Category Archives: Commonwealth of Virginia

New Long Term Care Facility Outbreaks are Statewide

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By Carol J. Bova

Steve Haner said in a recent comment on “Nursing Home PPE Shortages and Deaths Still Rising,” published on baconsrebellion.com, “I can’t seem to tell on the VDH site where the new outbreaks are. Are they following the pattern with cases, which are surging in Eastern and SW Virginia, but very diminished now in NoVA and fairly low in Central VA?”

The only way to tell is to download the Outbreak Dataset and sort by Health District, Long Term Care Facility (LTCF) outbreaks, and date reported, then sort into regions.  Since VDH doesn’t give case numbers or deaths in this dataset, we can only compare number of outbreaks by date. (The Outbreaks tab on the COVID-19 Dashboard only gives the total number of cases from all five categories of outbreaks.)

In the past month, 24 of 35 Health Districts had increases in outbreaks.

The 11 that did not were Alexandria, Eastern Shore, Lord Fairfax, Loudon, New River, Norfolk, Prince William, Roanoke, Southside, West Piedmont, Western Tidewater.

By Health Regions:
Central:       Increases in 6 of 7 Health Districts
Eastern:      Increases in 6 of 9 Health Districts
Northern:    Increases in 2 of 5 Health Districts
Northwest:  Increases in 4 of 5 Health Districts
Southwest: Increases in 6 of 9 Health Districts

Virginia Department of Health (VDH) first published outbreaks by Health District and report date on May 9, 2020; starting numbers occurred before that date.

Long Term Care Facility Outbreaks by Health Districts

 

Nursing Home PPE Shortages and Deaths Still Rising

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By Carol J. Bova  Published on Bacon’s Rebellion, August 23, 2020

Deaths in COVID-19 cases originating at Virginia long-term care facilities.

After a review of over 15,000 nursing home reports submitted to the Centers for Medicare and Medicaid (CMS), Brian E. McGarry, David C. Grabowski, and Michael L. Barnett published a paper in Health Affairs on August 20th. In “Severe Staffing and Personal Protective Equipment Shortages Faced by Nursing Homes During the COVID-19 Pandemic,” they concluded, “Despite intense policy attention and mounting mortality, the shortages have not meaningfully improved from May to July of 2020.”

While six fewer Virginia nursing homes reported nursing staff shortages as of August 9,  there were more reports of all other staff shortages and supplies of Personal Protective Equipment (PPE) between the weeks ending June 7 and August 9 according to the CMS COVID-19 Nursing Home Dataset. Meanwhile, COVID-19 cases and deaths continue to rise.

 

Cases originating in Virginia long-term care facilities.

On June 8th, I wrote to COVID19JIC@vdem.virginia.gov, healthandhumanresources@governor.virginia.gov, and Tammie Smith at the Virginia Department of Health. She replied to my question of whether the Virginia Department of Health reviewed the dataset and what action they took, if any, in regard to the PPE shortages reported May 31. Her response was:

Long term care facilities are encouraged to practice PPE conservation per CDC guidance and to reestablish their PPE supply chains; access has improved recently. Those unable to source PPE through their regular supply chains routinely contact the State Unified Command for assistance.

Publicly provided PPE is distributed regularly to these facilities to ensure optimum safety in response to the COVID-19 pandemic. PPE requests are coordinated and sent to the Virginia Emergency Support Team (VEST) through their Regional Healthcare Coalitions.

Guidance information for nursing homes is here https://www.vdh.virginia.gov/content/uploads/sites/182/2020/05/VirginiaLongTermCareFacilityTaskForceCOVIDPlaybook.pdf

Two months later, there are still 57 Virginia nursing homes reporting PPE shortages, 20 without a current supply of N95 masks and 13 of those with no surgical masks either, and one without any hand sanitizer.

The system isn’t working. Whether there are additional failures in infection control procedures is to be seen as normal nursing home inspections resume. But there is no excuse for the Commonwealth’s failure to ensure adequate supplies of PPE. If owners are at fault, fine them or take other actions. The Commonwealth needs to act now.

As McGarry et al said, “Unless these shortages are prioritized by policymakers, long-term care residents will continue to be at a great disadvantage in the pandemic.”

As of August 21, 14.6% of all LTCF (long-term care facility) cases (1,321 of 9,020) have ended in death, and represent 54.1% of all COVID-19 deaths in Virginia. By comparison, correctional facilities have seen a total of 16 deaths. Our nursing home residents do not deserve a death penalty for being in a nursing home without adequate supplies or staff.

Comparison of Nursing Home shortages reported to CMS weeks ending Jun 7 and Aug 9, 2020

 

 

Sixty Percent of All Virginia Covid-19 Deaths Are in Long Term Care Facilities

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By Carol J. Bova

Updated July 6

Long Term Care Facilities (LTCF), have had 242 LTCF outbreaks, 6,889 cases, and 1,099 deaths that represent 60.5 percent of all COVID-19 deaths in Virginia according to the Virginia Department of Health (VDH) report as of July 1. But VDH won’t release the names of 52 facilities.

Back on May 1, there were 132 LTCF outbreaks responsible for 311 of Virginia’s 581 COVID-19 deaths. When Julie Carey from NBC4 in Washington asked at Governor Northam’s press conference why the number of deaths had increased from 118 to 311 in one day, the governor said, “Well first of all, that’s not the state of Virginia. Is that nationwide?” She told the governor, “No, that was in our data today.”

Heath Commissioner Dr. Norm Oliver turned to Dr. Laurie Forlano, the deputy commissioner of population health at the Virginia Department of Health, and Virginia’s Office of Epidemiology public health director, and asked, “Do you want to take that, Laurie, or do you want me to take it?”

Dr. Forlano didn’t explain beyond saying “…numbers of cases,  et cetera, associated with an outbreak are added as quickly as possible to that file, so-to-speak. And so sometimes, there is a lag in capturing that and entering the data. I’d have to go back to the team to fully understand he jump, but that’s what I think it’s likely to be.”

Roger Watson from the Farmville Herald followed up saying that North Carolina reversed its decision on identifying individual longterm care facilities with outbreaks. He asked, “Is changing that rule in Virginia something that you will consider in the coming days?”

Dr. Oliver repeated the question and then said, “As I’ve stated before, this is not a decision that was made by the health department. It is actually something that’s incorporated into the Virginia code, which first of all identifies facilities and corporations, businesses as persons. And then requires us to protect the anonymity of person. So unless the code changes, I don’t see how we could do that.”

On June 19, Governor Northam announced he was “directing VDH to release the names of individual long-term care facilities (nursing facilities and assisted living facilities) that have experienced a COVID-19 outbreak.”

He said, “VDH has previously released aggregate data about outbreaks in long-term care facilities, given their responsibility to protect patient and facility anonymity under the Code of Virginia. However, due to the widespread nature of this pandemic, it is now unlikely that releasing facility information would compromise anonymity or discourage facilities from participating in a public health investigation.”(1)

No one from the Northam administration has cited exactly what section of the Code of Virginia barred the release of the facility names and numbers of cases. The Virginia Code discusses privacy of patient records, not hiding the identity of health care entities.

When the governor’s Long Term Task Force posted the list of nursing home and assisted living facilities with COVID-19 cases, they omitted 52 facilities from their list.(2) When contacted, their spokesperson, Brenden Rivenbark, explained that the Task Force only reported nursing home, assisted living and multicare facilities, but the VDH Outbreaks report includes two other categories: group homes and residential behavioral health facilities.

The only way to see what kind of facilities are in each outbreak category was to go to the VDH COVID-19 website, go to the Outbreaks tab, then go to the category in the list beneath the total outbreak and cases numbers, and then, click on the number of outbreaks. A list then appeared showing what the category includes. The information is now available under Data Downloads as of July 6.

But that’s not the complete answer. Nineteen Virginia nursing homes reported two or more confirmed cases to the Centers for Medicare and Medicaid (CMS), so they should have been in the VDH Outbreaks numbers and on the task force list. They were not on the June 30th list, but we have no way to know if they have been included in the outbreak numbers. As of July 6, two have been added to the list and one more identified using a name variation, leaving sixteen still to be posted.

At the tele-press briefing on July 2, Laurie Forlano said some of the facility names were withheld because of the small size of some facilities and the need to protect their anonymity.

Since the Task Force suppresses any number of cases or deaths fewer than five, exactly what does small mean, and why should they be exempt from public disclosure? And where is that authorized in the Code of Virginia?

The Task Force spokesperson sent an email on July 2 that he was scheduled that afternoon to discuss updates in facility name reporting and would be in contact after that so he could provide up to date information.

July 6 Update

Brenden Rivenbark advised today that the Task Force list of nursing homes, multiicare and assisted living facilities with COVID-19 outbreaks is now available to download under Data Downloads on the VDH Coronavirus site, https://www.vdh.virginia.gov/coronavirus/

The list includes 192 facilities and there are 16 more from the CMS  reports. That accounts for 208 of 254 total outbreaks, and at least 61 are currently active.

He also said, “In addition, we are working to clarify definitions on our pages to better outline which types are included in our various data sets.  Lastly, Dr. Oliver was instructed to release the names of nursing homes, assisted living facilities, and multi-care settings by Governor Northam due to the increasing rate of outbreaks in these types of facilities.  Our leadership team continues to evaluate outbreaks in other facility types and the public health benefits that may be associated with sharing the names of other types of facilities.”

The VDH changes and response are appreciated.

This post will be updated as new information comes in.

 

  1. https://www.governor.virginia.gov/newsroom/all-releases/2020/june/headline-858302-en.html7
  2. https://www.baconsrebellion.com/wp/where-are-the-other-52-nursing-homes-with-outbreaks/

Throwing Out a
Perfectly Good Plan
Is No Way to Treat a Virus

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By Carol J. Bova

On April 2nd, James C. Sherlock talked about the “Commonwealth of Virginia Emergency Operations Plan, Hazard-specific Annex #4, Pandemic Influenza Response” in an article on the Bacon’s Rebellion blog. He posted again on April 3rd that the plan had been removed from the state website.

The Commonwealth’s September 2019  Emergency Operations Plan not only removed the pandemic plan, it dropped all references to a pandemic and fails to offer any steps needed to deal with one.

If the Virginia Department of Health (VDH) still had that plan as a guideline, we could  have been more prepared and more responsive to the Covid-19 pandemic in Virginia.

Look at the plan stages in the abandoned document and when they would have kicked in.

Stage 1 –Suspected Human Outbreak Overseas 
WHO Phase 4
This occurred in November, 2019 in China.

VIRGINIA DEPARTMENT OF HEALTH:

  • Review and exercise the VDH pandemic influenza plan.
  • Continue surveillance.
  • Coordinate with partners.
  • Initiate education campaign.
  • Prepare pre-scripted messages.
  • Review and adjust inventories of selected resources.
  • Coordinate with suppliers.
  • Review and update the fatality management plan.

We don’t know if VDH reviewed supplies and coordinated with suppliers at that point. If they did, why don’t we at least have (Personal Protective Equipment (PPE) for our healthworkers four months later?

The Virginian-Pilot on April 2nd posted the Commonwealth’s March 30th request for Strategic National Stockpile (SNS) resources, showing the amounts requested and amounts received.

The article noted this was the third shipment. It would be informative to know when the state made the first two requests and when they first took steps to procure supplies directly from manufacturers before turning to the SNS.

Stage 2 –Confirmed Human Outbreak Overseas
WHO Phase 5
This occurred December 31 2019 – January, 2020

VIRGINIA DEPARTMENT OF HEALTH:

  • Declare a “public health emergency.”
  • Review and activate appropriate plans.
  • Maintain dialogue with partners.
  • Maintain heightened hospital and community-based surveillance.
  • Continue education/guidance to the public.

Jan 26 VDH news release said first 3 test specimens sent to CDC, announced novel corona virus webpage and provided information.

Jan 27: Two cases negative. Waiting for third results.

Did VDH review the pandemic plan? Were supplies ordered? No mention in media release.

Jan 30, WHO declares international public health emergency
 9976 cases in 21 countries
Stage 3 –Widespread Outbreaks Overseas 
WHO Phase 6        

VIRGINIA DEPARTMENT OF HEALTH:

  • Maintain heightened hospital and community surveillance.
  • Prepare to implement surge plans.
  • Review and implement anti-viral distribution plans.
  • Continue education and guidance to the public

No VDH announcements on surge plans or supply inventories.

Stage 4 –First Human-to-Human Case in North America 
WHO Phase 6
This occurred January 21 First case confirmed in Washington state after travel from Wuhan.

VIRGINIA DEPARTMENT OF HEALTH:

  • Maintain heightened hospital and community surveillance.
  • Prepare to implement surge plans.
  • Review and implement anti-viral distribution plans.
  • Continue providing education and guidance to the public.
  • Implement antiviral treatment/targeted prophylaxis.

Feb 13: VDH publishes infographic on Covid-19 symptoms

Feb 21 Fairfax County Health Dept. “Flu is making people sick in Fairfax, not coronavirus.” https://www.facebook.com/122759944481405/videos/640000020132352/

Stage 5 –Spread throughout U.S.  
WHO Phase 6
This occurred February 26-28: Cases in California, Oregon, Washington, New York

VIRGINIA DEPARTMENT OF HEALTH:

  • Maintain situational awareness of impacts on the health and medical sector.
  • Continuously evaluate epidemiology of the virus.
  • Update recommendations on treatment and protective actions

March 7, VDH confirms first two Covid-19 cases in Virginia in Fairfax

“Governor Northam and Cabinet officials have been briefed. Officials at Fort Belvoir Community Hospital and the Virginia Department of Health are working cooperatively, according to longstanding public health protocols. The teams are in regular and close communication with federal, state, local, and private sector partners.”

“Public health officials caution that evidence has not been seen of COVID-19 spreading  in Virginia and said the risk is low.”

March 8, VDH press conference – status update

Virginia Health Commissioner Norm Oliver [4:03]: “A coordinated public health response is already underway. While the risk to the general public is low, the Virginia Department of Health is working with the Centers for Disease Control and Prevention, the Fairfax Health District, the Prince William Health District, and our Department of Defense partners to identify people who had contact with the cases and may be at risk of becoming infected with this Novel Corona Virus. I would like to sincerely thank our partners for collaborating in this very complex and rapidly evolving situation.

Before I turn this over to my colleagues to provide more details, I would like to emphasize that protecting the health and well being of Virginians is our top priority. The virus is spreading much like the Novel Influenza Virus would. VDH, the Department of Health, has led a very robust and comprehensive pandemic influenza preparedness effort since 2004. VDH successfully responded to the H1N1 flu pandemic in 2009 to 2010 and that work serves as a very solid foundation for the work that we’re doing for the response to Covid-19. The Virginia Department of Health works across all sectors, including healthcare providers, state and local government, first responders, and many community partners to prepare for and respond to outbreaks in all types of emergencies.”

State Epidemiologist, Lillian Peake [6:28]: “Testing for the case at Ft. Belvoir was conducted at Walter Reed National Military Medical Center. Testing for the patient from Fairfax City was conducted at the Department of General Services, Division of Consolidated Laboratory Services in Richmond, Virginia. Both tests will be confirmed at the Centers for Disease Control and Prevention. Both cases had travelled internationally days before developing symptoms and the two cases are not related. At this point, there are no signs of the virus spreading in the community in Virginia. As of nine o’clock this morning, 44 Virginians have been tested for the Novel Corona Virus. Thirty-six tests were negative, and we are awaiting results on six tests. Virginia has been preparing for the possibility of cases occurring in the Commonwealth since early January when the novel corona virus was first identified in China. The Virginia Department of Health has been closely coordinating with clinicians, our state lab, and other key partners statewide so we are able to identify patients early and take action quickly to prevent the spread of the disease to others. Virginia’s local health departments across the state are working with their communities to prepare, increase awareness, and encourage prevention. VDH set up a Covid-19 webpage very early in the response, and we are keeping it up to date with accurate information.”

The governor declared state of emergency March 12.

VDH Infographic releases:

http://www.vdh.virginia.gov/coronavirus/resources-and-support/

Mar 13: VDH infographics on symptoms, local and travel
Mar 13: CDC About Covid-19
Mar 16: CDC on stopping spread
Mar 18: About CDC response and activities
Mar 20: CDC on symptoms

When were PPE supplies ordered or requested from SNS before March 30th?

TBD
Stage 6 – Recovery/Preparation for Subsequent Waves
WHO Phase 6

VIRGINIA DEPARTMENT OF HEALTH:

  • Assess regional impacts on the health and medical sector.
  • Review lessons learned and implement adjustments.
  • Replenish essential resource inventories.
  • Adjust regional staffs to meet needs.
  • Prepare for next wave.

Repeating what State Health Commissioner Norm Oliver said March 8th, “VDH, the Department of Health, has led a very robust and comprehensive pandemic influenza preparedness effort since 2004. VDH successfully responded to the H1N1 flu pandemic in 2009 to 2010 and that work serves as a very solid foundation for the work that we’re doing for the response to Covid-19.”

So why was VDH still denying the possibility of a widespread outbreak in Virginia, and why hadn’t they worked to secure supplies earlier?

Draft Floodplain Ordinance

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Submitted to Floodplain Management Ordinance Committee by G. C. Morrow

This draft is based on the National Floodplain Insurance Program (NFIP) Floodplain Management Requirements and related documents issued by FEMA.

 

Click to access Mathews-County-DRAFT-Floodplain-Management-Ordinance-12-21-18-2-15.pdf

 

Click to access Spreadsheet-Notes-on-Draft-Ordinance-Amendments-12-21-18.pdf