It’s always interesting to me that ERs and hospitals in the area have similar volume patterns. It would be very unusual for my ER to be busy and other surrounding ERs to be quiet. On low volume days, we generally have low volume across our neighbor ERs as well. I find this to be true across the region and even across states. A physician colleague of mine had a colleague who was pretty sick, and my colleague called me to see if we could accept him from an another ER across the river to VHC because the patient had a huge wait for an inpatient bed (he was boarding in there ER). Unfortunately, although our boarding wasn’t as bad, we didn’t have space to accept a transfer from an outside hospital. Separately, a friend of mine was with a family member in an ER a few states away. What should have been a 2-3 hour ER visit took 8 hours. COVID, flu, and winter volumes are really behind us, yet ERs and hospitals are still full.

We’ve had a drop in the COVID mortality rate since the spring of 2020. Many people early on expected COVID to ultimately be like the flu and mortality wise, COVID is closer now. But 2022 still saw over 260,000 people die of COVID. The flu typically kills 40-60K in a year. There was a study published in JAMA Open Network comparing mortality rates of hospitalized patients with flu versus COVID. This was a Swiss study with over 5000 patients. The comparison period was COVID patients from essentially the first quarter of 2022 compared to flu data from 2018 to early 2022. And the Swiss have a 98% COVID vaccination rate. Overall, COVID mortality among hospitalized patients was 7% compared to 4.4% of flu patients. Noteworthy is the drop in COVID mortality rate from early in the pandemic when it was 12.8%.

Frequently, I write about one study or another that clearly shows the benefits of vaccination. And yet, today, while killing time at the airport, I heard about a Florida politician trying to pass a law to ban COVID vaccinations across the state completely. I like to think I’ve been pretty apolitical for the last few years with these posts, and I won’t provide any additional details about this politician, but holy cow, I really wish the people who represented the citizens could consistently follow the science and not just try to make headlines.

I actually thought the Ivermectin debate was completely over, but I guess some people are still studying it. Published earlier this week in JAMA, researchers looked at high dose Ivermectin versus placebo on time to sustained recovery in the outpatient setting. This was a well designed study—double blind, placebo controlled, and randomized. The median time to recovery was 11 days whether you got Ivermectin or placebo. 84% of the population was vaccinated. The authors concluded that the probability that Ivermectin reduced symptom duration by more than 1 day was <0.1% and that the findings did not support the use of Ivermectin in the outpatient setting.

I was in Orlando this past week. Only in the Disney area, can you walk almost 6 miles in a day without trying while basically sitting in a conference room from 730am-530pm. Turns out the round trip from my hotel room to the conference center was over a mile.
Coronavirus is not quite done with us yet.

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

Mike

PS: In case you missed last week, after much consideration, I want to let everyone know that I expect to have my last “weekly update” on Friday, March 10th. Thank you for your kind comments last week.