Facebook Live 4/13- Answers

Good afternoon! I have a few updates for everyone.

Curve Update:

The curve continues to flatten. Based on projections we have, we expect we will be at the peak of the curve on the 20th. Based on the latest reports, we have capacity to take care of everyone in Virginia who requires a ventilator and ICU bed.

Numbers Update:

There are now 150 deaths in Virginia, and about 40 of those deaths have been at Canterbury. There have not been any deaths in several days.

Question 1:

If the curve flattens, will the Governor roll back his June 10th stay at home order?


If we get to the place where that is safe, I think he will. There is still a lot of uncertainty beyond the crisis point, but we would love to open the economy.

Question 2:

If the virus is so bad, why are hospitals laying people off, and why are emergency rooms empty?


Hospitals have shut down everything else, except for capacity for emergencies and COVID cases. We don’t want hospitals filled with those who could get exposed, that’s why there are no elective surgeries. That is also why people are being furloughed, but we are looking to bring those people back to take care of COVID patients.

Question 3:

When will antibody tests become more widely available?


Antibody tests are being checked for reliability and waiting for approval to be used. We still don’t know how they will be distributed. It takes between 2 and 12 weeks to develop antibodies that are long term. For example, someone could carry the virus but not show symptoms and be developing immunities, and someone else could initially be negative for antibodies but become positive for antibodies in the future.

Question 4:

Have we had any recoveries in Virginia?


Yes! We’ve had many recoveries in Virginia. We’ve asked the Secretary of Health to publish those numbers. In my experience, we’ve had more recoveries than not. It is still incredibly dangerous, but we have used in trial an immune response medication when patients move from being sick with the virus, to inflammatory problems. Henrico Doctors Hospital has been chosen as one of the centers to access those doses. So yes, people are recovering!

Question 5:

There are fewer deaths from COVID-19 than the flu, so why are we locking down over this common cold virus?


It wasn’t common in the way it spread and the way it caused illness, and in the way it affected those with pre-existing conditions. I understand that it is difficult to stay home, but I believe it is that motivation to stay home that has dampened the curve. It was the safest thing to do. Other places that were less successful in their mitigation tactics, such as New York, allowed the virus to spread, and the infection and death rates are much higher.

Question 6:

How do you get widespread immunity when we’re locked down?


Some people were exposed before lockdown, and while they didn’t experience symptoms, they exposed other people, and while those people may have experienced a mild case, many who tested positive didn’t show any symptoms. I’m hoping that many of us have already had it and experienced no symptoms. However, we won’t know for sure until there’s widespread antibody testing.

Question 7:

We’ve heard from other doctors that this is more like a blood disease than a virus, and oxygen is the right treatment, not ventilators. What are your thoughts?


I would have had to have heard what that other doctor said. I don’t know if they were talking about the lung response, which is so severe, or something else. Different levels of response of the lungs to having had the infection are resulting in different needs and uses of the venitalors.

Question 8:

What about vitamin D levels? There seems to be a tie between vitamin D and getting over any illness?


I agree. Both vitamin C and D are healthy supplements to take. Generally, vitamin D is something many of us have a deficiency of, and about 1,000 to 2,000 international units is an ideal dose. I can recommend taking vitamin C and vitamin D each day.

Question 9:

Should we go back to work?


Yes, I hope so, very soon. However, that depends on what kind of work you do, and what kind of precautions you can take. If you are a non-essential business, no you should not go back to work because there is still a jeopardy in doing that.

Question 10:

Is there any contact tracing being done at Canterbury?


Yes, the health department is spending a lot of time with those workers to see where they are going, and what their risk of exposure is so they can demonstrate good practices.

Question 11:

Are you able to address the request for additional taxes and funding that the Governor is going to present at the recall session?


I have not, he has not shared that with us. We have just received amendments, and we are working on that as quickly as we can. However, I don’t know that he is going to include any additional taxes. I do think there is the jeopardy of that in future sessions. Right now, he can send down a few things in the budget, but it mostly has to be germaine to what we’ve already done. Right now, all funding is frozen to what we’ve already decided in prior sessions and what we had in that budget.

Question 12:

What is Virginia doing for widespread testing of any kind? NPR published a study today about the federal government failing on almost all promises for public/private partnerships for testing.


I’d have to look at that article. I can tell you that we have dozens of public/private partnerships in Virginia for testing. We have fairly rapid testing, and most of the testing we do at my hospital is through LabCorp, so it is private testing. We are working to try and use all testing that is available. That doesn’t change what we use the tests for, I can’t see the benefit of testing everyone in the home to see if they’re positive or not, other than in the instance of more rigorous circumstances where the individual is in the home, but hopefully you’re not seeing other people outside the home anyway. We like to test when it affects how we’re going to behave, and what interventions we want to initiate, and I’m not sure we’re going to change interventions for someone who is in their home.

Question 13:

Would you recommend businesses open back up and social distancing being relaxed without widespread or universal testing?


I am going to wait and see. The most important thing we can do moving forward is develop a good plan that we all represent and agree on, that has good evidence and science behind it for why we're doing it. We will have to take precautions moving forward. Until we have more knowledge as to who’s immune, there will have to be some kind of restriction in place.

Question 14:

Will people be forced to be vaccinated?


No, medical interventions are not something anyone’s ever forced to do. Vaccinations in Virginia are something that you can opt out of. I hope we will reach herd immunity, which is about 95% or better immunity through vaccination of the virus. However, after all this I do think there will be people who are interested in being vaccinated.

Question 15:

How do we know that it is the social distancing that is helping and not just the course of this virus running?


We won’t know 100%. However, when we look at places that don’t have mitigation because they weren’t successful in social distancing, we’ve had a very different course here. We based our early projections on a scenario where we had a similar exposure similar to other models with more exposure and ours is very different. The thing we did differently is social distancing. This isn’t an absolute, but our best guess right now is that the social distancing did it.

Question 16:

How is the outsourcing of the manufacturing of many of our medications and medical supplies affecting the slow responses in getting enough for everyone?


There is a lot of thought that that has affected things significantly. That is more a federal issue, but basically because this is more clear in the PPE that a lot of that was manufactured outside of America, so we couldn’t up our production because we weren’t producing in America as much. We will have to look at that as a national security issue moving forward. The other issue is that of medications, and many come in from China. We wanted to make sure they weren’t contaminated, as well as make sure people are getting them. This has been an eye-opener, and strategic thinking moving forward will look at how we can more rapidly scale because we have supply and demand here, so we’re not getting it from somewhere else.

Question 17:

What is the current occupancy rate of our hospitals?


I can’t answer that right now, but I can go to the Virginia Hospital and Healthcare Association website HERE, and then I can tell you how many we have hospitalized. I don’t know the hospitalization rate, but I do know that the hospitals are quiet, and there aren’t many people in the general hospitals at large. We do know how many COVID patients we have, how many COVID pending patients we have, how many ICU beds we have, and ventilators. I wish the VHA posted the numbers of how many people have left the hospital after being treated for COVID, and I will continue asking for them. Occupancy rates are very low.

Question 18:

Is it foreseeable to start allowing non-emergency operations in the future, or is Virginia’s healthcare system expected to be too overwhelmed to allow this?


No, I hope that as we get through the surge, we’ll be able to reinstitute non-emergency services. Maybe with an eye to the possibility of small increases of COVID, but I hope that we will be able to get back to normal utilization.

I just received word that 467 people have been discharged from hospitals. Currently, 1,238 people are hospitalized who are either COVID positive or pending. We are only using about 23% of our ventilators. In the ICU we have 428 people who are COVID positive, and 302 of those are on ventilators.

Question 19:

Are you speaking to the Governor to champion reopening? Are you advocating for getting surgeries approved?


Yes, we have some who are performing surgeries in their offices, and they weren’t using supplies that hospitals need, and we are advocating for an approach that gets rid of the ban on anything that is non-emergent. I am hoping that as we get beyond the curve that will loosen up. I’m not speaking to the Governor directly, but I am on phone calls to work with them. I am waiting until we get past the surge, and I am trying to balance good decision making with an understanding of science and healthcare. I don’t know when to champion reopening, but when I have a clear idea of what’s in the best interest of everyone, I will champion reopening. I am trying to be a conduit to you, but there are great minds who are working on these problems and I look to those people. I believe we should follow the strategists guidelines, and until we get beyond the surge, I think we need to stay the course to get past it. Again, the max day for Virginia is estimated to be April 20th.

Question 20:

Any logistical insight on how the General Assembly is going to reassemble on the 22nd and function while still under the executive orders?


Yes, I know for at least the Senate we are going to be meeting in a space that allows for social distancing and it has great capacity for speakers and audio. We will be able to be 6 feet apart and likely in masks, but we will be able to function as we do in our traditional location and speak to each issue we need to in order to have a fairly normal session. We will meet our constitutional obligation to reassemble, but we will do so in a way that accommodates social distancing.

Thanks so much for being on, and I’m happy to get answers to your questions, what I don’t know I will find out.