Hospitals across the state are being overwhelmed by a tremendous influx in demand spurred by soaring cases of the omicron Covid-19 variant and ongoing test shortages.
On Friday, Sentara announced its healthcare facilities will be postponing all non-emergency, hospital-based procedures, surgeries and diagnostic testing in an effort to manage "record high" hospitalizations.
Local doctors are also asking people not to rush to the emergency room for treatment unless they’re experiencing severe symptoms or a true emergency.
At a teleconference Thursday, Jordan Asher, Sentara Healthcare’s Chief Physician Executive, said that essentially every Sentara facility – including those on the Peninsula – are experiencing “unprecedented levels of admission from Covid-19 or with Covid-19.”
Asher also said the current wave is leading to more admissions than any other surge since the start of the pandemic.
“This is effectively our fourth peak. It is our highest peak, and it is a peak that is continuing to increase every day at greater rates than we have seen before,” Asher said. “Additionally, our emergency rooms are busier than they ever have been in history.”
Significantly compounding the situation is the fact that many individuals with mild symptoms of Covid-19, such as a headache, sore throat or fever, are inundating hospitals to request Covid tests.
“Unfortunately, this is creating an undue and great strain on our emergency department,” Asher said.
Throughout the state and nationwide, the availability of Covid-19 tests is in short supply. Over the past few weeks, demand for tests has reached an all-time high, and many people cannot find appointments or locate at-home test kits.
Those who suspect they may have Covid-19 are urged to stay home, contact their local clinician and follow CDC guidelines regarding isolation - even if they can't immediately access a test. Primary care providers may also be able to prescribe tests through telehealth services and can provide further guidance, according to the Virginia Department of Health.
Asher said the number of patients with Covid across Sentara’s hospitals has tripled in the past ten days. He expects the situation only to further worsen in the coming weeks.
“The increase per day is much greater with this wave than it has been with any other wave,” he said. “If the numbers keep going up as they are, they are going to be much, much higher than our previous peak.”
To make matters worse, many hospitals and urgent care facilities are facing staffing shortages as healthcare workers become sick themselves.
"Our healthcare professionals have done unbelievable jobs caring for those in need. And now we're in a situation where those caring for others in need are also getting sick,” Asher said.
Asher said some people falsely believe they no longer need to take precautions if they’ve been vaccinated. Many are also under the impression that they’ll be able to access treatments if they get sick, but often, that is simply not the case.
“Yes, we have heard that if you've been vaccinated and boosted, you might not get as sick,” he said. “But unfortunately [omicron] is so infectious that even if the percentage or likelihood of you getting sick is lower, the overall number of people getting sick is higher because of the sheer strength of the virus.”
While patients are frequently requesting monoclonal antibodies, those treatments are currently in very short supply in the state. According to Asher, only about 1,100 doses are arriving in Virginia each week – an “incredibly small” number in comparison to the demand.
Additionally, while some oral medications are starting to become available, they're also hard to come by, and they don't work for everyone. On December 22, the FDA issued emergency use authorization for Pfizer's new antiviral medication, Paxlovid, but it's reserved for those with the highest risk for severe outcomes. It must also be given within five days of symptom onset.
“Unfortunately, with Covid, the treatments are very minimal right now,” Asher said. "Only one of the three monoclonal antibodies that are out on the market work for omicron, and on top of that, there's an incredibly short, limited supply of it."
As a result of the challenges, healthcare practitioners are asking all residents to follow preventive safety protocols to help alleviate the strain on already-exhausted staff. It's also important, they say, to avoid going out if you're feeling sick.
“If you don’t feel well, stay home,” Asher said. “You might not be the one who needs our care in the hospital, but someone else will.”
Sentara is just one of several healthcare systems pausing elective procedures or initiating emergency responses amid challenges spurred by understaffing and yet another wave of Covid-19 infections.
In a statement Friday, Sentara announced its healthcare staff is "stretched to their capacity," and all non-emergency procedures will be postponed until further notice, effective Monday, January 10.
Patients with an impacted test or procedure will be contacted directly and will be able to reschedule after the surge has passed, Sentara said.
Similarly, VCU announced earlier in the week that all non-urgent procedures requiring a hospital bed or blood donations will be postponed until further notice. Impacted patients will be contacted by the hospital directly with further instructions.
The Richmond-based hospital system says the changes were unavoidable amid the "very high number of hospitalized Covid-19 patients" and understaffing, which is continuing to worsen as medical staff fall ill.
"The Covid-19 pandemic continues to challenge health care providers globally and nationally, including VCU Medical Center, resulting in yet another surge in the number of Covid-19 patients and a blood donation shortage," a statement by VCU said. "As we continue to navigate the pandemic and adjust to the changing health care needs of our patients, our downtown hospital is seeing unprecedented demand for inpatient care."
VCU also noted that there is currently a high potential for breakthrough infections to occur given the fact that Covid-19 activity is "extremely high in the community right now." As a result, residents who believe they may have Covid are encouraged to seek telehealth appointments whenever appropriate.
Meanwhile, Inova, a nonprofit healthcare system based in Northern Virginia, declared emergency status Monday "in response to increasing patient volume and team member staffing challenges." The declaration means that the hospital is able to flexibly make operational modifications, including changes to its hours, for the foreseeable future.
As is the case with Sentara, Inova is struggling to access monoclonal antibody treatments and has had to restrict their use to immunocompromised patients only.
To help alleviate pressure on healthcare workers, local residents may want to consider postponing elective procedures - even if the procedure is scheduled at a hospital that is continuing to perform them. Asher noted that many people who are showing up for elective surgeries are testing positive for Covid and must, therefore, postpone those procedures anyway.
“If something can be postponed, postpone it,” he said.
As healthcare facilities continue to face great challenges, including understaffing, many providers have questioned the Northam administration for months regarding its refusal to re-initiate a state of emergency or other governmental assistance, according to Virginia Mercury.
Waivers previously granted by the state "made it easier for hospitals to add bed capacity, hire out-of-state health workers, launch drive-through testing sites and solicit federal funding assistance,” says Dr. Todd Parker, president-elect of the Virginia College of Emergency Physicians (VACEP). They also allowed hospitals the flexibility to enact other important emergency measures.
But those waivers expired when the emergency declaration ended on July 1.
Northam has stressed that his administration is committed to assisting hospitals. Nonetheless, he has resisted implementing another state of emergency in spite of ongoing pleas from the Virginia Hospital and Healthcare Association, Virginia Nurses Association, VACEP and other healthcare worker advocacy groups.
Last week, VACEP, which represents emergency room physicians throughout the state, sent out another letter to the governor pleading for the emergency declaration to be renewed.
"Emergency physicians and teams are tired and understaffed," the group said in a statement. "We require protections and practice flexibility to ensure quality care for our patients, our communities, our families, and ourselves. We ask Governor Northam to reinstate these protections for hospitals, health systems, and the people entrusted to deliver care.”
Northam has not yet responded to the request. In an October interview with ABC 8 News, the governor said he is aware that staff burnout is reaching an all-time high at medical facilities but argued it would be too logistically difficult to approve another state of emergency solely to assist hospitals.
"It is very difficult to declare a state of emergency that just affects hospitals. It would impact a lot of other things," he said.
Northam said a better solution is to encourage more vaccinations.
But Parker says hospitals are currently facing some of the worst challenges they've had to endure since the start of the pandemic and are struggling to stay afloat without state assistance.
“I worked every day this past week, and these were probably the worst shifts that I’ve worked during the pandemic, period," Parker, who practices in Hampton Roads, told NBC News 12.
While the omicron variant is believed to be less severe than the delta strain, Parker said physicians are still seeing serious cases, and the sheer volume is causing a critical situation for healthcare facilities throughout Virginia.
"We're still seeing [severe cases], but we also have the crushing background volume of all these other people who are coming in," he said.
VACEP also warned in its recent statement that while emergency departments serve as a vital safety net for patients needing care - regardless of income or insurance status - Virginia's emergency medicine system "is under threat of collapse due to excessive patient volume."
Echoing the sentiments expressed by Asher, the Virginia Department of Health is urging people with mild cases of Covid - or other ailments like the flu - to avoid seeking care at "already burdened hospital emergency departments."
Unnecessary visits to the hospital cause delays in care for patients in true crisis and deplete "finite resources" such as medical staff, PPE, therapeutic treatments and test kits, they say.
Mild to moderate symptoms - which can usually be effectively treated at home or in coordination with a primary care provider - include:
Mild fever that can be managed at home
Severe symptoms which require a visit to the emergency department include:
Intense chest pain
Elevated temperature for days
A person should not go to the emergency room just to receive a Covid-19 test. To find testing locations, visit VDH’s website.
Riverside Healthcare system also encourages local residents to use its symptom checker tool for help determining whether or not a medical situation warrants an emergency room visit. Sentara and Riverside also both offer free nurse advice hotlines - as do many insurance companies - for those needing guidance about the best care option for an illness or injury.