Friday night update from ER in Arlington, VA: ‘COVID numbers are back where they belong’; Influenza and RSV occupy the emergency room


Thanks as always to Dr. Mike Silverman, Chairman of the Department of Emergency Medicine at Virginia Hospital Center in Arlington, for such great updates!

Friday Night ER Update in Arlington, VA

COVID numbers are back where they belong. I reported a fairly substantial increase in COVID cases being diagnosed in the ER when I wrote last Friday. This week, the COVID numbers look much better. This week’s total of COVID-positive patients who were tested due to “covid symptoms” was the lowest we’ve seen in some time. And the positive numbers among all patients tested in the ER were more in line with early October than the week ending last Friday. The number of patients hospitalized with COVID remains fairly stable. This is higher than two Fridays ago but similar to last Friday. You may recall that we had a pretty big bump last Friday compared to the week before, but we’re generally in the ballpark we’ve been at for months and far from our peak numbers.

But the emergency department is about as busy as we’ve ever seen. Our volume this week (and indeed last week) is 20% higher than our usual volume. We certainly see it with the flu and RSV numbers. We are also seeing it in the increased number of pediatric patients coming to the emergency room. I worked on our lower acuity side during my last shift. During this shift, I see my own patients and supervise two Advanced Practice Providers (APPs) who work with me on the unit. We had two families check in within minutes of each other to be checked for flu-like symptoms, which brings back memories of our omicron push last winter when we regularly had families who checked in throughout the day. One of the APPs I was supervising that day told me he thought he had diagnosed 10 people with the flu. I also had a solid handful of people with the flu that day. I don’t recall seeing anyone with COVID but it’s certainly possible that I did. There is a lot of influenza A circulating. The vast majority of these patients have not been vaccinated. Moreover, the vast majority of these patients do not require hospitalization. Instead, they just need supportive care – fluids, Tylenol, and ibuprofen.

That said, just like with COVID, the elderly and immunocompromised are at high risk. We are also seeing an increase in pediatric flu hospitalizations. The CDC released data and a statement recently that “flu season is making an early return as flu-related hospitalizations are the highest in more than a decade at this point in the season,” according to the CDC. . “There have been approximately 880,000 laboratory-confirmed cases of influenza, 6,900 hospitalizations and 360 influenza-related deaths nationwide this season.”

The flu tests we used in emergency before COVID were generally not very good. Because of this, it was very rare to test people for the flu when it was not flu season. We always knew that if you tested enough people we would find some flu even in the summer, but given the accuracy of the old flu test, the sensitivity and specificity of the tests limited their usefulness in the off season. flu. And whether you had a positive or negative flu test in a patient with a suspected viral illness, the lack of a test generally did not change management.

For some time we have had access to a test called the viral respiratory panel. This is a very precise but extremely expensive test that can identify many different viruses (but far from all viruses). It takes some time for the lab to run, and historically the benefits of the results have not outweighed the cost or time to get results for the typical ED patient going out. This test was often reserved for patients with respiratory infections who needed to be hospitalized. This panel tests for influenza as well as RSV and is very accurate. Therefore, we always knew we had a bit of flu and RSV around.

The main PCR COVID test we have used for the past two years tests both COVID and influenza with the same swab. This was incredibly helpful last winter during omicron and flu season, so we knew who we were dealing with. (As it turns out, there has been very little flu since the pandemic began.)

I can’t speak highly enough of our hospital lab team, reporting team, and business intelligence team when it comes to providing data for me (and others) since the pandemic began. I realize that some of you want more detail than I have provided over the past two years. Some of these details were very difficult to obtain and would have required map revisions. For example, in the first 6 months after vaccines became available, the percentage of patients admitted with COVID who were vaccinated or not was really interesting. This is an excellent question that has been studied in other centers, but was not clinically relevant to your typical community hospital. And unfortunately, it wasn’t practical to hire someone to do file audits and track that kind of data.

That said, I asked the lab for updated flu data and they sent me a fantastic graph. Between our dual COVID/flu test and our viral respiratory panel, we typically test for influenza and RSV approximately 1600 times per month. However, in January of this year and last month (October), we performed over 2,000 of these tests. Last January during our COVID surge, we had 11 positive flu tests and 3 positive RSV tests. Last month, in October, we had 160 positive tests for influenza and 59 positive tests for RSV. I’m willing to bet that the overwhelming majority of them took place in the second half of October and probably the last week of October. For comparison, the number of positive influenza tests in the summer is typically in the single digits, as is the number of positive RSV tests for most of the year.

The coronavirus is not done with us yet.

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



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