Omicron omnipresent at Obici

Published 11:10 pm Thursday, January 6, 2022

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Fueled by what’s likely the omicron variant, Sentara Obici Hospital has been seeing its highest number of COVID-19 patients since the start of the pandemic, and its president says it will likely see even higher levels before the numbers decline.

Obici has 58 COVID-19 patients in the hospital as of Jan. 6, according to the Sentara Healthcare dashboard. The number of COVID-19 patients at Obici has been rising steadily since Dec. 25, when it had 18 patients, and its newly expanded emergency department has overflowed with people seeking treatment in the past week.

“I don’t know what we would have done had we not had those rooms,” said Sentara Obici Hospital President David Masterson. “We still had people in hallways and other setups, and surgical areas and cath areas after hours, bringing people at night into other areas because our volumes hit in the evening and at night in the emergency room. So as people are coming to the emergency room, say after physician office hours, that was our peak time.

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“And a lot of our outpatient areas are closed for the day. We don’t have staffing, so we have to pull staffing in to put patients in other areas, but when you double in the volume that we did last week, we ran out of space in the emergency room, even the expanded emergency room.”

Sentara Healthcare Chief Physician Executive Dr. Jordan Asher said in a Jan. 6 briefing that the fourth peak of the pandemic has been the highest and is causing an “undue strain” on its emergency departments.

“Our emergency rooms are busier than they ever have been in history,” Asher said.

At Obici, it would normally see 120 to 125 patients per day in its emergency department, and its expansion was designed for volumes of fewer than 180 patients per day, Masterson said.

But between Christmas and New Year’s Day, it peaked at 240 patients, though it was able to treat and release a large amount, “so that gives us an indication that what we’re seeing is predominantly the omicron virus.”

The CDC estimated earlier this week that more than 95% of new COVID-19 cases in the U.S. are the omicron variant.

“It’s a huge strain,” Masterson said. “When you double the emergency room volume, it’s going to have a ripple effect on everything else in the hospital.”

It hasn’t been an ideal circumstance, but he said the staff has not compromised on the quality of care.

“I don’t think we’re doing anything unsafe,” Masterson said. “But I do think at times when we’re holding people in hallways for rooms to become available, it’s not the most appropriate level of accommodation. The care, awesome, but it just puts more burden not only on the patient — visitation and limiting the visitation for family — but also the burden on the staff to be able to work outside of their normal zone.”

Asher said it is a difficult time, but not just for the hospital system, but for everyone, calling for everyone to come together in the midst of unprecedented COVID-19 admission levels.

“This is effectively our fourth peak, and it is our highest peak,” Asher said. “And it is a peak that is continuing to increase every day, at greater rates than we have seen before (and) our emergency rooms are busier than they ever have been in history.”

Masterson said the hospital has an adequate supply of tests and will test people showing symptoms of COVID-19, but people cannot come in to be tested if they are asymptomatic. Asher said Sentara hospitals are seeing unprecedented levels of testing requests, as home antigen tests have been in short supply.

Dr. Laurie Forlano, deputy director of the Virginia Department of Health’s office of epidemiology,  said in a briefing earlier this week that it is just one of many test providers and said it does a minority of the testing, with the private sector, healthcare providers or pharmacies doing more of the testing. She said it has run into staffing issues at some of its testing events.

She said people should be getting tested for COVID-19 if they are experiencing symptoms of the virus, and if they have come in close contact with someone with COVID-19. The state department of health recommends getting tested on day five after an exposure, but said getting tested on days three-to-five after being exposed is also acceptable. People should also be tested if their workplace has asked them to be tested.

But with hard-to-find tests — “the availability of rapid antigen testing might be strained for some time,” Forlano said — “the state health department is also asking people to consider how critical it is to get a test and whether another option is available during a time when there is high community transmission of COVID-19.

She also said those who have tested positive for the virus and have recovered do not need to be tested as long as they do not show new symptoms.

And those with a known or suspected exposure to COVID-19 should quarantine at home and stay away from others, but that also depends on vaccination status.

Gov. Ralph Northam announced Jan. 6 that VDH would open nine new community testing centers paid for by an initial $5 million and is seeking money from the Federal Emergency Management Agency to reimburse the state, with one of those locations in Norfolk at Military Circle Mall.

The new testing centers are expected to provide more than 50,000 tests in January and will operate four to six days per week from 9 a.m. until 6 p.m., depending on location.

The urgency in people seeking tests comes as positive cases and hospitalizations have soared in the Western Tidewater region.

COVID-19 hospitalizations across the Sentara Healthcare system have more than doubled in the past 10 days and quadrupled in the past month, with the vast majority of cases, hospital officials say, coming via the omicron variant. And more than one in two people are testing positive for COVID-19 at Obici, according to Masterson. Earlier in the pandemic, the hospital would see about 20% who would test positive.

“We’ve definitely seen a surge in the community,” Masterson said.

As of Jan. 1, COVID-19 cases caused by the omicron variant have risen to nearly 94% in the regions the hospital system serves, according to the Centers for Disease Control and Prevention.

Contrary to reports of fewer hospitalizations, the Virginia Department of Health reported a record 33 for Suffolk Jan. 2, another 16 two days later and 11 Jan. 6.

The most recent 7-day positivity for Suffolk for PCR tests was 47.2% for the week ending Jan. 1, while the 7-day positivity rate statewide is up to 33.6% as of Jan. 6, and 40% for the Western Tidewater Health District localities of Suffolk, Franklin, Isle of Wight County and Southampton County.

However, Masterson said those who have been admitted, generally, are not experiencing as severe a case of COVID-19 as those who had symptoms of the delta and other variants.

The severity of cases depends, he said, on a person’s level of vaccination. Those who are fully vaccinated with a booster or third dose are experiencing more mild symptoms than those who are either not fully vaccinated, or not vaccinated at all. They are also seeing cases in most age groups and demographics.

“There very clearly is a line of distinction between those who have had the vaccines, those who have had the vaccine with boosters and those who haven’t been vaccinated at all,” Masterson said.

The ones coming in before the past week had not been as sick as those who have been through the emergency department more recently.

“We have seen a rash of people coming in,” Masterson said, “but up until this week, the acuity wasn’t as high, so they weren’t as sick with COVID as they had been in the past with previous surges.”

Those who have been vaccinated and experiencing COVID-19 have had sinus issues, while unvaccinated people have had those issues exacerbated with fluid draining down into their chest, causing congestion.

“Last week, I would say omicron was not as acute,” Masterson said, “although more virulent, as they would say, or more contagious. But this week, we’re starting to see sicker people, and it might be because they’ve been hanging out with it for a week and just allowing themselves to get sick. On the other hand, it’s very difficult to find a place that will test. And they’re holding off, or are in denial that they have it. They’re hoping that it’s a common cold.”

He also said a number of people they’ve seen in the emergency room are those who might otherwise have been helped in an urgent care facility or with better access to testing, and they’re coming because they want to protect their family, friends and those around them.

“They’re sick, but they’re worried they have COVID,” Masterson said. “They’re not sure whether they have COVID. They want to get ahead of it before they get more sick (and) if they could confirm through the local pharmacies through their testing that they were not COVID (positive), then they probably would not come to the emergency room. I think some of them are the worried sick who have legitimate illnesses but are not COVID, necessarily.”

The hospital is also seeing some gastrointestinal symptoms — vomiting and diarrhea — that Masterson said it is trying to determine whether or not it is related to COVID-19.

What symptoms appear helps doctors know whether it’s omicron or delta.

“If it’s more of a sinus headache, drippy nose, sinuses, that leads to congestion in the chest, that seems to be more of an omicron signature,” Masterson said.

Omicron variants have been responsive to monoclonal antibodies and other treatments, but Masterson said they don’t have access to all of the potential treatments as manufacturing of them ramps up. Asher said just one of the monoclonal antibodies — Sotrovimab — works for the omicron variant, and that is in short supply, with just 1,100 available in Virginia. Oral medications are also in short supply.

“Please don’t think that it’s OK if I get COVID because there are medications that will prevent me from getting very sick, ending up in the emergency room or the hospital,” Asher said. “Right now I would not be thinking that way.”

Statewide, the 7-day average number of cases through Jan. 6 is 14,547, with a state high of 19,506 cases Jan. 2. Statewide hospitalizations also reached a one-day state high of 556, with a 7-day average of 309.

Suffolk has experienced four of its highest positive COVID-19 case counts of the pandemic in the past week, including a high of 238 Jan. 6, 210 (Dec. 31), 208 (Jan. 2) and 205 (Jan. 4). The city has a 7-day average number of daily new cases reported of 197 and 196.6 cases per day per 100,000 population.

Masterson said patients have not been as sick, generally, but they’re so infectious, even if the likelihood of infection is lower, the number of sick people is higher because of the sheer strength of the virus.

Sentara officials still urge people to get their COVID-19 vaccinations or booster, along with shots for the flu, which has re-emerged after being largely dormant last year.

While Masterson said they have the staff to care for patients, COVID-19 continues to impact them also, as some have been getting sick and are having to be quarantined, or they have had to care for family members who have COVID-19, impacting their staffing levels at a time when he said they’re most needed.

Earlier this week, Obici also cut back on elective procedures, though it will still be treating emergency cases.

“Elective cases we are trying to postpone for two reasons,” Masterson said. “Number one, the staffing that are involved with the surgical care can help us with patients that are in the emergency room or are admitted to the hospital, but it also takes a little pressure off the need for inpatient beds for surgeries that could otherwise be postponed.”

Masterson said it is anticipating the worst-case scenario of even higher numbers of people coming through the emergency department and having to be hospitalized, assuming that people who were exposed last week could become sicker this week.

The hospital is trying to set up processes and support systems to help doctors, nurses and respiratory therapists treat the people coming to Obici for care.

He said Obici’s staff have been committed and caring, but they’re growing weary. It has more staff than it has ever had, but it has also had more patients than it has ever had.

“They’re working a lot of hours, and quite frankly, they’re tired,” Masterson said, “and I think they’re also a little bit frustrated. And I’ve heard the conversation with the fact that a lot of the folks that we’re seeing are unvaccinated. So I think that we just wish people would get the vaccines and let’s put this behind us.”