Pandemic Part Two? Loudoun Healthcare Officials Prepare for Possible Winter ‘Twindemic’

Nearly a year after the stateside arrival of the COVID-19 pandemic, healthcare officials throughout Loudoun County are bracing for the likely convergence of a coronavirus spike and arrival of the winter flu season.

It’s been a career-defining year for Loudoun’s healthcare heroes, who found themselves working long hours with ever-changing protocols in the spring months. 

“Things were changing on an hourly basis back in March and April. You’d have one thing down and then another protocol would come out, or more information, and you’d have to change accordingly. It was a rapid-fire amount of information,” said Dr. Laura Cook, an emergency room physician with HCA’s Stone Springs and Reston hospitals. “Having the most up-to-date information, up-to-date protection, that was the biggest thing at the beginning, and kind of bracing ourselves.”

Cook said neither hospital ever reached full Intensive Care Unit capacity, with a surge plan needing to be implemented, but they came close. The hospitals were also always well stocked with personal protective equipment for staff, and ventilators.

It was similarly busy at Inova Loudoun Hospital, which also, fortunately, was always well-stocked in terms of needed equipment and staffing. 

“We were having like 40 people in the hospital with COVID, three different critical care units running, and we had a lot of very sick people,” Inova Loudoun Hospital Medical Director Dr. Christopher Chiantella said. 

Now, after months of the number of daily new COVID cases in the hospital staying relatively flat, Cook said she is starting to see the numbers creep back up. StoneSprings has also been receiving transfers of patients from southwest Virginia, where healthcare systems are being overwhelmed with a surge in COVID cases. 

Loudoun Health Department Director Dr. David Goodfriend is seeing a similar trend.

“In the beginning of October, we were seeing about 25 cases a day on average, with a lot of day-to-day variation. Now we’re up to about 40 cases a day,” he said. Those numbers represent the number of positive tests returned in a day, and are based on a rolling, seven-day average, he said. 

Goodfriend said he does not believe this jump is attributable to the second surge of COVID that many nationwide are bracing for, but instead just a general letting down of the guard and COVID fatigue.

“It’s more just people getting together, playing youth sports, going to folks’ houses, going to eat dinner. Things they had put off for a while, but they’re being a little less careful now,” he said. “We’re really trying to reinforce to folks the critical importance of keeping numbers as low as possible, so when we do get into the winter surge we expect that it will be much more manageable.”

Chiantella said the number of COVID patients admitted to the hospital—not discharged and released—has been relatively flat since the early summer months.

“What we are finding in general is patients are not quite as sick as they were before, not anywhere near the patients in a critical care position as in the May/June time frame. Most people are not in an ICU bed,” he said.

Both of Loudoun’s two major hospital systems, however, are prepared for things to change rapidly as the temperatures cool, and flu season makes its annual arrival. 

Chiantella is cautiously optimistic.

“I would have to say in general, intuitively, it would seem this would be a better year for flu,” he said. “Everything that people should be doing to try to limit the spread of COVID would also limit the spread of influenza. In the past we haven’t worn masks. We’re using good hand hygiene, wearing appropriate garb, social distancing. All these things that we’re doing for COVID should also work for influenza.”

Hospital systems also are in a better position to battle COVID than in the spring. In addition to it now being a known entity, Chiantella said Remdesivir, which has been shown to provide a faster recovery time for COVID-positive patients, is now readily available, in addition to the hospital having supplies of needed steroids and blood thinners on hand. 

The University of Virginia and the Virginia Department of Health have been collaborating on predictive models that use data analytics to forecast possible changes in COVID cases in the state. The most recent, Oct. 30 report predicts that confirmed cases will peak during the week ending Jan. 17 with more than 14,000 cases. That projection could get better or worse, depending on Virginians’ behavior.

“If we continue on this trajectory, we would expect 203,473 total confirmed cases by Thanksgiving,” the report reads. “This reflects recent stabilization of new cases in Virginia. However, there are a number of risks that could influence case growth over the next several weeks, including fall weather, the holiday season, and a national surge in cases. If these result in a jump in case growth, cases may peak in January with over 23,000 new cases per week. However, if Virginians respond by improving prevention efforts such as hand washing, social distancing, wearing masks, and avoiding indoor gatherings, cases could peak in early December, at just over 10,000 cases per week.”

As of Nov. 10, Loudoun’s 73 COVID cases and seven-day average of 54 new cases a day was still well below its late May peak average of 107 new cases a day, following the first free mass testing events.

The Loudoun County Health Department continues to schedule regular COVID-19 testing events, with half a dozen scheduled for the month of November alone. On Tuesday, lines formed for testing at both Philip A. Bolen Park in Leesburg and Brambleton Community Park in Ashburn. [Renss Greene/Loudoun Now]

Goodfriend said the Health Department and area medical providers are emphasizing the need to get a flu vaccination ahead of the winter months. Current data shows that many Loudouners are heeding that advice. 

“We know that there are significantly more people getting vaccinated than in a typical year. What we don’t know is if they’re just getting vaccinated earlier, versus new people getting vaccinated. A lot more people have gotten vaccinated for the flu, at least through mid-October,” Goodfriend said, pointing to state statistics. “Each winter our emergency departments get very crowded and hospital beds start filling up. The more we can keep the flu out of the community, the more capacity we have to deal with COVID.”

Flu cases at Inova Loudoun Hospital have thus far been relatively low, Chiantella said. He echoed Goodfriend’s urge to get a flu vaccination, and noted that all of the medical providers at the hospital have received flu vaccinations, and almost all of the remaining staff. 

“I think it’s important for people to realize when we get an influenza shot the focus is to prevent death from influenza. The death rate from COVID is 30 to 40 times more than the death rate from flu,” Chiantella said. “The average seasonal flu death rate is below 0.1%. The death rate from COVID is 3% to 4%. It really puts things in a different perspective. I think people should take the stance that they should not take an unnecessary risk.”

One of the many great unknowns as the winter months get closer is what the effect of a “twindemic,” COVID and flu together, will have on the general population.

“We don’t know what the effect of COVID and flu together on an individual are. Even though a young person may do fine with COVID, if you have COVID and the flu is it going to be more severe? The symptoms are very similar. Flu-like symptoms could be flu or COVID, or you could be positive for both. A lot more folks may end up getting quarantined,” he said.

Cook said her hospitals have rapid testing for both COVID and flu at the ready, but test results are not always reliable.

“It used to be during the height of flu season we would stop testing people because everybody had the flu. At the beginning of COVID that was our stance, too,” she said. “We assumed people had it and told them to isolate themselves. Sometimes there are false negatives, and you don’t want to be reassured by a negative test if you still have all the signs and symptoms. It’s still hairy.”

Goodfriend said the Health Department is working to build up its cadre of case investigators ahead of any potential surge, to do a high level of follow-up for patients. The department is also preparing for the arrival of a COVID-19 vaccine, which could be available to the area’s higher-risk populations in the next few months. It could be available to the general public as soon as March or April, he said.

Goodfriend acknowledged that general public hesitation about the fast-tracked vaccination is a “significant concern” for health directors.

“We need to feel comfortable as health directors, and the health commissioner needs to feel comfortable. Once we all feel that it’s safe, how do we share that belief with the public?” he said. “The good part for the average Loudoun County resident is they are not in that first wave of vaccination. By the time it’s open to the general public there will be a good history of people getting vaccinated.”

Goodfriend asked anyone who is interested in joining the Loudoun Medical Reserve Corps to reach out, as there is a need for both medical providers and non-medical personnel who can do tasks like directing traffic and other essential roles. More information can be found at loudoun.gov/1352/Medical-Reserve-Corps

Cook urged the public to make smart choices as they prepare for the winter months.

“Wear a mask, wash your hands, don’t go somewhere that has 800 people there,” she said. “You need to protect yourself, protect your family. If you are having symptoms and are concerned, let people know. Let people know they may have been exposed so they can be safe and protect themselves. People need to be on the lookout and vigilant about it.”

Gov. Ralph Northam, in his regular COVID-19 update on Tuesday, also urged vigilance among Virginians, and acknowledged that it has been a long eight months.

“I know you’re tired. I’m tired,” he said. “The new normal is still ahead of us. But I want to say by and large people have listened to the public health advice and we can’t stop now. We need to keep it up. It’s more important now than ever. We cannot get complacent or let our guard down.”

Goodfriend said the Health Department will continue to schedule free COVID testing events, although the format may need to change a bit once it gets colder, with a goal to hit every part of the county. Four more testing events are upcoming: two in Leesburg on Nov. 14, and one each in South Riding and Purcellville on Nov. 21.

Goodfriend said the coming months could resemble the lockdown environment of April and May, if recent surges in other states and in Europe are to be any kind of forewarning.“We may get lucky,” he said, “but we want to make sure we’re prepared.”

2 thoughts on “Pandemic Part Two? Loudoun Healthcare Officials Prepare for Possible Winter ‘Twindemic’

  • 2020-11-12 at 8:03 pm
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    If anyone doesn’t see what is going on here, I’ll spell it out for you: When Joe Biden takes office, he will order us to be on lockdown again for at least two weeks, maybe a little longer. Then when lockdown is over, COVID cases will suddenly disappear like a fart in the wind and Joe will be the hero. People will go back to dying from old age, the flu, cancer, heart attacks, strokes, accidents, etc. and COVID will not even be mentioned on the news anymore.
    I have been saying this is the plan for months now. The dems will also try their best to force a vaccine on all of us (look at what Ticketmaster has already done).
    If you do not see this coming, you are not looking.

  • 2020-11-17 at 10:13 am
    Permalink

    Loudoun Director Goodfriend has been AWOL. He shows up for a comment from time to time, but he has provided no leadership to this county.
    Look at his quote below. Does anyone think there is a small bump up due to increased covid testing? Yes.
    Why is Goodfriend peddling fear? We have a whopping 40 new cases in a county of 413,000 people.

    The Covid death rate is NOT 3-4 percent. That is false. STOP peddling fear.

    “The death rate from COVID is 3% to 4%. It really puts things in a different perspective. I think people should take the stance that they should not take an unnecessary risk.”

    Loudoun Health Department Director Dr. David Goodfriend is seeing a similar trend.

    “In the beginning of October, we were seeing about 25 cases a day on average, with a lot of day-to-day variation. Now we’re up to about 40 cases a day,” he said. Those numbers represent the number of positive tests returned in a day, and are based on a rolling, seven-day average, he said.

    Goodfriend said he does not believe this jump is attributable to the second surge of COVID that many nationwide are bracing for, but instead just a general letting down of the guard and COVID fatigue.

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